Easily accessible healthcare for 250+ employees
Optimum Referral is one of our group PMI products, designed to deliver a high standard of medical care for your clients’ employees on an open referral basis.
And because patient safety is our key concern, the majority of hospitals available to your clients are selected based on Care Quality Commission and Health Improvement Scotland ratings.
Trusted specialists
We only work with specialists who meet our high professional standards based on General Medical Council registration and our internal quality controls
No shortfalls for hospitals or specialists
Eligible bills are settled in full, directly with the hospital or specialist
Star treatment
Dedicated account management for you and your client
Why Optimum Referral?
Optimum Referral is a great solution for large companies looking for health and wellbeing support that brings benefits to both your clients and their employees.
- We only recommend specialists who are trusted from a clinical perspective as they meet the high professional standards of the relevant governing bodies. We also only work with specialists whose charges we believe are fair.
- Once an member has obtained an open referral from a GP, their care is tailored to their needs. This will depend on their symptoms or condition, and on the type of clinical referral that they've been given.
- On this basis, our claims assessors will discuss a choice of specialists and hospitals that are within a 25 mile radius with the member – all of whom will meet our strict quality criteria.
- Optimum Referral promises that, where the open referral process is followed, there will never be a shortfall for hospitals or specialists when payment is due.
- Eligible bills are settled in full, directly, ensuring peace of mind to members and employers.
For Employees
- Employees can manage their claims online via MyAviva or over the phone
- Extensive choice – our claims team will discuss options and provide information about the choice of hospitals and specialists available, so that employees can make an informed decision about who they want to see and where
- Simplicity – there's no need for employees to chase around looking for the right specialist or hospital. Our claims consultants can handover to key hospital groups from the initial call
- Quality treatment guided by needs – members receive the most appropriate treatment, undertaken in quality facilities
- Flexibility – we won’t interrupt the flow of a claim where the employee is already following a treatment plan. Equally, we’ll look to provide alternative treatment providers where required
- Bills are settled directly – no need to worry, eligible bills will be paid in full.
For your clients
- We challenge doctors, evaluate fees, and embrace medical advances to maintain quality and value
- Tackling the key reasons for escalating costs – dedicated case management of mental health and musculoskeletal conditions, and of cancer claims, to aid employee recovery and return to work
- Regular reviews and reports – to demonstrate how the scheme is running, in terms of both cost and performance.
Back to work sooner
A key objective of the healthcare provided under Optimum Referral is helping to reduce the cost of absenteeism and promoting wellbeing in the workforce.
BacktoBetter
- Musculoskeletal (MSK) conditions are one of the biggest causes of long-term absence.* The BacktoBetter service offers prompt access to clinical support for members who have MSK symptoms
- Members get the right treatment at the right time, with access to conveniently located physiotherapists where appropriate, without waiting for GP appointments
- BacktoBetter is included as standard within Optimum Referral.
Find out more about BacktoBetter
* Work-related musculoskeletal disorders statistics in Great Britain, 2024-2025. HSE Contains public sector information licensed under the Open Government Licence v3.0
Mental Health Pathway and Pathway Plus
We offer dedicated support for mental health, helping your clients to manage their employees mental health in the workplace. Available as an optional extra, mental health pathway gives your clients’ employees access to dedicated case managers, expert in managing mental health conditions. If chosen, this option will increase the policy premium.
Cancer support
We understand that receiving a cancer diagnosis could be life changing and your client’s employees may experience a whole host of emotions. Our specialist cancer services provide help and support for them and their loved ones throughout their cancer journey and beyond.
You can find further information about these services in our Cancer guide for Large Corporate Clients (PDF 179KB) or by visiting our Cancer options page.
Wellbeing
We want to help your clients' employees lead healthier lives. That’s why we offer several added value benefits with our Optimum policies that provide quick and easy access to wellbeing support. Visit our wellbeing hub to find out more.
The open referral claim process: 4 simple steps
Optimum Referral explianed
Transcript for video Optimum Referral
If you need medical treatment, you want to make sure you get it at the right time and in the right place.
That’s where Optimum Referral comes in because it’s designed to do just that.
Let’s look at what Optimum Referral is and how it benefits you.
We commission healthcare that is safe, evidence based and effective.
We only work with healthcare providers who are aligned to our values and deliver care in a safe, supportive environment.
We give you a choice of treatment providers from a list we’ve hand-picked based on healthcare ratings from the Care Quality Commission, Healthcare Inspectorate Wales and Healthcare Improvement Scotland.
We have a choice of hospitals across the country and will tailor our recommendations to you based on your needs, symptoms, condition and type of clinical referral your doctor has given you.
All of this means you’ll get the most clinically appropriate care plan for you, all carried out in quality facilities.
Starting a claim is easy too.
It’s just four simple steps from contacting us to sorting out your treatment.
The first step is to get your open referral.
An open referral means you're referred for further treatment without a specific clinician or treatment centre being named. We’ll help you choose a suitable clinician and give you a choice of hospitals.
Once you have your open referral, we support you every step of the way.
The second step is to contact us.
You can go online at MyAviva (visual of web address), use our Live Chat, or call us directly.
Whichever you prefer, it's up to you.
Next, one of our claims team will chat to you to get a full understanding of your situation and then talk to you about the choice of specialists and hospitals available.
They’ll give you all the information you need to make an informed decision about who you want to see and where you want to go.
The final step is you choose the specialist and hospital you’d like to go to from our recommended options.
We can pass your information to your chosen hospital and transfer you to them there and then to book an appointment on the same call.
It all happens as quickly as that.
There's no messing about, no repeating the same information to different people, no delay to your treatment.
It's fast and it's simple. It's all designed to keep things as stress free for you as possible.
Optimum Referral can set you on the path to treatment quickly, without any fuss.
It takes Aviva to help you get the right treatment you need, at the right time, in the right place.
For full details of cover, please refer to the relevant policy documents.
Which documents should you use?
Optimum Referral literature is a useful guide for you when you’re talking through the options available to your clients.
It’s important that you get to know the brochure well, as it will help you conduct a compliant sale.
These documents explain how the option works
Related products & services
Optimum
Our group PMI product overing 250+ lives - lets your clients flexibly choose benefits suited to their business needs.
Solutions
Flexible private medical insurance (PMI) for SME businesses with 1-249 employees. Giving its members access to private medical treatment from a nationwide network of hospitals and clinics.
Mental Health Pathway Plus
Optional mental health management add-ons for your corporate clients that tailors the support employees receive for their mental health, with a focus on personalised clinical care.
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