Cover Options

Out-patient Cover pays for costs such as consultant appointments and physiotherapy, and diagnostic tests like MRI scans, blood tests and x-rays
The costs we cover depend on what you add to your plan:

• Out-patient cover with a limit. We can pay for diagnostic tests, consultant appointments and out-of-network physiotherapy up to a set limit.
  A limit of £500, £750, £1,000, £1,250 or £1,500 can be chosen.
• Full Out-patient Cover. We pay for all the out-patient treatment, consultant fees and diagnostic tests needed.

MRI, CT and PET scans
We pay for these scans, as long as your employees have been referred by a consultant.

MRI, CT and PET scans will be paid in full, and not treated as part of the employees' Out-patient Cover limit.

The VitalityHealth physiotherapy network includes over 2,000 accredited physiotherapy clinics across the UK. This means that, more often than not, your employees will be able to have treatment at a convenient location, less than 10 minutes’ drive away from their home or place of work.

Cover for a physiotherapist within our network
Treatment will be covered in full, and will not form part of the Out-patient Cover limit.

Cover for a physiotherapist outside of our network
Treatment will continue to be deducted from your employees Out-patient Cover limit and will be limited to £35 per session. 

If you have chosen a limited Out-patient Cover option, you can choose to add on full cover for diagnostics – you can upgrade your Out-patient Cover so that out-patient diagnostic tests would be covered in full, and only consultant appointments and out-of-network physiotherapy would be covered by your chosen Out-patient Cover limit.

Out-patient diagnostics will be covered in full. Consultant appointments and out-of-network physiotherapy will continue to be covered up to the limit you’ve chosen for your employees.

We pay for up to 28 days of in-patient or day-patient treatment, and up to £1,500 for out-patient consultations (e.g. with a psychologist). Talking Therapy arranged through our network is covered in full, and won’t be deducted from your out-patient limit. All in-patient mental health claims are managed by our team of experienced case managers.

28 days in-patient or day-patient treatment
A separate £1,500 out-patient treatment limit
Full cover for in-network Talking Therapies

Chiropractic treatment, osteopathy, chiropody/podiatry, acupuncture, homeopathy, and two consultations with a dietician following GP or consultant referral.

Full Cover

At some point, everyone faces emotional problems such as relationship or money worries, stress, and bereavement. If your employees have problems like these and are finding it hard to cope, an Employee Assistance Programme can help.
With the programme, your employees get:

• Debt counselling, legal and financial advice through our 24-hour helpline
• Up to six confidential, face-to-face counselling sessions per year 

Our Employee Assistance Programme is provided by Health Assured.

Unlimited access to a confidential telephone advice service, 24 hours a day, 365 days a year

You can give your employees a Personal Health Fund to help pay for everyday healthcare bills that aren’t usually covered by private medical insurance. Your employees can use their Personal Health Fund for:

Optical Treatment	Includes fees for sight tests, fitting, spectacle repairs, prescription swimming or diving goggles. They can also claim for glasses, lenses, spectacle frames, contact lenses, and prescription sunglasses.
Dentistry Claims	Check ups and treatment at a UK dentist, including fillings, crowns and bridges, plus hygienist fees.
Health Screens	They can claim back the costs of a health screen with our screening partner.
Chronic Prescriptions	If they have a chronic condition, they can use their PHF to cover the cost of a prescription prepayment certificate (PPC), which will cover the cost of NHS prescriptions for 3 or 12 months. This is the only healthcare expense they need us to authorise for payment from the PHF beforehand.
Private GP appointments	They can use their PHF to pay for a face-to-face appointment with a private GP.
Medical aids and devices	Your employees will be able to claim back 50% of the costs of a range of medical aids and devices including hearing aids, blood pressure monitors and TENS machines.
£100 towards a fitness device	They can use £100 of their fund to pay for a device which can be used to record Vitality points. Maximum of one claim of up to £100 per adult every three plan years. This excludes Apple Watch and smartphones.

Vitality status	Personal Health Fund
Start off at Bronze	£75
Reach Silver	Add £50
Silver	£125
Reach Gold	Add another £50
Gold	£175
Reach Platinum	Add another £50
Platinum	£225

                               
(Any unused balance will be rolled over to the following plan year. A maximum Personal Health Fund balance of £1,000 per adult member will apply)

This cover option is available now for plans starting on or before 31 August 2021. After this date, you won’t be able to buy Dental Cover. It will be replaced with our new cover option - Optical, Dental and Hearing Cover.

If you add Dental Cover to your plan, it will be replaced with Optical, Dental and Hearing Cover at the first annual plan renewal date.
You can choose between two levels of dental cover for your employees, depending on how much you want to spend, and how much cover you want to offer them.

All benefits are per insured member, per plan year unless otherwise stated.

	Major dental treatment	Major and routine dental treatment
Routine examinations Maximum of two claims per plan year		Up to £30 per claim
Routine scaling and polishing Maximum of two claims per plan year		Up to £40 per claim
Dental x-ray (radiography of the teeth or jaw) Charges for radiography of teeth or jaw Maximum of two claims per plan year		Up to £40 per claim
Fillings Maximum of two claims per plan year		Up to £40 per claim
New or replacement crowns	Up to £300	Up to £400
New or replacement inlays, onlays and overlays		Up to £100
New or replacement bridges or implants	Up to £200	Up to £300
Root canal treatment	Up to £150	Up to £250
Apicectomy	Up to £100	Up to £150
Extractions	Up to £150	Up to £250
New or replacement dentures	Up to £250	Up to £350
Emergency treatment from a specialist if you have a dental accident We can cover up to four claims for each year of your plan	Up to £2,500 per claim	Up to £2,500 per claim
Emergency dental treatment for severe pain, a haemorrhage or an infection We can cover up to two claims for each year of your plan		Up to £300 per claim
Emergency call-out fees	Up to £50 per claim	Up to £50 per claim

This is available now, on plans starting on and after 1 September 2021. It allows your employees to claim back expenses for:

• Eye tests, new prescription glasses or contact lenses – We’ll cover 100% of the bill, up to £500 each plan year when your employee uses Vision Express. If your employee chooses another provider, they can claim back 80% of the bill, up to £300 each plan year
• Routine dental appointments – We’ll cover 100% of the bill, up to £100 each plan year
• Dental treatment – Such as fillings, crowns, or implants. We’ll cover 80% of the costs, up to £400 each plan year
• Dental accidents – If your employee has an accident and needs treatment for broken or damaged teeth, we’ll cover 100% of the bill, up to £2,500 per claim. We'll pay for up to two claims each plan year
• Hearing tests and new or replacement hearing aids – We’ll cover 80% of the bill, up to £300 each plan year. They can claim back for the cost of a replacement hearing aid every five years. But they can claim in any plan year if their audiologist recommends a different type of hearing aid. 

On 1 September 2021, our Emergency Overseas Cover will change. We will be enhancing it with increased benefit limits.

If you add Emergency Overseas Cover to your plan on or before 31 August 2021, your cover will be updated with the new version at the first annual plan renewal date.

Whether your employees are on holiday or on a business trip, our Emergency Overseas Cover means they’ll get emergency medical treatment if they need it.

Existing product – for plans starting on for before 31 August 2021

For trips of up to 90 days	Amount
Medical cover if taken ill overseas, including accommodation costs and travel expenses for one person to remain behind with the sick or injured member*	Up to £100,000
Repatriation or evacuation expenses* and transfer of body or ashes back to the UK	Up to £1 million
Cost of burial or cremation outside the UK	Up to £1,000

*Your employees will need to pay a £50 excess on these benefits.

Enhanced product – for plans starting on or after 1 September 2021

For trips planned to last up to 120 days	Amount
Medical cover if taken ill overseas, including accommodation costs and travel expenses for one person to remain behind with the sick or injured member* Repatriation or evacuation expenses* and transfer of body or ashes back to the UK	Up to £10million
Cost of burial or cremation outside the UK	Up to £2,500

*Your employees will need to pay a £50 excess on these benefits.

Worldwide Travel Cover

On 1 September 2021, our Worldwide Travel Cover will change. We will be enhancing the cover option with increased benefit limits and cover for travel vaccinations and medication.

If you add Worldwide Travel Cover to your plan on or before 31 August 2021, your cover will be updated with the new version at the first annual plan renewal date.

This covers trips planned to last up to 120 days and includes things like emergency medical expenses and lost luggage. You can apply to include this benefit to cover at the plan start date, or a future renewal date, provided all applicants are aged 79 or under at the time the benefit is included.

Existing product – for plans starting on for before 31 August 2021

Overseas medical expenses
Medical cover if taken ill overseas, including accommodation costs and travel expenses for one person to remain behind with the sick or injured member* Repatriation expenses* Transfer of body or ashes back to the UK	Up to £10 million
Cost of burial or cremation outside the UK	Up to £1,000
Other travel expenses
Loss of or damage to personal belongings*	Up to £2,000
Loss of personal money*	Up to £1,000
Loss of or damage to business machines*	Up to £1,000
Delayed departure	Up to £100
Missed departure*	Up to £500
Cancelling the trip or cutting it short*	Up to £4,000
Personal accident	Up to £25,000
Personal liability	Up to £2 million
Loss of passport*	Up to £250
Delayed baggage*	Up to £200
Legal expenses	Up to £25,000
Replacement employee travelling costs*	Up to £1,000
Winter Sports Cover (cover is limited to 21 days in total each plan year)
Loss or damage to ski or snowboarding equipment*	Up to £500 per plan year
Loss of ski pass*	Up to £500 per plan year
Piste closure(£30 a day)*	Up to £500 per plan year
Loss of use of hired skis and ski pass due to illness or injury*	Up to £500 per plan year

 

Enhanced product – for plans starting on or after 1 September 2021

Overseas medical expenses
Medical cover if taken ill overseas, including accommodation costs and travel expenses for one person to remain behind with the sick or injured member* Repatriation expenses* Transfer of body or ashes back to the UK	Up to £10 million
Cost of burial or cremation outside the UK	Up to £2,500
Other travel expenses
Loss or damage to personal belongings*	Up to £3,000
Loss of personal money*	Up to £1,000
Loss of or damage to business machines*	Up to £1,000
Delayed departure	Up to £250
Missed departure*	Up to £1,000
Cancelling the trip or cutting it short*	Up to £10,000
Personal accident	Up to £50,000
Personal liability	Up to £2 million
Loss of passport*	Up to £250
Delayed baggage*	Up to £600
Legal expenses	Up to £25,000
Replacement employee travelling costs*	Up to £1,000
Travel vaccinations and medication	Up to £100 per plan year in total
Winter Sports Cover (cover is limited to 21 days in total each plan year)
Loss or damage to ski or snowboarding equipment*	Up to £500 per plan year
Loss of ski pass*	Up to £500 per plan year
Piste closure(£30 a day)*	Up to £500 per plan year
Loss of use of hired skis and ski pass due to illness or injury*	Up to £500 per plan year

*Your employees will need to pay a £50 excess on these benefits

Unless we state otherwise, the benefits are for each insured member on your plan, per trip. Separate terms, conditions and exclusions apply to our Worldwide Travel Cover – please speak to your adviser to find out more.

We offer your employees access to the best possible medical care and when they need treatment we ensure it’s at a hospital which offers clean and comfortable surroundings. There are two options as to where they may be treated and you can choose which options suit you and your employees best.

If you choose Consultant Select you will be offered a choice of high quality consultants to treat your condition at a private hospital in your area. Or you can choose which hospitals your employees can use from our Hospital Lists:

• Countrywide
• London Care.

You can choose for your employees to contribute to the cost of their treatment up to a maximum amount. We then pay for the rest of their treatment, up to any limits on your plan.

The higher contribution your employees pay, the lower we can make your premiums. You can choose this maximum contribution to be £0, £100, £250, £500 or £1,000

Once you’ve chosen an excess, you choose whether your employees pay once per plan year or each time they make a claim.

Vitality status-linked excess

For Business Healthcare plans with five or more employees you can link your employees' excess to their Vitality status. As they improve their Vitality status, we reduce the amount of excess they need to pay without changing your premiums.

The excess levels do not apply when making claims for NHS Hospital Cash Benefit, Childbirth Cash Benefit, Weight loss and Corrective Surgeries or costs relating to Vitality GP.

This excess would also not be applied to claims made under the Dental Cover option or the Optical, Dental and Hearing Cover option, and also the Worldwide Travel Cover and Emergency Overseas Cover options, where a different excess or co-payment may apply.

When we’re working out whether we can cover your employees, what we can cover them for and how much their cover will cost, we go through a process called underwriting.
There are four different kinds of underwriting that you can choose from. Which one’s right for your business depends on whether you’ve already got a company plan with someone else, how much information you want us to ask your employees  for, and how large your business is.

1. Full Medical Underwriting
   If you’re happy for us to ask your employees about their medical history, you can choose Full Medical Underwriting. We might need to exclude some pre-existing conditions from their cover, but we always tell them upfront exactly what they’re covered for.
2. Moratorium Underwriting
   If you don’t want us to ask your employees’ medical history, we tell them whether they’re covered at the time they make the claim. Your employees won't initially be covered for any condition that they have had within the five years prior to the start of their cover.
3. Continued Personal Medical Exclusions Underwriting
   If you’ve already got a company health insurance plan with another provider, you could choose Continued Personal Medical Exclusions Underwriting which means we will apply the same personal medical exclusions as your current insurer.
4. Medical History Disregarded Underwriting
   If you’ve already got a company health insurance plan with another provider and all members are currently insured on a Medical History Disregarded basis, or your company is currently uninsured but you wish to ensure 20 or more employees, you could choose Medical History Disregarded Underwriting.