With the football season in full swing, amateur and professional sportsmen and women are looking forward to another successful year free from injury. But for those who are unlucky enough to suffer one of the 19 million sporting injuries which occur every year, many will rely on the benefits of their PMI policies.
Once this happens, their medical needs differ vastly from those of the average person. Treatments like physiotherapy and MRI scans, which might be routinely included in a “normal” PMI plan, are an essential sporting requirement – and they are used so much more frequently by professionals and keen amateurs that the cost of these benefits can run into thousands. To add insult to injury, many scans and outpatient physiotherapy procedures do not necessarily lead to surgery – often they amount to little more than expensive health checks.
This can create problems for insurers. And the greater their prominence in the market, the more carefully they need to consider the ways in which they can offer a cost effective package which meets the needs of all parties.
BUPA currently insures the majority of the UK’s top sports clubs. It has over 3,000 registrations from professional sports bodies and specialises in the four main areas of football, rugby, cricket and athletics. Until recently, sports clubs were eligible to join all BUPA schemes, including LocalCare, Local HospitalCare, BUPACare and EssentialCare. The contracts were sold to clubs as group schemes and individual contracts. All plans offered an MRI scan as part of the package, an expensive procedure, valued at anything from £400 to £700, including the radiologist’s report.
In August 1996, BUPA took the decision only to offer sports clubs contracts with the following exclusions: MRI and CT scans; out-patient physiotherapy; outpatient alternative medicine; psychiatric cover; and NHS cash benefits. But many clubs remained as members of the original plans, still taking advantage of the original features.
In addition, BUPA had earlier omitted to exclude professional sports from its individual contracts. High-profile sportsmen and women were still able to take advantage of individual PMI policies at very affordable prices.
BUPA re-evaluated the cover supplied to sports clubs earlier this year as part of a widespread analysis, according to spokeswoman Anne Marie Cooklin.
“We looked at how we could provide professional sports clubs with more appropriate cover and how we could offer the best value. Obviously they have special needs because of the nature of the activities they undertake.
“We found that from a cover perspective we could offer a keener price if we excluded some of the benefits, for example, MRI and CT scans and out-patient physiotherapy. It will be cheaper for the club to negotiate their own prices for these things with local providers, especially as many have close relationships with local hospitals. Their intermediary can also negotiate good prices locally,” says Cooklin.
Cooklin denies the review was undertaken in response to the insurer making heavy losses on claims: “It was triggered from an analysis of the cover sports professionals were buying. And what we have done is given them more appropriate cover. Some clubs were claiming for MRI scans but some buy it themselves anyway and weren’t necessarily claiming.”
But is this what the sports industry really wants?
Dr Rav Naik, a medical director of Sheffield’s Sports Medicine Clinic and club doctor with the premier league football team Sheffield Wednesday, disagrees with Cooklin, and suggests that many of these procedures were traditionally paid for through the insurance policy.
|s Alternative scheme “Most of our claims for imaging, such as MRI, CT scans and x-rays, go through the scheme we use, although non-playing staff here go through the local hospital,” states Naik.
Sheffield Wednesday protects its players’ well-being via an alternative scheme to BUPA. This scheme, The FA Premier League Medical Care Scheme, administered by Croydon-based independent healthcare consultants, Healthfirst (UK), was established in June 1996 and is not an insurance scheme. Director of marketing and product development, Keith Phillips, explains: “It is a self-funded trust-based scheme which can be used as a complete alternative to medical insurance or can complement existing schemes.”
The plan works by judging the historical spending of the club and assesses the past three to five years of claims. A premium is based on this figure and the club then pays this directly to the medical trust. Naik is convinced of the merits of The FA’s scheme.
“The sum we pay is very competitive. And the advantage is that Healthfirst is totally geared to looking after sports people. It completely understands the issues involved in that sports people need prompt referrals and rapid authorisation. There is no paperwork and it can all be done in one phonecall,” says Naik.
Scans are included in the list of The FA’s scheme’s list of benefits. Naik adds that the exclusion of imaging is a major omission: “It would make the job of a sports physician more difficult than it would otherwise be.”
Another healthcare consultancy which recognises the demand for MRI scanning is Leeds-based Corporate Healthcare Protection (CHP). Whereas Healthfirst deals with the Premiership, CHP works with other league clubs, rugby and other professional sports. Director Alan Walton describes how CHP provides a scanning service: “Clubs can take our ProSport Network scan card to over 160 scanning centres and receive a scan for a 50% reduction. Fifty five clubs have requested the scan card, the majority of which are using them.
“And we provide scans through such organisations as Alliance Medical, BMI Healthcare, Lister Bestcare, Health South Plc and London Imaging, as well as a multiple of individual private hospitals. In addition, scans are available from these providers through the BUPA Hospital Network. Players don’t even need medical insurance, they can go through us to do it.”
Walton is a supporter of BUPA’s decision to withdraw BUPA LocalCare and BUPA Local HospitalCare from sports professionals. Sports groups are now transferred to Large BUPACare or to the two corporate plans, Premier Care and Premier Network on renewal. Large BUPACare is a group scheme which has a sponsor and is paid on a voluntary basis. The key element is that subscriptions are directly related to the group’s claims experience. All of these schemes exclude MRI scans to professional sports players and clubs joining after 1 July this year. The existing schemes, including BUPACare and BUPA EssentialCare, are now closed to new members.
“We have recommended to clubs that everyone transfers to Large BUPACare, even if they are eligible to remain,” says CHP’s Walton. “In the long term, it’s in their best interests. It’s our opinion that BUPA will have to redress the premiums of the present plans at a later stage.”
Intermediary Mike Hastings, director of Beckett Healthcare in Rutland (formerly Rutland Advisory Services) does not ascribe to Walton’s opinion. The firm has 40 clubs on its books, half of the premiership, and has not transferred a single one to Large BUPACare. And has no intention of doing so.
“We have taken each case on its merits and discussed all the alternatives with each club,” says Hastings. “Some have stayed where they were, some have switched to BUPA Premier, but none have gone over to Large BUPACare for professional sports clubs.
“We insure players as individuals and under the individual scheme [BUPACare], the benefits continue and players continue to get MRI and CT scans. This is not the case with Large BUPACare or BUPA Premier or BUPA Network. It is the case if they have been in these schemes prior to this year – then they continue to get MRI scans paid.
“But if they’ve switched this year, they lose the MRI benefit. For that reason we’ve left them where they are if their previous claims history justifies it. The deciding factor is often the attitude of the club physiotherapist and club doctor.”
An intermediary who has taken a different approach to the world of sports is PMI Cheshire-based Health Matters. The company approached the insurer AXA, sponsors of the FA Cup, and negotiated a new scheme aimed at sports players.
Managing director, Michael Dundon, says his firm of intermediaries is the only one which can sell The Health Matters Insurance ,Consultants Ltd Access Sports Club Scheme: “The plan does not include MRI scans but does offer full cover as an in-patient and full cover for all outpatient consultations, as well as £500 for alternative medicine. Non-playing staff are also entitled to full cover, including MRI”
Health Matters’ director of sales and marketing, David Pearson, adds the firm was well aware of the pitfalls of including scans in a policy: “Procedures like that are one of the causes of major increases in PMI premiums over the years and have contributed to the reluctance of insurers to deal with the product. With 30 players on a team’s books, the claims for scans can be astronomical.”
Dundon and Pearson are confident that their scheme is especially beneficial for footballers who can benefit from “top-up” monies from the Football League. The football body pays a certain amount of money toward paying for medical cover, including contributions to the cost of scans. Testament to their optimism is the news they have recently signed up Manchester City FC.
Despite increased competition in the sports clubs arena and criticism of recent changes to its portfolio, BUPA maintains that the majority of clubs are moving over to Large BupaCare, Premier Care or Premier Network on renewal.
BUPA’s Cooklin affirms the insurer’s commitment to the sports club business and encourages intermediaries to confront it if they have any doubts.
“We want intermediaries to talk to us if they’re not sure why we’re doing it. We did go through a consultation process with intermediaries before we did anything but we want to be sure they know we are doing the right thing,” she says.