1. Summary
October 2014
Business Health Select
Summary
October 2016
Private healthcare for small and medium businesses
Including Employee Assistance Programme
2. 2
Contents
Section Page
1 Overview of Business Health Select and
Business Health Select 6
3
This section gives a brief description of our Business Health Select plans
2 Employee Assistance Programme 9
This section gives a brief description of our Employee Assistance
Programme options
3 Important information 11
Additional useful plan information
3. 3
1. Overview of Business Health Select
This section gives you a brief description of the Business Health Select plan
with an Employee Assistance Programme from AXA PPP healthcare.
It doesn’t contain the full terms and conditions. These can be found in your
Group Secretary Guide and membership handbook.
Words and phrases
Group plan
When we use ‘group plan’ we mean the group as a whole.
Plan
When we use ‘plan’ we mean the individual contract of insurance held with
each eligible employee.
1.1 > Summary of the Business Health Select plans
1.2 > Choose from a range of Options
1.3 > The main things we don’t cover in the Business Health Select plans
1.4 > How you can reduce the cost of your cover
4. 4
1.1 > Summary of the Business Health Select plans
You can build a Business Health Select plan which is unique to your business. We
offer a wide range of flexible choices which can be tailored to suit the needs of your
business. With services like Fast Track Appointments, we can save your members time
and trouble by quickly finding up to three specialists. We can also arrange and book the
appointments at suitable times and locations for your members.
Cover for your members
With Business Health Select your members have ‘Core cover’ as standard. ‘Core cover’
describes their main benefits. You can then choose their ‘Options’.
Core cover includes:
If a member is an in-patient or day-patient:
•Private hospital and day-patient unit fees
•Cash payment of £50 each day or night if a member uses a hospital or day-patient unit
that is not in our Directory of Hospitals
•Specialist fees
•Accommodation for one parent while a child is in hospital.
If a member is an out-patient:
•Surgery
•CT, MRI or PET scans
•Active treatment of cancer, including charges for radiotherapy and chemotherapy
•Cash payment if a member has a CT, MRI or PET scan at a hospital or day-patient unit
that is not in our Directory of Hospitals.
Other benefits:
•Ambulance transport
•Cash payment of £50 a day up to £2,000 a year if a member has chemotherapy or
radiotherapy free on the NHS
•Expert Help. Direct access to our healthcare experts for your members and their
family.
•Dedicated nurse telephone service providing dedicated clinical medical support for
employees and their family members if diagnosed with cancer.
•Working Body - If your members experience muscle, bone or joint pain, they can
speak to a physiotherapist over the phone without the need to see a GP first. The
physiotherapist will listen to their concerns and advise the most appropriate treatment
for them.
»» For further details about Core cover, see Section 1.1 in the membership handbook.
5. 5
1.2 > Choose from a range of Options
As mentioned in Section 1.1, your members have ‘Core cover’ as standard. You can
then tailor your plan to suit your business by choosing which ‘Options’ you want for your
group plan.
Business Health Select Options
You can personalise your Business Health Select plan by choosing from the following
Options.
Out-patient Options
If you would like out-patient cover there are three levels available. Please only choose
one of these for each employee.
Standard out-patient Option
•Specialist consultations - up to two specialist consultations per year
•No yearly limit on diagnostic tests when your member’s specialist refers them.
Enhanced out-patient Option
•A combined yearly limit of £1,000 for specialist consultations, diagnostic tests when
your member’s specialist refers them and practitioner fees when your member’s
specialist refers them.
Full out-patient Option
•No yearly limit for specialist consultations, diagnostic tests when your member’s
specialist refers them and practitioner fees when your member’s specialist refers them.
Therapies Option
• No yearly limit on fees for out-patient treatment by physiotherapists, acupuncturists,
homeopaths, osteopaths or chiropractors when the Working Body team or your
member’s GP refers them. This is available up to an overall maximum of ten sessions
a year.
• Further sessions (when your specialist refers you) as long as we agree them first.
Mental Health Option
In-patient or day-patient
• Private hospital and day-patient unit fees for psychiatric treatment paid in full
• Cash payment if your member uses a hospital or day-patient unit that is not in our
Directory of Hospitals. They will receive £50 a night for in-patient treatment and £50
a day for day-patient treatment.
• No yearly limit on specialist fees for psychiatric treatment.
Out-patient
• No yearly limit on specialist consultations for psychiatric treatment
• No yearly limit for psychiatric treatment by psychologists and cognitive
behavioural therapists.
6. 6
Extra care Option
• Nurse to give your member chemotherapy or antibiotics by intravenous drip at home.
This will be paid in full.
• Cash payment when your member has free treatment under the NHS. They will receive
£100 a night up to £2,000 a year.
• Oral surgery will be paid in full as long as your member uses a facility that we have an
agreement with covering oral surgery
• Chiropody fees up to £150 a year.
Dentist and Optician Cashback Option
• 80% of your member’s dentist’s fees, up to £400 a year
• 80% of the cost of prescribed glasses and contact lenses, up to £200 a year
• Up to £25 a year for an eye test.
»» For more details, see Section 1.2 in the membership handbook
Extra Cancer Cover Option
• No time limit on cover for specialist cancer drugs, such as biological therapies
(including Herceptin and Avastin) as long as they are used within the terms of their
licence
• Experimental drug treatment, as long as it’s part of an ethically approved trial
• Purchase of wigs up to £150 a year
• Purchase of external prostheses up to £5,000 a year
• Hospice donation of £100 a year.
»» For more details, see Section 4.1 in the membership handbook
Extended Cover Option
• Fees for treatment at any hospital, day-patient unit, or scanning centre in the UK paid
in full up to the normal daily rates published and charged by the facility
• Charges for treatment received outside of the UK paid up to the cost we would pay for
equivalent treatment in the UK
• Fee limited specialist fees paid in full
• Doctor@Hand - Up to five consultations with a private GP a year. This GP service is for
online, video or telephone consultations.
• Up to £500 a year for private GP consultations.
»» For more details, see Section 4.1 in the membership handbook
Travel Option
• Our ‘Travel Cover’ plan will be applied with this Option. This provides cover towards
the cost of emergency medical treatment abroad.
»» For more details, see the Travel Cover summary.
7. 7
Can I select different levels of cover for my members?
If you’re looking to insure six or more employees, you can personalise your plan further
by selecting different levels of cover for the different categories of employees in your
business, such as management and staff.
You can have a maximum of three categories within your group plan. Each category
must contain three or more employees.
1.3 > The main things we don’t cover in the
Business Health Select plans
Like all health insurance plans, there are a few things that your members’ membership
isn’t designed to cover.
We’ve listed a summary of the more significant things here.
The main things we don’t cover:
•Routine pregnancy and childbirth
•Treatment of medical conditions a member had, or had symptoms of before they joined
•Treatment of ongoing, recurrent and long-term conditions (chronic conditions)
•Fees if you choose to use a hospital that is not in our Directory of Hospitals
•Emergency or urgent treatment if the Six Week Option is selected.
The main things we don’t cover depending on the Options your members have:
•If your members don’t have an out-patient Option, they don’t have any cover for
out-patient diagnostic tests or consultations
•If your members don’t have the Therapies Option, they don’t have cover for fees for
physiotherapists, acupuncturists, homeopaths, osteopaths or chiropractors
•If your members don’t have the Mental Health Option, they don’t have cover for any
psychiatric treatment
•If your members don’t have the Dentist and Optician Cashback Option, they don’t have
cover for dentists’ or opticians’ fees.
»» For more details, see Section 3 in the membership handbook
8. 8
1.4 > How you can reduce the cost of your cover
You can choose to select one or more of the following to help reduce the cost of your
cover.
Optional excess
You can choose an excess of £100, £250 or £500 for each employee. This excess only
needs to be paid once every membership year for each member on the plan that claims
- not for each claim.
»» For more details on how your excess works and how to pay your excess please see
Section 5 in the membership handbook.
Six Week Option
If you decide to have the Six Week Option included in your group plan, your cover will be
for in-patient treatment and day-patient treatment and any surgical procedure if the NHS
can’t give your members that treatment within six weeks of when treatment should take
place. If the NHS has available treatment within six weeks of when it should take place
then your members should take treatment on the NHS and can claim a cash benefit.
Annual payment
You can save a further 5% off your subscription when you pay with an annual direct
debit or cheque.
9. 9
2. Employee Assistance Programme
This section gives you a brief description of our Employee Assistance
Programme options.
2.1 > Employee Assistance Programme overview
2.2 > EAP Essential
2.3 > EAP Premier
10. 10
2.1 > Employee Assistance Programme overview
We offer two levels of Employee Assistance Programme (EAP) - EAP Essential and
EAP Premier.
Our Employee Assistance Programmes offer a confidential telephone service 24 hours
a day. Your employees can receive information, support and counselling for any worry or
concern they might have.
This is a group level purchase so the level of EAP will apply to all members and their
family members.
2.2 > EAP Essential
Unlimited access to confidential telephone support available 24 hours a day for
psychological, practical and medical issues.
•Psychological Needs Practitioners answer every call so that all employees speak with
a fully qualified counsellor.
•Counselling via email available.
•Access to dedicated website axabesupported.co.uk which offers a range of information
on practical, medical and wellbeing topics.
2.3 > EAP Premier
All the support of EAP Essential but if you’re looking for a more packaged mental health
provision, our EAP Premier model provides first stage intervention alongside budgetary
certainty.
•Face-to-face counselling included. Up to five sessions for each employee each issue
when clinically appropriate, through our network of over 650 clinical specialists
nationwide.
»» For further information on our Employee Assistance Programme options please call us
on 0800 587 0955.
11. 11
3. Important information
3.1 > How long is my cover?
3.2 > Cancelling your plan
3.3 > How to complain
3.4 > Claiming against AXA PPP healthcare
12. 12
3.1 > How long is my cover?
Your group plan will be arranged to last for an initial period of 12 months.
3.2 > Cancelling your plan
You have a 14 day cancellation period if you’re an unincorporated business (a sole
trader or a partnership which is not a Limited Liability Partnership) and you’re
purchasing the cover for yourself as well as your employees. The cancellation period
begins on the day your contract is agreed or the day you received your full plan
terms and conditions (if this is later) and will also apply from each renewal date. The
cancellation period does not apply if you’re not an unincorporated business or where
you’re purchasing cover that does not include cover for yourself. Full details can be
found in your Group Secretary Guide.
3.3 > How to complain
We aim to provide you with the highest possible standards of service but accept there
may be occasions when you feel that things have gone wrong for you and you are
unhappy with us. If you have a complaint about any matter please contact us and we’ll
do our best to address your concerns. Your feedback is vital to helping us to improve.
Further details on how to complain can be found in the ‘Making a complaint’ section of
the membership handbook. If you’re dissatisfied with the outcome of our
investigation, you can ask the Financial Ombudsman Service (FOS) to consider your
complaint. You should contact the FOS (0300 123 9123 or 0800 023 4567) to find out
whether you would be eligible to have your complaint considered by the FOS, as you’ll
need to meet specific criteria depending on your particular circumstances.
3.4 > Claiming against AXA PPP healthcare
In the unlikely event that AXA PPP healthcare becomes insolvent and is unable to pay
benefits under your group plan, you may be entitled to claim compensation from the
Financial Services Compensation Scheme (FSCS). You’ll need to meet specific FSCS
criteria depending on your particular circumstances. To find out whether you’d be
eligible to claim under the scheme you should contact the FSCS (0207 892 7300).
Further information about the operation of the scheme is available on the
FSCS website: fscs.org.uk
