Aviva Health Adviser: PMI for 250 plus employees

Optimum - health insurance for 250+ employees

Optimum is our group PMI product. With your help, your clients can tailor their cover to provide a unique set of benefits suited to their business needs, while helping their employees get access to private medical treatment.

Flexibility

A modular product that lets your clients choose cover, helping to create a healthy balance between meeting their business needs and their budget

Great wellbeing benefits

Access to a variety of wellbeing services including the Aviva Digital GP app*

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Star treatment

Dedicated account management for you and your client

Product details

Why Optimum?

Optimum is our bespoke private medical insurance (PMI) product for businesses with 250 employees or more. This is a highly flexible PMI product. It’s up to your clients what’s included and what isn’t.

Benefits include:

Different levels of cover for different categories of employees if required
Added value benefits that could help improve the health and wellbeing of the workforce
Access to medical treatment that could help employees return to work faster
A choice of cover levels for cancer, supported by our Cancer Pledge
Expert care throughout their cancer journey with a range of specialist support services .

Larger businesses want PMI that can help them raise morale and productivity, show a commitment to employees by promoting a caring attitude, and reduce absenteeism. Optimum can help your client achieve all these goals.

If they're considering a switch to us, we can work with them to match their benefits where possible and continue to provide them with quality cover.

Additional services

A choice of additional services

A key objective of the healthcare provided under Optimum is reducing the costs of absenteeism and promoting wellbeing in the workforce.

BacktoBetter – support for employees when they need it most

MusculoskeletaI (MSK) conditions are one of the biggest causes of long-term absence*. Provided as standard with Optimum, BacktoBetter is a third party clinical case management service that uses evidence-based medical guidelines to help manage musculoskeletal symptoms.

Through the BacktoBetter service employees can have their own personal treatment plans without the need for a GP referral no matter how large or small the problem.

Quick intervention could help many employees return to work faster – BacktoBetter gives access to the most clinically-appropriate treatments before the condition deteriorates.

* Work-related musculoskeletal disorders statistics in Great Britain, 2022-2023. HSE, November 2023. Contains public sector information licensed under the Open Government License v3.0

Mental health pathway

Mental health pathway is an option your clients can choose to enhance their cover. With treatment based on individual need and not a set monetary limit, mental health pathway helps your clients' employees get quick access to quality talking therapies and psychiatric assessment, where required. There's no need for a GP referral - all employees need to do is call our claims team and we'll route them straight through to our third party clinical provider for assessment and required treatment.

Wide range of underwriting options

We offer a number of underwriting options to clients with schemes of 250 plus employees. We’re happy to answer any questions you or your clients may have about the different types of underwriting and what's involved.

Medical History Disregarded – available to companies taking out PMI for the first time, or switching to us from another insurer on MHD underwriting
New Moratorium – Your client could choose a new moratorium based policy
Continued Moratorium – available to clients transferring from an existing medical insurance plan that’s underwritten on a moratorium basis
Full Medical Underwriting – the past health of members is considered, and any pre-existing medical conditions and related conditions will be excluded unless we agree to accept them
Continued Medical Exclusions – can be chosen if the client is transferring from an existing plan that was fully medically underwritten

A claims process that helps employees and employers

Healthpoint: efficient scheme management

Why Aviva?

What makes our PMI different?

As well as being one of the UK's leading providers of PMI, we also draw on extensive expertise from our third party clinical providers to create policies that can help your clients reduce the costs associated with sickness in the workplace and promote wellbeing among their workforce.

And, it’s a competitive market – your clients need to know they’re getting the right Group PMI policy for their business. We take the time to understand their needs and work with them to build a policy that meets their objectives.

Why choose Aviva’s Optimum policy?

We offer dedicated account management – to every adviser who’d like to offer our Optimum product to his or her clients – our National Accounts team can come to you if that’s more convenient
Our claims process promotes prompt returns to health and the workplace – with dedicated teams for specific medical conditions and experienced claims consultants, we offer one-on-one support and treat each claim on a case-by-case basis
Our cancer support sets the standard for providers - we offer three different levels of cancer cover that your client can choose from
We help take the stress out of making a claim – we focus on what’s important – helping employees make a recovery, rather than dealing with paperwork
We stay abreast of industry issues and continually evolve our products – helping employers use benefits to promote health and improve productivity and profitability

In addition, your client's employees will get access to MyAviva, our online portal that helps them manage their Aviva policies and schemes in one secure and easy-to-use place.

Using MyAviva, clients can:

Start a new claim, update an existing claim and view authorised treatments.
Check policy information, including cover and benefit details
View a claim's summary, update on the next stages of treatment and track the bills paid against a claim
Keep track of their excess and out-patient benefits (if applicable)
Chat to our Online Assistant where they can get support 24/7. They can help answer their questions or direct them to someone who can.

Claims

When it comes to making a claim, our focus is very much on the individual employee concerned. We’re here to help them return to health and get back to work as quickly as possible.

To do this, we’ve created a smooth, stress-free claims process:

Employees have case-by-case support for complex and lengthy claims
We use our experience and clinical insights to individually guide them to the right treatment
Most of our claim outcomes are decided over the phone, without any need for the employee to complete any paperwork. . They can also start a claim virtually by using MyAviva, our online portal where they can manage their Aviva policies and schemes in one secure and easy-to-use place.
Group administrators can monitor claim levels online

Our approach to claims

When employees need to make a claim, they’ve become patients – people whose needs differ from case to case. They may not be feeling 100% when they call, so our claims teams are sympathetic to their needs.

We’ll help as much as possible, often eliminating the need for employees to complete paperwork. Our staff work in an environment where they can familiarise themselves with the details of each claim they’re working on.

Specialist expertise and support

We have specialist condition management teams enabling us to call on a dedicated bank of expertise, focusing on areas such as cancer and mental health.

Each of these teams offer guidance from highly trained experts, who understand the condition and the treatment required. They are able to provide dedicated one-to-one support and remain as a point of contact for your clients throughout the course of their treatment. This ensures they have consistency of care and can progress from one stage of treatment to the next as seamlessly as possible.

Employees can rest assured, knowing that they’ll be talking to experienced staff who can empathise and understand what they are going through.

Cancer claims

If your clients’ employees need to make a claim for cancer, they’ll find that our approach takes the sensitive nature of this condition very much into consideration. We have a specialist cancer claims team who’re trained to help patients deal with different types of cancer, and this team are backed up by support from our clinicians.

As soon as an employee makes a claim, we'll be on hand to give them support. The case will be assigned to the dedicated cancer claims team who'll ensure the consistency of the service that your clients' employees recieve.

While some of your clients will want to offer full cover for cancer treatment, we recognise that others may not have the appetite (or budget) to take the additional risk these high-cost treatments could represent to their claims fund. That's why we offer three different levels of cover.

In addition, we’ve learned how important it is to make things as comfortable as possible for patients during treatment. To do this, we offer extensive aftercare that includes rehabilitation, consultations with a dietician, and money towards a prosthesis or a wig if necessary.

BacktoBetter – making a musculoskeletal claim

Step 1

The employee should call our customer service helpline and describe their symptoms - remember they don't need a GP referral before calling us.

Step 2

Providing it's a valid claim, our advisers will arrange for a third party clinical case manager to contact them at a convenient time, to assess their symptoms.

Alternatively, they can access the service through an online link. It means anyone using the service can start their assessment and treatment much sooner.

Step 3

The third party clinical case manager will determine whether a referral for treatment is necessary. If treatment is not necessary, the employee will be taught how to self-manage their condition.

If treatment is recommended, they'll be transferred to a physiotherapist approved by the third party case management provider or they'll be referred to a specialist for diagnostic tests and, if required, treatment.

Mental health pathway - making a claim

If your client has selected mental health pathway then their employees can follow these steps to make a claim.

Step 1

The employee should call our customer service helpline where one of our advisers will transfer them through to our third party clinical provider for a thorough assessment or we can arrange a suitable call back time. There is no need for the employee to get a GP referral to make a claim.

Step 2

Following the telephone assessment, the third party therapist will agree on the most appropriate help for the employee from a range of treatment options ranging from self-directed online support through to remote talking therapies, face-to-face treatment or further assessment or treatment by a psychiatrist or psychiatric specialist, if clinically necessary.

Making a claim for non-musculoskeletal or mental heath conditions

Step 1

Employees should visit their GP as usual. If their GP wants them to see a medical professional then it is simpler for them to ask for an open referral. This simply states their condition and what type of specialist they need and we'll then help them find the most appropriate one for them. If your client has selected Optimum Referral they will always need to get an open referral.

It’s really important that employees get in touch with us before attending any appointments so we can make sure their claim is covered under the terms and conditions of the policy before they incur any costs.

Step 2

When an employee has been given a referral by their GP, they need to contact us to set up their claim. They can do this either through MyAviva or by calling our claims team.

Step 3

If their specialist recommends hospital treatment they need to ask for a description of the treatment and a procedure code (called the CCSD code), if there is one.

Once they’ve contacted us with these details, we can confirm whether their treatment can be covered. If it can, we will provide further information about where they can have their treatment, which may be through one of our networks, at a hospital on their hospital option, or at other facilities recognised by us.

Step 4

Most eligible bills can be settled directly with the hospital. Specialists usually send their bills straight to us, but if the group administrator, or the employee receives the paperwork, it will need to be forwarded to us.

Systems that support administrators’ needs

By logging in to Healthpoint, Group Administrators can generate reports on claims to date. We can help your clients use this information to pinpoint areas of concern, such as high levels of musculoskeletal injury in a physical working environment.

This helps your clients meet their Health and Safety responsibilities, and encourages employers to take a pro-active role in promoting wellbeing among staff. In turn, this could lead to reduced costs of absence due to sickness or injury.

Wellbeing

We want to help your clients' employees lead healthier lives. That’s why we offer a number of added value benefits with our Optimum policies:

Aviva Digital GP* - Provided by Square Health. The Aviva Digital GP app can give your clients’ employees and their covered dependents over 16 around the clock access to private GP video consultations and repeat NHS prescriptions (all NHS England exemptions accepted) at the touch of a button. Aviva Digital GP is available to residents of Great Britain, Northern Ireland, the Channel Islands and the Isle of Man at home or abroad. The terms and conditions and the privacy policy for Aviva Digital GP can be viewed in-app before they sign up. Mobile data charges may apply. If your client has BacktoBetter or Mental Health Pathway, remember they don't need a GP referral and can contact us directly. If the reason for the consultation is related to a complex health need, complex medical history or they have a health need that requires hands-on examination, we may need to get additional information from their clinical team.
Aviva Wellbeing app* - Whether your clients’ employees want to sleep more, stress less, lose weight or get fit, Aviva Wellbeing could help them achieve lifelong change - one easy step at the time. Terms and conditions and the privacy policy for Aviva Wellbeing can be viewed in-app before signing up. Mobile data charges may apply.
Aviva Line Manager Toolkit: Mental Health* - Empower line managers to spot the warning signs of poor mental health. The digital Aviva Line Manager Toolkit: Mental Health provides clinically-underpinned, bite-sized videos, designed to help line managers identify signs and symptoms of poor mental wellbeing among team members, both in the physical and remote work environment.
Get Active* - With access to over 3,000 health and fitness clubs across the UK, as well as providers of at-home fitness and a range of other products and services designed to enhance healthy and happy lifestyles, your clients' employees will enjoy access to some great offers to help them stay fit, happy and healthy. Terms and conditions and the privacy policy can be viewed online before signing up.
Stress Counselling Helpline - If your members are having difficulty with the demands and expectations they face, it’s good for them to talk. They can do this through a secure helpline to trained counsellors, helping them to work through problems and resolve them. This service is available 24/7 to members and their insured dependents aged 16 or over.
Mental Health Support* - Looking after mental health is as important as looking after physical health. That's why we've put together a range of information, advice, guidance and tools to help your clients' employee's identify and manage mental ill health, stress and anxiety. It means they can have meaningful help at their fingerstips, exactly when they need it. We've produced ten bite-sized videos for your clients' employees to watch whenever they need to. Designed by our expert clinician, they cover a range of mental health topics.

* These services are non-contractual benefits that could be changed or withdrawn by Aviva at any time. To be eligible for Wellbeing services, your client's employees must be permanent residents of Great Britain, Northern Ireland, the Channel Islands, or the Isle of Man.

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.

Dedicated Cancer Claims Team – Our Cancer Claims Team are so much more than claims consultants. They’re people like you and your client’s employees with families and loved ones. They’ve been specially chosen for their understanding, patience, and empathy. With regular training, they’ve an in-depth understanding of what it means to be living with cancer - offering so much more than just paying medical bills.
Our Cancer Care Guide* – Developed in partnership with Macmillan Cancer Support, our guide makes it simple for your client’s employees and their loved ones to find information to help make life that bit easier. It’s packed full of useful tips to help them every step of the way. And, if they’d like practical support or to talk to one of Macmillan’s specialist cancer nurses, there is a helpline number for them to call.
Talking Through Cancer – is on hand to help your client’s employees and their loved ones throughout the cancer journey and beyond.   With a thorough knowledge of the different experiences people go through when living with cancer, the dedicated team of third party specialist cancer therapists will help both them and their loved ones work through the emotional ups-and-downs offering compassionate support and practical techniques along the way. They will help your client’s employees feel more in control of the situation, listening and gaining a thorough understanding of their needs, going at their pace - offering the right support, when they need it.
Careology* – At a time when life can feel overwhelming, the Careology app offers a simple way for your client’s employees to record and manage information relating to their cancer care. Whether they want to make a note of their questions, thoughts, and feelings, receive reminders to take medication, or keep track of their side effects and symptoms, it holds everything securely in one place - helping them feel a little more in control.
Cancer Care with Get Active* – our Get Active wellbeing offers include savings on products and services that could help make a small difference if your clients' employees or someone close to them is living with cancer. So, whether they’re looking to improve their current health and wellbeing, show someone their support, or they just want to feel more like themselves, there’s a choice of specially arranged products and services to help.
Cancer Care with Aviva Digital GP* – Aviva Digital GP is there 24/7 for your clients' employees. From talking to a private GP about symptoms that could be linked to a possible cancer diagnosis, to getting swift, convenient, empathetic support for general medical concerns following a diagnosis or during and after treatment – it’s there when they need it.

You can find further information about these services in our Cancer guide for Large Corporate Clients (PDF 179KB).

* These services are a non-contractual benefit Aviva could change or withdraw at any time

Helping you sell

Here you’ll find ideas that can help you identify clients, overcome objections, and make it easier to recommend Optimum.

Target Market Statement

Finding the right clients

Whilst any business can benefit from offering a pro-active benefits package, Group PMI policies are a common purchase in the following sectors:

Manufacturing
Professional services
Motor vehicle trade
Engineering

One reason for this is that the impact of sickness absence can be felt much more in industries requiring professionals with specific skill sets. Asking yourself the following questions could provide a good starting point:

Are your offices near to local businesses?
Are you networking with key decision makers?
Could you run a seminar that introduces PMI to potential clients?

Overcoming objections

Clients with 250 or more employees are likely to have a first-hand understanding of the dramatic impact that illness or injury can have on their workforce.

Here are some of the most common objections we hear, along with some ideas to help you overcome each objection:

“It’s too expensive.”

Optimum is a bespoke product designed to be extremely flexible in the benefits and costs associated with cover. Working closely with our Account Managers, you’ll create a bespoke proposition that meets your clients’ budgets.

Ultimately, without PMI in place, employees may have to wait for NHS treatment, which can affect the overall productivity of your client’s business.

“We don’t need a PMI policy for our employees.”

A group PMI policy can help reduce the costs of ill health in the workplace. It means your client could offer a more attractive employment package than their competitors, helping them recruit and retain valuable employees.

Our knowledge of the market helps employees get access to private medical care and appropriate treatments which could enable a quicker return to work following illness or injury.

“PMI is not our top priority”

Knowing your clients as you do, you’ll have an insight of their plans for the future – expansion, perhaps, or specialisation in a particular market. Good health among employees, and ways to keep absence-related costs to a minimum, can play a key role in a business’s economic future.

“We already have a policy in place…”

That’s excellent news. It demonstrates that your clients have understood the value of providing PMI for their employees.

We’re happy to offer a consultation process, which may show cost savings and enhanced benefits to the business.

Answering clients’ technical questions

Our National Accounts managers are on hand to answer questions in person for Optimum clients. This gives you an exceptional level of support from a provider – but we recognise that it’s also important to show your own detailed insights.

Here are a few of the questions we’re asked regularly.

“What’s the difference between acute conditions and chronic conditions?”

An acute condition is a disease, illness or injury that’s likely to respond quickly to treatment so that the individual can return to their previous level of health.

Chronic conditions are those illnesses, diseases or injuries that either continue indefinitely, have no known cure, come back (or are likely to come back), need long term monitoring or need on-going control or relief of symptoms, such as diabetes or Crohn’s disease.

“What are hospital lists?”

Your clients can choose a selection of hospitals where they’d like employees to receive treatment. They do this by selecting one of the following ‘lists’ of facilities.

Key hospital list – this provides access to a nationwide network of over 200 private hospitals
Extended hospital list – it's the same as the Key hospital list but contains more hospitals around the central London area.

Use our online Hospital List Checker to show clients the facilities available in their area.

“What’s the difference between an in-patient, out-patient and day-patient?”

An in-patient is someone who is admitted to hospital and who occupies a bed overnight, or longer, for medical reasons.

As a day-patient, employees would be admitted to a hospital or day-patient unit because they need a period of medically supervised recovery but would not occupy a bed overnight.

An out-patient is someone who attends a hospital, consulting room or out-patient clinic and is not admitted, either as a day-patient or

in-patient.

“Which type of underwriting would my client have to use?”

We’ll work with you and your client to find the most efficient and effective way of underwriting cover – whether it’s a new policy, or a transfer from another provider.

For more details about our wide range of underwriting choices, look at the Additional Services tab on this page.

If you’re approaching a large company

We can provide dedicated support to help you introduce the benefits of our Optimum product. Our Account Managers will be happy to go with you to see your clients.

Call: 0800 0014 272 Monday to Friday 9.00am – 5.00pm or email hcnd@aviva.com. Calls may be monitored and/or recorded.

We’re here to offer you support with your clients, deal with any queries, and give you information that will help companies with 250 or more employees proceed with confidence as they buy an Optimum policy.

How to make a claim

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Transcript for video 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 contact 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.

Key messages

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.

Quote and apply

Can we help?

Think of us as part of your team. For help or queries, simply get in touch:

Sales Support:

0800 0014 272

Monday to Friday 9.00am – 5.00pm

Or email hcnd@aviva.com

Calls to and from Aviva may be monitored and/or recorded. Opening hours may vary depending on the department you need to speak to.

Which documents should you use?

Our documents help clients understand what policies are designed to do. They can also help you introduce the benefits of each product to your clients.

Optimum 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 these documents well, as they can help you propose options that will make up a bespoke policy and conduct a compliant sale.

Key documents

View document library

Tools and resources

Hospital lists checker

Haven't found what you're looking for?

See our contact us page for a full directory.

Go to contact us

Optimum

Optimum - health insurance for 250+ employees

Flexibility

Great wellbeing benefits

Star treatment

Product details

Why Optimum?

Additional services

Wide range of underwriting options

A claims process that helps employees and employers

Healthpoint: efficient scheme management

Why Aviva?

Claims

Our approach to claims

Specialist expertise and support

Cancer claims

BacktoBetter – making a musculoskeletal claim

Mental health pathway - making a claim

Making a claim for non-musculoskeletal or mental heath conditions

Systems that support administrators’ needs

Wellbeing

Cancer Support

Helping you sell

Target Market Statement

Finding the right clients

Overcoming objections

Answering clients’ technical questions

If you’re approaching a large company

How to make a claim

Transcript for video How to make a claim

Quote and apply

Which documents should you use?

Key documents

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