Optimum

Bespoke Group Private Medical Insurance

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 staff get access to prompt, private medical treatment.

Flexibility

A modular product that lets your clients choose cover that creates a healthy balance between meeting their business needs and their budget

Great benefits as standard

Extensive cancer cover is standard on every policy, as is access to a variety of wellbeing services and the Aviva Digital GP app

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 staff 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

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 current level of cover.

Facts and figures

A choice of additional services

We encourage clients with 250 employees or more to consider services designed to reduce the cost of absenteeism whilst helping boost the morale, working relationships, and productivity of their workforce.

BacktoBetter – support for employees when they need it most

Provided as standard with Optimum, BacktoBetter is an independent 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 to see a GP, 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.

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, the Mental Health Pathway helps your clients' employees get quick access to quality talking therapies and psychiatry assessment, where required. There's no need to see their GP - all 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.

Wide range of underwriting options

A claims process that helps employees and employers

Healthpoint: efficient scheme management

Why Aviva?

What makes our PMI different?

As one of the UK’s leading providers of PMI, we draw on extensive clinical expertise 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’ll match your clients’ existing cover – if your clients want to transfer from another provider, we’ll match their current benefits
  • 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 in-house clinicians we offer one-on-one support and treat each claim on a case-by-case basis
  • Our Cancer Pledge sets the standard for providers – Optimum is a completely bespoke policy so, your clients can tailor their cancer benefits to their exact needs
  • 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

 

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
  • Associated stress levels are reduced for employees
  • Group administrators can monitor claim levels online

 

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

We want to help your client's employees lead healthier lives and promote a feeling of appreciation towards their employer. That’s why we offer a number of added value benefits with our Optimum policies:

  • Get Active* gives your clients' employees access to discounts at a range of health and fitness clubs, online workouts and a variety of other products and services that can enhance a healthy lifestyle. Terms and conditions and the privacy policy can be viewed online before signing up.
  • Aviva Digital GP app* could help minimise downtime when your clients’ employees need a GP consultation or are seeking medical advice, giving them swift and convenient access to GP video consultations and repeat NHS prescriptions (all NHS England exemptions accepted). 

Please note, 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. Aviva Digital GP is powered by Square Health.

  • Stress Counselling Helpline can be a good place for your clients' 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 for members aged 16 and over. 
  • Aviva Wellbeing app* is dedicated to helping your clients' employees and insured adult dependents live life to the max. They can also join challenges designed for every fitness level, to help build team spirit. Terms and conditions and the privacy policy for Aviva Wellbeing can be viewed in-app before signing up.
  • 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 are available to 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. 
  • Discounts for all employees on home, motor and travel insurance - terms and conditions apply and can be found here

* These services are non-contractual benefits that can be withdrawn by Aviva 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

Overcoming objections

Answering clients’ technical questions

If you’re approaching a large company

How to make a claim

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Transcript

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.

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.

How our BacktoBetter service works

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Transcript

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.

Physiotherapy

Your case manager will set up a 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

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

 

Lines are open Monday to Friday, 9am to 5pm.

Calls to and from Aviva may be monitored and/or recorded.

 

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.

These documents explain how the product works

Company facing

Optimum Brochure (PDF 976KB) – employer-facing pre-sale brochure

BacktoBetter Brochure (PDF 2920KB) – post sale employer information

Mental Health Pathway Brochure (PDF 1119KB) - Employer guide

Employee facing

BacktoBetter leaflet - employee information(PDF 245KB)

Optimum policies include the Extended hospital list as standard. Use our online Hospital List Checker to show clients some of the private facilities their employees could access with an Optimum policy.

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