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.
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*
*This is a non-contractual benefit that could be withdrawn or changed at any time
Dedicated account management for you and your client
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.
- 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 the introduction of a range of 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.
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 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 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, 2021-2022. HSE, November 2022. 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 clinical provider for assessment and required treatment.
Wide range of underwriting options
A claims process that helps employees and employers
Healthpoint: efficient scheme management
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 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 in-house clinicians 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
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
- Group administrators can monitor claim levels online
Our approach to claims
Specialist expertise and support
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
We want to help your clients' 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:
- 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.
- 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.
- MyAviva - We know life is busy, so that’s why we’ve developed MyAviva to make things easier for your clients’ employees. Our online portal will help manage all their Aviva policies and schemes in one secure and easy-to-use place. It puts a whole host of benefits at their fingertips, letting them check their policy or scheme information, including cover and benefit details to starting a new claim or update us on an existing one. MyAviva is safe secure and tailored to use on most popular devices. It’s available to download from the App Store or Google Play. Mobile data charges may apply.
* These services are non-contractual benefits that could be changed or withdrawn by Aviva at any time.
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 training from our qualified medical experts – now including a cancer surgeon, 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 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 client’s 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 client’s 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
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How to make a claim
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.
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.
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Can we help?
Think of us as part of your team. For help or queries, simply get in touch:
Monday to Friday 9.00am – 5.00pm
Or email email@example.com
Lines are open Monday to Friday, 9am to 5pm.
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.
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