This plan is a company paid (a voluntary scheme version will be launched soon) and community-rated major medical expenses (major medex) plan for employees and has a minimum group size of five employees. It pays if the insured employee needs a specified hospital treatment, with a smaller cash lump sum payable if they have free NHS treatment instead. Two options are available.
- Surgery Choices1. This covers over 60 surgical procedures (some of which also include a specified number of post-operative out-patient physiotherapy sessions). Westfield sources a fixed price private treatment package which covers all costs including any complications arising within 30 days after the procedure. The maximum benefit per treatment is £10,000 (operations are split into three bands, the lowest set at up to £3,000) and the maximum lifetime benefit is £100,000. Premiums start at £5.37 per employee per month.
- Surgery Choices 2. This is similar but covers over 1,300 procedures (set out in a 25 page list and split into 12 bands, the lowest being up to £850). Maximum benefit per treatment is £25,000 and the maximum lifetime benefit is £250,000. Premiums start at £16.00 per employee per month.
Generally, the plan pays for non-urgent surgical or medical procedures. All surgical procedures relating to cancer or heart disease are excluded, as are any emergency treatment, psychiatric treatment, pregnancy or childbirth and chronic conditions. Pre-existing conditions are excluded under a two-year rolling moratorium (three years for Surgery Choices 2) but other underwriting options are also available. Pre-admission diagnostic tests and consultations are not covered, but could be under a separate health cash plan up to pre-set limits.
Employees only may be covered, although Westfield says partner cover is ‘coming soon’.
If the employee prefers to have free NHS treatment or is assessed as unsuitable for a private health package, Westfield pays a smaller cash lump sum either to the employer or to the employee (the employer decides which when the plan is taken out or at annual renewal).
What They Say
Executive director, sales and marketing, Paul Shires said: “Delays in non-urgent medical care can increase sickness absence and places a heavy financial burden on employers. Hospital Treatment Insurance will help employers to manage staffing levels more effectively and lower costs, while employees – many of whom will be able to access private care for the first time – will benefit hugely from having more choice and control over where and when they have their surgery.”
What We Say
PMI is a great employee benefit, but it is also expensive and, in many cases the cost will rise faster than inflation. This plan can offer a third way – especially if used in conjunction with a good HCP. In fact, we would strongly recommend having an HCP alongside this plan.
But, the list of exclusions is long and while listing all procedures covered is in many ways a good thing, few employers (or employees) are likely to understand what is missing compared to regular PMI.
The one area this plan is better than PMI is that it pays out a significant sum if NHS treatment is chosen instead. That can help towards extra costs often involved in being in hospital (e.g. transport, loss of income and close family visitor costs). One disappointment is that major medex has not developed much from how it began. Unless it does, we can see this plan only having a relatively limited appeal.