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Business Health Insurance – Huge Discounts – Bit of a worry?

October 19th, 2011

This week we have been reviewing some of our bigger clients Company Schemes. Never before have I seen such huge discounts being applied by medical insurers. Some insurers are very obviously buying business. My concerns are that we switch a client to the insurer based on this irresistable price and the following year – BOOM! Up goes their renewal premium. Insurers cannot categorically tell us how they calculate renewal premiums or give us any idea of a cap on renewal. BUPA still offer their 2 year fixed deal of course. However, the fear of what is going to happen in year 3 steers us clear away from this option. Pruhealth used to offer a 10% cap on loadings but this is now a thing of the past since they took over Standard Life.

Our approach at the moment is to make hay while the sun shines. This seems to be received very well by our clients who are all trying to make savings but we just hope we are not making our lives difficult for 2012 renewals being compared to the excellent rates we are getting in 2011.

One client this week was offered renewal terms of £80,000. We conducted a full review and a large insurer were offering a £72k quote. We then went back to the existing insurer with this who agreed to price match. We went back to the competing insurer who then reduced the price once more to £64k, so still maintaining a £8k saving for the client. They also ‘chucked in’ dental and optical cover. I cant really advise the client to ignore this £8k saving when they can switch on a no worse terms basis to a reputable insurer offering them better cover for fear of what might happen in 2012!

Oh, the dillemas of a Medical Insurance Broker. Things may change next week as insurers budgets dictate these discounts after all. We are enjoying being able to offer our clients such good deals that are almost too good to be true.

Psychiatric Treatment – A real Muddle

October 5th, 2011

One of my cilents called me last night with a problem getting a claim authorised by Pruhealth. Psychiatric treatment is a real grey area and for intermediaries, comparing the hidden policy wording can be tricky.

Pruhealth state clearly that all psychiatric claims are managed on a case-by-case basis and on their new plan clients can choose cover up to £15,000 or £20,000 for each plan year for in-patient.

Bupa on the other hand will offer options on their Select plan which will give 45 days in patient cover with out-patient cover taken from within whichever out-patient limit they have.

It takes a good old dig around in their policy wordings to get to the bottom of how a mental health claim would be treated.

I called both of their mental health teams with this real scenario:-

My client suffered post traumatic stress due to an incident but had previously been of excellent mental health. He was refered to a psychiatrist by his private GP. He called Pruhealth and the claims team were trying to suggest that he couldnt go to that psychiatrist but should have 6 sessions with a psycho-analyst. The client became very distressed because, of course, he was in a very frail state of mental Health (the clue is in the claim!) and in the end his elderly father took the call over. He was of course angry with the claims department and eventually put the phone down on them as they refused to put him through to a manager. Pruhealth called him straight back and a Manager quite promptly offered to pay for the referal to a psychiatrist.

From my clients point of view, he was angry as he didnt feel his son was treated fairly and he felt that the insurer was trying to get out of paying! As an independant party, I can understand that insurers have to cost contain and will have their stringent processes to follow in order to authorise a claim. I wonder (and have asked them) how the claims team are directed to deal with people in a poor state of mental health and if they should be dealt with by a specific department.

The client responded by asking me to switch him back to BUPA as he felt sure that BUPA wouldnt treat him like this. However, I find it very hard to give my client the re-assurance he needs as although the policy wording indicates this would be covered, what is to stop BUPA or any insurer from directing their claims team into persuading the client to take a “cheaper” route?

Bupa’s mental health team were very helpful and explained that in this case study (above), they would have authorised my client to see the psychiatrist and not tried to persuade him to see a psycho-analyst. They used to request that the client saw a psychiatrist to manage any therapy but now will refer on the GPs recommendation directly to see a therapist if that is what was required.

The lesson from this? Well it is for Intermediaries really, read the policy wordings and make sure you understand the intricacies of major elements such as cancer cover and psychiatric treatment. This sort of claim is so emotive.

Boost for Private Health market

September 20th, 2011

A report today in The Guardian newspaper outlines the fact that private healthcare firms are experiencing an increase in business due to the financial squeeze across the NHS in England.

It is of course natural that patients that have to wait on the NHS for treatment will consider paying for their own care privately. Private Medical Insurance would not cover pre-existing conditions so once someone experiences an NHS wait for a condition, they are stuck with dipping into their own pocket!

The Chief Executive of the NHS Partners Network confirmed in the article that “We are certainly picking up that some patients are being asked to wait longer than they would have expected and are therefore deciding to pay for themselves rather than wait.”

The Healthcare Industry Barometer 2011 was published today highlights the fact that this upturn is a boost for a UK private health market which that was hit hard by the downturn in 2008.

The Guardian reports that “The current lack of optimism in the healthcare industry is seen by some as a natural consequence of high expectations for rapid reform a year ago being dashed by current political uncertainty,” said Warren Taylor, head of healthcare at Nabarro.

“However, for those taking a longer term view, there’s much to merit cautious optimism. The direction of NHS reforms under the coalition remains positive for the sector.”

Private Medical Insurance in demand more than ever?

September 19th, 2011

According to an article in Health Insurance Magazine, things are not getting any better for those relying on the NHS for their operation.

Recent statistics from the Department of Health show that 9,939 people still on an NHS waiting list in July having been referred for treatment more than 52 weeks earlier. In total, 2.6 million are still waiting for operations.

There were 300,000 patients seen in July but over 28,000 had waited beyond the target which was an increase of 34% from July 2010.

One can only suggest that the demand for people to take their concerns into their own hands and search the market for private health insurance.

We really do need to move away from the old fashioned view held by some IFAs/Advisors that Private Medical Insurance is expensive. It might have been in the days when they only had BUPA to choose from! But now, there is so much choice and premiums can be affordable for most.

At Best Health, we are seeing an increased demand from customers that have never had specialist medical insurance advice before. Our new clients are astonished that they had been paying such high premiums all these years unnecessarily.

Finding the right Staff

September 14th, 2011

I usually blog about Health Insurance but today, we are heavily focused on finding staff.

We have already met some amazing candidates but anyone that runs their own business knows how difficult it is to find the right fit for their organisation.

There is so much to consider. Will they fit in with the team? Will my clients like them? How will they come across over the phone? Have they made their CV look better than it really is?

Something that has really helped me more than I ever imagined was paying an HR Consultant (Alli Hooton -3103HR) to help me re-write my Job Description so that it made more sense to the candidate. Whatsmore, the new layout made it easier to manage their KPIs (Key Performance Indicators) so they can see how they will be monitored in the role.

Health Insurance is a topic that most people dont plan to go into from School. Like many people in Financial Services, we fall into the role, hopefully having had a great but perhaps non-vocational, education!

I dont often ask for a new recruit to have experience in the subject as I can train anybody, given enough time.

Ah, there is the catch! Enough time? There is not enough time. Are there any Managing Directors out there that feel they do have enough time I wonder?

Advice – a prescription for PMI’s ills

August 10th, 2011

Employees are starting to get disillusioned with PMI. But quality advice can solve many of their problems says Debbie Kleiner-Gaines, AMII executive committee treasurer and MD of Best Health UK

 

These days more and more employees rate private medical insurance (PMI) as one of their most valued employee benefits. A prompt return to work coupled with minimum disruption makes PMI a good choice for the employer as well.

But whilst employees might be grateful for PMI, a Mercer report in November 2010 highlighted that they still lack understanding generally about their benefit rewards and are unsatisfied with the communication they receive about them.

I have experienced such dissatisfaction amongst some employees who have seen their PMI premiums increase due to high claims from their colleagues. I recently took over a scheme referred by a general insurance broker that had been serviced by them for eight years. The client offered PMI to 20 management level staff but two employees’ dependants had very high claims for cancer. At renewal, the scheme premiums increased by 50 per cent and then again by the same amount the next year.

The employer was unable to leave the existing insurer due to the two dependants’ continuation of cover. This resulted in the employees becoming disillusioned with the cover and questioning whether it was worth the 40 per cent tax they were paying on the very high premiums.

Eventually 18 employees left the scheme leaving just the two high claiming members on cover.

The general insurance broker concerned had suggested setting up a second scheme, leaving the two high claimers with their existing high cost insurer. Most insurers frown upon this practice and a statement from Aviva in the subject reads: “This is not a practice that we condone.

However, if this situation did happen, as the remaining members would be experience-rated they would incur appropriate increases at renewal to cover the risk the scheme presents with the reduced membership”.

Many intermediaries use this “splitting” approach as standard practice. But most group administrators don’t like the idea of running two schemes.

“Many issues where employees are disillusioned can be resolved if the scheme is looked after by a specialist medical insurance intermediary”

And here’s another example of dissatisfaction relating to additional costs due to tax. PMI is the second largest benefit in kind by value.
Company-paid PMI is taxed in three ways insurance premium tax, employer’s class 1A National Insurance and a benefit-in-kind P11D charge on the employee at their marginal rate of tax. A professional dancer requiring hip surgery for an injury sustained during a performance will have no tax charge, whereas a sales director who is off work for several weeks with an injury sustained during a dance class would result in a tax charge if her employer pays for private treatment to get her back sooner. For some types of treatment this could result in a P11D tax bill for the employee of many thousands of pounds.

Recently I’ve taken over a few schemes from a non-specialist broker where the client had no understanding of how claims would affect their premiums at renewal. They had also made some odd decisions about having an excess, where the employee pays it and claims it back from the company. There are tax implications on that rebated excess that employees would not be happy about.

Some employers seem to be changing their thinking in relation to PMI as a benefit. Some are looking at cash plans as an option to run in tandem with an inpatient only PMI scheme. But this can be complicated and would therefore require input from a specialist. So, what are the solutions to this dissatisfaction? How do we keep the SME PMI market buoyant while faced with these sorts of issues?

Luckily, many issues where employees are disillusioned can be resolved if the scheme is looked after by a specialist medical insurance intermediary. They would usually offer to present the scheme to staff at each renewal, bringing in the insurer to summarise the cover while the specialist intermediary and insurer would together explain the scheme in laymans terms.

And when it comes to tax, although most intermediaries will not formally answer tax questions relating to PMI and will always refer their client to their accountant, they are well versed in the tax implications of offering PMI to employees. But advice such as whether to offer an excess on a policy should be taken, especially if an employer is considering refunding this to staff.

Clients, whether small employers or HR directors in larger firms face many challenges in providing for staff and keeping the business going. Rising premiums that they don’t understand that can be avoided are irritants they don’t need. Areas like these are where specialists can add real value.

Cancer rate in middle age rises 20%

August 3rd, 2011

Prostate cancer increases sixfold

The cancer rate in middle-aged men and women has increased by almost 20 per cent in a generation, according to new figures released today by Cancer Research UK.

Among women in their forties and fifties cancer rates have risen by more than 25 per cent.

In 1979 44,000 people, aged 40-59, were diagnosed with cancer in Britain but the latest figures for 2008 show almost 61,000 people in the same age group have been struck by the disease. The cancer incidence rates in this age group have increased from 329 per 100,000 to 388 per 100,000.

The increase can partly be explained by the fact that more cancers are being detected by the NHS breast screening programme and the PSA test for prostate cancer.

Prostate cancer is the fastest rising cancer in middle-aged men, with rates increasing sixfold from 7.7 per 100,000 40-59 year old men in 1979 to 51.0 per 100,000 in 2008. However, lung cancer rates in men have fallen by about 60% in the same period, due to a reduction in smoking.

Breast cancer rates in middle-aged women have increased by around 60 per cent since the late 70s. This is partly due to the introduction of a national screening programme but also due to changes in women’s lifestyles, such as the use of the contraceptive pill, changes in weight and increased alcohol consumption.

Among both men and women malignant melanoma is also a fast rising cancer.

Cancer Research UK is also reporting that the number of people surviving cancer is better than even before, with figures showing that survival has doubled since the 70s to almost 50 per cent.

Cancer is the leading cause of critical illness insurance claims. Legal & General reports that the average age of a claimant is 44.

NHS ‘pays out millions’ for treatment as patients complain over 18 week failings

August 3rd, 2011

More get private option as some PCTs struggle with target

Patients who did not receive treatment within 18 weeks of GP referral have been treated in the private sector at a cost of millions to the health service, it has been claimed.

Research published today suggests that NHS managers have paid nearly £40m to private firms to treat patients on waiting lists after they made formal complaints under the health service constitution.

The amount is on top of hundreds of millions already paid to private healthcare companies by the NHS as part of formal waiting list clearance initiatives.

Pulse, the trade journal for GPs, said that if its research from 55 primary care trusts is extrapolated across England, it would mean that around £100m will have been paid out for private treatment as a result of patient complaints.

Figures published last month show that across the country 90.5% of patients are seen within 18 weeks, down from 92.1% this time last year.

Pulse said that the situation leaves GPs with an “ethical and legal dilemma” as they take over responsibility for commissioning care, with clinical decisions over access to treatments complicated by the potential for challenges under the constitution.

The Department of Health told Pulse: “Under the NHS Constitution, patients have a legal right to receive their first treatment within 18 weeks of referral, whether delivered by usual NHS providers or the independent sector.”

Analysis: Cash plans – are voluntary schemes worth the effort?

August 3rd, 2011

The commission conundrum explained

As budget-conscious employers look to trim their healthcare costs, some are looking to voluntary cash plan schemes as an alternative. But what does this mean for intermediaries’ income? Sam Barrett reports

Cash plans are becoming a standard part of an adviser’s armoury, enabling employers to offer a low cost, high value benefit. But while all the adviser attention is on the company-paid plans, some of the providers believe that advisers are missing an opportunity by ignoring the voluntary market.

“Advisers often do the difficult bits and then leave the voluntary benefits on the table for someone else to pick up and grow a relationship with their client,” says Brian Hall, sales and marketing director at BHSF. “But there are some large schemes out there, generating significant earnings for their advisers.”

In addition to preventing others from getting a foot in the door, recommending a voluntary cash plan can be a stepping stone to a company-paid scheme.

“We do find that some employers will put a voluntary cash plan in to gauge how much employees value it and, if take-up is good, they’ll switch to a company-paid scheme. We’ve won lots of business this way,” explains Lara Rendell, marketing manager at Health Shield.

Helping to drive this is the fact that cash plans are a highly visible benefit. Employees claim at least once a year, especially when it’s a benefit they pay for themselves. This can help to raise the profile of the benefits package generally as well as of the cash plan.

Commission conundrum

But, while the cash plan providers are keen to promote the merits of recommending voluntary schemes, there is a key reason behind advisers’ reluctance to explore this area – money.

Commission is not as chunky as it is on a company-paid scheme. For example while Health Shield pays 10% initial and 10% renewal on its company-paid business, voluntary scheme commission drops to 10% initial and 2.5% renewal.

With other providers the remuneration is even more meagre. Howard Hughes, head of employer marketing at Simplyhealth, says there is so little margin in a voluntary cash plan, an adviser can only really expect a one-off payment for introducing the business.

“We might be able to offer more generous commission, say 10% initial and 10% renewal, if it was an SME scheme and the adviser did all the legwork with the client. But this is purely hypothetical as we don’t get advisers bringing this sort of business to us,” he explains.

To put even more of a dampener on voluntary schemes, there is no guarantee of getting the volume of sales with a voluntary scheme. Take-up varies according to the sector and the range of employee benefits that are also in place as well as how the cash plan is positioned and how much it’s promoted.

Mike Blake, compliance director at PMI Health Group, the national advisory firm, does not believe voluntary schemes offer sufficient appeal to advisers.

“You have to really push to get employees to take them out,” he says. “I’ve seen plenty of voluntary schemes where only six or seven employees out of several thousand take them out. They can be virtually invisible. If a client asks about a voluntary cash plan I’ll put them in touch with a cash plan provider and leave it at that.”

BHSF’s Hall, however, says that where a voluntary scheme is managed well the take-up can be significant, with the broker benefitting from the commission this generates. As an example he points to a scheme that was set up by employee benefits specialists Team Rewards for nationwide cash and carry company Batleys. This saw more than 300 employees sign up for its voluntary cash plan.

Richard Rankin, managing director of Team Rewards, says he often puts voluntary cash plans in place that get as much as 25% to 30% take-up.

“If you only put details in the brochure or on the intranet you’ll get less than 1% of employees taking it up but if you work with a cash plan provider that’s proactive with communications you can get significant uptake,” he says. “We’re a fee-based business so the commission is immaterial. Instead we recommend voluntary cash plans because they add value to the employee benefits proposition and help to build the relationship with the client.”

Simple to implement

And while the financial reward may be meagre, implementing a voluntary scheme can require very little work from the adviser. Once notified of a company’s desire to introduce a voluntary scheme, cash plan providers will take over and run the account management and communications programmes.

“We’ll go in and run the worksite marketing, visiting the different sites and speaking to employees about the plan. We’ll also provide copy for the intranet as well as other marketing literature to help increase take-up,” says Health Shield’s Rendell.

Because cash plan providers will be looking for volume, companies need to be fairly large when it comes to voluntary schemes. Although some providers will entertain smaller companies, Paul Shires, executive director, sales and marketing at Westfield Health, says a company needs at least 1000 employees to make a voluntary plan viable.

“In theory we don’t have a minimum but the margins are so small we do need volume to justify the work involved,” he explains.

Additionally, because the cash plan provider does all the legwork, the choice of provider is important. Hall recommends looking for a provider with national sales force coverage as this can make it easier to service a client, especially those that have sites around the country.

There is also some debate around the best way to get employees to sign up to voluntary schemes, with some providers siding with payroll deduction while others prefer direct debit with the employee. For instance while Shires recommends promoting direct debit so terms can be continued even if the employee leaves the company, Hall says payroll deduction is the better option.

“Only a handful of our 2,800 client organisations use employee direct debit. Payroll deduction is essential for employee buy-in,” says Hall.

Some commentators, however, do not even think advisers should bother with arguments over how to set up payment.

“The voluntary cash plan market is a tough area for advisers,” says Hughes. “Advisers would be better focusing on company-paid schemes. It’s a growing market and it offers many more opportunities for advisers.”

Businesses braced for rise in employee healthcare costs as NHS reforms bite

August 3rd, 2011

Half of employers believe they will need to shoulder more of the healthcare burden

Senior HR and finance professionals in the UK’s largest businesses expect reforms to the NHS to hit their corporate balance sheets dearly, according to research published this week.

Almost half (47%) of respondents to a study carried out by London South Bank University predict an increase in per-employee health benefit costs resulting from government health reforms. Just 4% think the reforms will result in a decrease.

The survey, sponsored by health solutions company vielife, also shows that there is confusion over employers’ expected responsibilities. There is also too much focus on cutting public spending rather than improving public health, according to 30% of survey respondents.

More than half of respondents (58%) believe UK employers are already bearing much of the economic burden of ill health costs, chronic disease and incapacity and 49% think many of the UK workforce’s health problems are attributable to generally worsening public health.

Professor Nicola Crichton of London South Bank University’s Institute of Primary Care & Public Health said that while “prevention is more effective than cure” in the pursuit of lower health spending, improving public attitudes to wellbeing to reduce pressure on the public health purse requires a “committed, single minded and consistent” approach across public services, the private sector and workplaces.

100 telephone interviews were conducted with 50 HR and 50 finance senior decision makers in UK public and private sector organisations with over 1,000 employees during April 2011.

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