Easily accessible, appropriate healthcare for 250+ employees
Optimum Referral is an option on our group PMI product, Optimum. It’s 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 hand-picked, based on Care Quality Commission and Health Improvement Scotland ratings.
We only work with specialists who meet our high professional standards based on GMC registration and our internal quality controls
Eligible bills are settled in full, directly with the hospital or specialist
Dedicated account management for you and your client
Why Optimum Referral?
Optimum Referral is a great solution for large companies looking for health coverage 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 those whose charges we believe are fair and reasonable.
Once an employee 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 consultants will discuss a choice of specialists and hospitals with the employee – all of whom will meet our strict quality criteria.
Guaranteed bill payment
Optimum Referral promises that, where the open referral process is followed, there will never be a shortfall when payment is due.
Eligible bills are settled in full, directly, ensuring peace of mind to members and reassurance to employers that their benefits budgets will be spent wisely.
- Employees can manage their claims, online via MyAviva or over the phone
- Extensive choice – our claims team will discuss options and provide information, 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. Our claims consultant will transfer them to the right person from the outset
- 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
- Cost control and management – our pricing approach reflects the value of long-term relationships
- 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 cases, 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 reducing the costs of absenteeism and promoting wellbeing in the workforce.
- 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
* Musculoskeletal diseases profiles, Public Health England, Dec 2019. Contains public sector information licensed under the Open Government Licence v3.0
Managing Mental Health in the Workplace
We offer dedicated support for mental health. Available as an optional extra, our 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.
The open referral claim process: 4 simple steps
- Members obtain an open referral from their own GP, or via Aviva Digital GP if this service has been selected.
- Members can contact us over the phone or via MyAviva. Where the claim is started online, they can arrange a call back at a time to suit them. They can also use live chat to speak directly with one of our claims experts.
- We’ll chat to members about the choice of hospitals and specialists available and get an understanding of their exact needs. These could be anything from understanding their medical requirements – through to where they’d like to have their treatment. When requested, we’ll send them through a notification of their options.
- Members choose their hospital and specialist. If they’d like, we’ll transfer their call directly to the hospital, so they can book an appointment there and then.
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
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