Solutions – health insurance for 1-249 employees
Solutions is our flexible private medical insurance (PMI) product for businesses with 1-249 employees. It gives its members access to private medical treatment from a nationwide network of hospitals and clinics. This helps your clients address issues around the absence levels of employees by reducing the time it takes to get a diagnosis and treatment.
We'll find the most suitable specialist and hospital for the employee's condition, giving them a range to choose from
Enhanced cancer cover
We understand the importance of providing extensive cover and support at every stage of cancer treatment
Mental Health Pathway
An end-to-end service based on clinical need, guided by clinical expertise, with a range of treatment options and no need to see a GP.
Why Solutions PMI?
As one of the UK’s leading providers of PMI, we’ve developed cover that helps your clients give their employees prompt access to the treatment they need, when they need it. Solutions provides health-centric benefits that are attractive to employees while helping them return to work faster after illness, saving your client money. PMI can also be a great way to help your clients attract and retain the best staff and enhance their business's profile.
We understand that no two businesses are the same. That's why with Solutions, you can create a level of cover that suit the needs of your clients - enhance their cover with additional benefits or decrease it to suit their budget.
Everything we do is rooted in our three key principles:
Simplicity A clear, flexible PMI product that's been designed to help meet the needs of your business clients and their employees.
Quality Access to expert advice, treatment, specialists and hospitals. Clear clinical pathways for key conditions such as BacktoBetter for musculoskeletal (MSK) conditions and Mental Health Pathway to support employee's mental wellbeing.
Affordability A focus on costs, choice, value and processes to keep premiums affordable. PMI can also help to keep absenteeism costs down, as health among the workforce improves.
When your clients start with our core cover, they can easily increase or reduce the cover level according to budget and needs. Employees receive the following benefits as standard:
In-patient or day-patient treatment of acute conditions at a facility covered under your hospital option
- Hospital charges at a network facility or a hospital on your clients' chosen hospital option
- Specialists’ fees
- Diagnostic tests such as MRI scans, blood tests and X-rays are covered in full
- BacktoBetter, the independent case management service for musculoskeletal (MSK) conditions
- NHS cash benefit of up to £100 each night, for a maximum of 25 nights for each member, in each policy year
Out-patient treatment of acute conditions at a facility covered under your hospital option
- Mental Health Pathway, covering out-patient mental health treatment
- Specialist referred physiotherapy, osteopathy and chiropractic treatment for non-musculoskeletal conditions
- Accommodation for one parent staying with a child of 15 or under receiving eligible treatment
- Home nursing on specialist recommendation following eligible treatment as an in-patient or day-patient
- Investigations into the cause of infertility subject to the qualifying period specified within the policy wording
- Treatment for complications of pregnancy and childbirth as specified within the policy wording
- £100 for each baby born to, or adopted by, a member within a year of birth
- Surgical procedures on the teeth performed in a hospital
- Hospice donation of up to £70 per day for up to 10 days
- Private ambulance if medically necessary
- Cancer treatment, as explained in full on our cancer pledge page
What makes our PMI different?
We believe the flexibility of policies and our clinical expertise makes us an excellent choice for both new clients and for those who have had PMI for many years.
Flexible, affordable, and fits around your clients’ needs
Our expertise means we route conditions effectively
BacktoBetter as standard on all policies
Mental Health Pathway available to all members
Our cancer pledge
Stress-free insurance claims
Upgrade levels of cover and increase premiums
- Mental health upgrade – in addition to the Mental Health Pathway, cover can be upgraded to include in-patient and day-patient treatment if diagnosed with an acute mental health condition such as clinical depression. Options include cover for 28 or 45 days and specialists' fees for in-patient treatment with this option. This upgrade option is not suitable for members living in the Channel Islands, Isle of Man or Northern Ireland.
- Routine and GP referred services – an overall benefit limit of £1,000 for each member, every policy year
- Dental and optical cover – eligible surgical procedures are covered by core cover, but this can be upgraded to include dental treatment up to £450, accidental dental injury up to £600 and routine optical expenses up to £250. A separate excess of £50 applies to both routine dental treatment and optical benefit.
A summary of all options is included in the Solutions pre-sale brochure.
Options that reduce levels of cover and decrease premiums
- Six-week option – if the NHS can treat employees within six weeks, they can’t claim for in-patient or day-patient treatment (including accident or emergency admissions), NHS cash benefit, NHS cancer cash benefit or for the cost of an NHS amenity bed
- Policy excess – a choice of member excess of £50, £100, £150, £200, £250 or £500 can be added to the policy, which will apply once for each member, every policy year, irrespective of the number of claims each person makes
- Selected benefit reduction – removes the following benefits:
- investigations into the cause of infertility
- treatment for complications of pregnancy and childbirth
- surgical procedures performed on the teeth in a hospital
- Reduced out-patient cover – ask for details
Differences for businesses with 100 to 249 employees
When your client employs a larger workforce, we make some changes to the policy. These are the key differences that will be seen by businesses covering 100 to 249 employees:
- Payments can be made annually or by a monthly or quarterly Direct Debit through a business account
- Depending on underwriting type selected, the qualifying periods for treatment regarding complications in pregnancy and childbirth, the maternity cash benefit, and investigations into the cause of infertility may no longer apply
- Experience rated premiums, which is more closely linked to the prior claims experience on the policy
- We’ll need to know how many employees are aged over 65
Expert Select, our core route to treatment
We've introduced a new hospital option, Expert Select, designed to help your clients protect their business from lost personnel and working days, manage their costs and provide a valuable benefit to their employees.
Backed by our clinical expertise and excellent customer service, when an employee calls in to make a claim, we’ll offer them a choice of, on average, between four and five quality assured medical facilities, including the largest hospital groups. All will be local to them, offering access to a number of specialists.
We base our recommendations on their diagnostic or treatment needs to make sure they get appropriate quality treatment options every time. This gives your clients and their employees an informed choice based on clinical need.
Once they’ve had their treatment, we’ll settle their eligible bills in full with the treatment provider which means we can guarantee no shortfalls on any eligible hospital or specialist charges for consultations, tests or treatment.
Alternative hospital options
Hospital lists are an alternative approach and can be a good option for businesses who would prefer to choose specific hospitals for their treatment
We have four hospital lists:
Key - this is our standard option and gives your clients access to around 200 private hospitals across the UK.
Extended - for an extra cost, your clients can upgrade to this list, which gives access to more hospitals, predominantly in the Greater London area.
Signature - Companies can reduce their costs by choosing this list with fewer hospitals. It could be a suitable option if your clients employees are based mainly in Scotland and Northern Ireland as this list excludes all hospitals in England and Wales.
Trust - This is a cost-saving option that uses the private patient units of NHS Trust and partnership hospitals. It’s only available for Solutions policies covering 1-99 members.
We have a dedicated department looking after our private medical insurance (PMI) claims, with staff who familiarise themselves with the details of each claim they’re working on. Our in-house clinicians are on hand to give claims advisers detailed support. Employees will have experienced claims advisers looking after their claim.
BacktoBetter - making a musculoskeletal claim
Mental Health Pathway - making a claim
Making a claim with Expert Select
Making a claim for all other conditions and hospital lists
Mental Health Pathway
As caring employers, it’s important your clients have the right mental health support in place. That’s why we’ve added Mental Health Pathway to core cover in Solutions - to help your clients protect their business and support their employees.
How does Mental Health Pathway work?
Our Mental Health Pathway offers an extensive range of cover to make sure your clients’ employees get quick access to quality talking therapy and counselling. We’ve partnered with providers who meet our quality of care standards and all the employees need to do is call our claims team and we’ll route them straight through to our clinical provider for assessment and required treatment.
All of the clinical case managers have a wealth of experience and cover a wide range of support services including practitioner psychologists, CBT therapists, EMDR consultants, psychiatrists and counsellors.
What are the benefits of Mental Health Pathway for employees?
- Rapid access to treatment - there’s no need for them to wait to see their GP; they can refer themselves for an assessment with a mental health practitioner.
- Clinical treatment determined by front end clinical assessment - routing them to the most effective treatment, including direct escalation to specialist assessment, if required.
- Cover based on clinical need - treatment continues as clinically appropriate, reducing delays in treatment for talking therapies and unnecessary admission to in-patient care. No excess or out-patient limits apply.
- Simple claim process - employees only need to contact our claims team once. Their treatment is then overseen by our independent clinical provider - leaving them to focus on getting better.
- Range of treatment options - including cognitive behavioural therapy (CBT), cognitive analytic therapy, person-centred therapy, interpersonal therapy and mindfulness.
- Choice of delivery options - remote (telephone or video link), face-to-face talking therapies and psychiatrist assessment.
What are the benefits of Mental Health Pathway for employers?
A service that complements your clients' well being strategies, offering preventative advice early on as well as treatment. The pathway is also available to dependants aged 12 and over, offering an extra layer of support for their members.
- As there's no need to see a GP, it 's quicker and easier for employees to access treatment.
- Employees get the right treatment at the right time, which can help lead to a faster recovery, reducing workplace absence.
- It's a service that delivers clinical best practice no matter how complicated the problem is
- Getting employees back to work quickly is especially important in the SME space where having key staff off work for any period of time can have a significant effect on the business. Our pathway has proven return-to-work rates with 78% of employees able to access clinical assessment before leaving work due to sickness absence. Of those that left due to their mental health condition, 99% were work ready at point of discharge*.
What if a member has already seen their GP?
If a member has consulted their GP before contacting us, the member's condition must still be assessed by our clinical case management providers. We will only cover treatment if it's managed by them.
BacktoBetter is included as standard on all Solutions policies because we believe it's the best way to manage musculoskeletal (MSK) claims and can help a quicker return to work for your employees.
It provides case management for employees. A clinical case manager will assess the employee's symptoms and establish the most appropriate clinical pathway that their condition requires.
How does BacktoBetter work?
If an employee experiences back, neck, muscle or joint pain, the BacktoBetter service is their first point of contact, there's no need for them to see a GP first.
Following their telephone clinical assessment, the employee will begin the most appropriate course of treatment for their condition. This could be self-managed exercises given to them over the telephone and backed up by online support physiotherapy, or referral to a specialist for diagnostic tests or treatment.
All of the clinical case managers have a wealth of experience; employees get support from someone who really understands their condition.
What are the benefits of BacktoBetter for employees?
BacktoBetter is a service that aims to deliver the right treatment for MSK symptoms or conditions. No matter how complex the problem is, the individual will receive on-going clinical support to help them meet treatment goals and get better more quickly. Early intervention is key in treating MSK conditions, which is why BacktoBetter is a fluid system enabling them to get treatment as quickly as possible.
- No need to see a GP
- If reduced out-patient cover has been selected the limit will not apply to physiotherapy treatment
- Choice of over 1,800 clinics throughout the UK
- A shorter claims journey for employees
- Provides easy access to clinical expertise and a tailored treatment plan specific to their individual condition
- A service that complements your clients' well being strategies, offering preventative advice early on as well as treatment
- As there's no need to see a GP, it 's quicker and easier for employees to access treatment
- Employees get the right treatment at the right time, which can help lead to a faster recovery, reducing workplace absence
- Getting employees back to work quickly is especially important in the SME space where having key staff off work for any period of time can have a significant effect on the business
- It's a service that delivers clinical best practice no matter how complicated the problem is
- It encourages happier healthier employees
Added value benefits included as standard
We want to help your clients' employees lead their best lives and promote a feeling of appreciation towards their employers. That's why we offer a number of added value benefits with our Solutions policies:
Aviva Digital GP app* could help minimise downtime when your clients’ employees need a GP consultation or are seeking medical advice, giving their eligible employees swift and convenient access to GP video consultations and repeat NHS prescriptions (all NHS England exemptions accepted).
Stress Counselling helpline can be useful for employees who need help with personal or work-related stress issues. Talking and sharing can be the first step in helping to work through problems and resolve them, aiming to achieve the best outcome for employees and employers. It is available to members aged 16 and over.
Aviva Line Manager Toolkit: Mental Health* consists of video modules, designed by clinicians which can increase awareness of your clients' employees' mental wellbeing. The toolkit aims to help line managers spot the warning signs of poor mental health, identify reasonable adjustments and manage professional boundaries. It also empowers them to feel more confident in having supportive conversations with team members, so they can address issues before they become more serious.
Mental health support articles provide guidance to support your client’s employees. Aviva can help manage and improve employee mental health by providing access to helpful information and advice.
MyAviva is our online platform which helps employees manage their Aviva policies in one secure, easy-to-use place at a time that suits them
*These services are non-contractual benefits that can be withdrawn by Aviva at any time.
Helping you sell
There’s no limit to the number of business clients you can approach about Solutions. We’re here to help you, whether you’re talking to a company that wants to cover all of its employees, or concentrating on a policy for just a few members of staff.
The costs incurred if staff have to wait for treatment on the NHS could be significant, so most businesses will be open to talking about ways they could save money. These ideas could help you identify prospective clients, overcome objections, and help you make an attractive Solutions recommendation that's suitable for the business’s specific needs
Target Market Statement
Finding the right clients
Group PMI makes sense
We’re here to help you
How to make a claim
How do you make a health insurance claim?
When you’re unwell and need to make a claim on your health insurance, we’ll do all we can to get you the healthcare you need, as soon as we can.
Here’s how you make a claim in four simple steps – and a few things to keep in mind along the way.
1. Ask your GP for a referral
First of all, see your GP, or use our digital GP app, and they’ll refer you for any investigations or treatment you need. Be sure to tell them you have private health cover with us.
There are two types of GP referral:
An open referral is where your GP says what kind of treatment you need, but doesn’t name a particular specialist or hospital.
A named referral is where your GP gives the name of a specific specialist, at a particular hospital. Though you’re not bound by this, and we can offer you other options, if needed.
It’s a good idea to ask for an open referral, so there’s more flexibility with where you’re treated. If you have Expert Select or Optimum Referral, you’ll need an open referral.
If your cover includes BacktoBetter or our Mental Health Pathway, you don’t need a GP referral to make a claim for musculoskeletal or mental health symptoms – just call us direct through MyAviva - your secure online account, or by phone.
Remember! Get in touch with us before you have tests or treatment, so you know they’re eligible for cover. That way, you won’t have any unexpected costs.
2. Start your claim and we’ll get things moving
The easiest way to start your claim is through MyAviva. When you log in simply select your policy or scheme and you’ll see the option to start your claim. Alternatively, you can also start a claim over the phone.
Whichever way you choose, we’ll ask you about your symptoms and explain the best next steps, in line with your cover. We’ll also guide you through the process and answer any questions you have.
Sometimes, we ask for more information to get a better picture of your condition. Otherwise, we aim to make a decision on your claim straight away, explain which tests and treatments we can pre-approve and connect you with the hospital or clinic to book your appointment there and then.
Where will you get your treatment?
You’ll either see a specialist at a hospital on your list, or, if you have Expert Select or Optimum Referral, at a choice of hospitals we’ll help guide you towards. If it’s available, you could get treatment at a facility that has expertise in treating specific conditions, like cataracts or knee pain.
The nationwide hospitals we use are based on ratings from independent regulators, like the Care Quality Commission – with most rated outstanding or good. We’ll also only recommend specialists who meet the standards of their relevant professional governing bodies, like the General Medical Council. So you know you’ll get the high standard of care you’d expect.
3. If you’re referred for more treatment
Hopefully by now you’ll be starting to feel better. But if your specialist refers you for more treatment we haven’t already approved, let us know, so we can check it’s covered. In MyAviva you can submit your update or start a Live Chat to speak to someone in the claims team there and then. You can also call us, if you’d feel more comfortable talking over the phone, or email us with any questions you may have.
Remember! For some treatments and tests, we’ll ask you for a procedure code. So check with your specialist, and have it handy when you get in touch.
4. And finally, we’ll settle the bills
Once you’ve had the care you need, we’ll settle bills we’ve authorised directly with your provider – so you don’t have to worry.
We’ll let you know through MyAviva if you need to pay any part of a bill, like if you have an excess or benefit limit. If any bills are sent your way, just send us a copy and we’ll do the rest.
Here’s a quick recap of how to make a claim:
Ask your GP for an open referral – and get in touch with us before you have any tests or treatment. For BacktoBetter or Mental Health Pathway, just contact us direct.
Start your claim and book your appointment at an agreed hospital.
Let us know if you’re referred for more treatment – and check for a procedure code.
We’ll settle authorised bills direct, so you don’t have to worry.
And that’s it! Four easy steps, and a friendly claims team on hand for guidance and support each step of the way.
So you can focus on your treatment, and getting back to health.
How our BacktoBetter service works
What is BacktoBetter?
If you have aches or pains in your back, neck, muscles or joints – known as musculoskeletal conditions – you’re not alone.
As many as one in four UK adults are affected by these conditions. The pain, stiffness and limited movement they cause can have a real impact on your quality of life, and the things that matter most.
But it doesn’t have to be that way. When you have BacktoBetter on your Health policy or scheme, it’s easy to get the expert treatment you need. Which could help you get better, quicker.
How does BacktoBetter work?
With BacktoBetter, whenever you have back, neck, muscle or joint pain, you won’t need to see your GP for a referral. Simply contact our claims team by phone, or through MyAviva, if available on your scheme, to get your claim moving.
To kick things off, our claims team will discuss your symptoms with you. Then, if you’re eligible, they’ll arrange a call with a clinical case manager for a more in-depth assessment, at a time that works for you – which could be there and then.
Your treatment starts now!
Your case manager will ask a few key questions about how your symptoms are affecting your daily activities, and will have the expertise to recommend the right treatment for you. They’ll offer advice about how to manage any pain, and explain the best next steps…
Which might be:
A guided treatment plan
That’s advice specific to you and your condition, and easy-to-follow, prescribed home exercises. And with extra online support, you’ll have the tools to help you get back to health.
Your case manager will set up an virtual or clinic-based appointment with a physiotherapist. You can rest assured that all physiotherapists under the BacktoBetter pathway meet the standards of proficiency set by the Health and Care Professions Council.
Your physiotherapist may also recommend simple exercises to help with movement and improve strength, until your first session. And don’t worry if you have an outpatient limit, it won’t apply to physiotherapy.
Along the way, your case manager or Physiotherapist will talk to you about your ongoing treatment. That might include a referral for diagnostic tests and further treatment with a specialist or other health practitioner.
Because we won’t rest until we’ve done all we can to get you back to feeling like yourself again.
For full details of cover including restrictions and exclusions, please refer to the terms and conditions documents.
Quote and apply
Our Aviva Sales Consultants are on hand to guide you through the process.
Lines are open Monday to Friday, 9am to 5pm.
Calls to and from Aviva may be monitored and/or recorded.
Our individual PMI product designed to help your clients get prompt access to diagnostic tests and eligible private medical treatment at over 400 UK hospitals.
Helps your clients beat the NHS waiting lists for eligible diagnostic tests – it's a product that’s significantly cheaper than traditional PMI because it doesn’t pay for any treatment.
Our group PMI product that lets your clients flexibly choose benefits suited to their business needs.
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