Most medical insurance excludes chronic conditions but employees need educating about this.
Providing group private medical insurance, which offers the ability for employees to jump the NHS queue and often also to enjoy the comfort of a private room, can offer very real benefits for employers.
As well as boosting morale and aiding recruitment and retention by making available a benefit with a very high perceived value, they can significantly slash absenteeism and presenteeism costs.
Instead of employees having to take time off work or struggle on in severe discomfort whilst they wait for months to be seen by the NHS, they can elect to receive treatment at a time convenient to them and their workloads. They may even be able to work remotely from their hospital room whilst recovering from an operation.
This all has major implications not only for the individuals who are unwell but also for their work colleagues, who are spared from being landed with extra work from an absentee or from having to share an office with a grumpy individual in constant pain.
What are chronic conditions?
But one major drawback of private medical insurance is that it has traditionally excluded so-called ‘chronic conditions’, which are essentially illnesses or injuries that need to be treated indefinitely or for the very long-term.
These can range from diabetes, heart disease and asthma to multiple sclerosis and musculoskeletal conditions like back pain or tennis elbow.
The chronic illness exclusion
This exclusion should not be seen as some sort of sly trick by insurers but as a commercial necessity to keep premiums affordable. If everyone was allowed to receive years of treatment for chronic conditions then the costs of private medical insurance would be out of reach to many employees.
The Office for National Statistics show that people who report having a long-term chronic condition have the highest sickness absence rate across all groups. 1* So, the situation can prove quite a headache for insurers.
BUPA Chronic Cover
However, the good news is that in January 2020 Bupa is going against the grain by introducing two new levels of chronic cover to support people living and working with chronic conditions like diabetes, heart problems or certain muscle, bone and joint complaints.
Bupa Chronic Cover opens up fast access to clinical resources such as out-patient consultations, minor diagnostics and therapies (up to an agreed benefit limit), with support when needed, even for emotional wellbeing. Bupa Chronic Cover Plus goes even further, providing an enhanced level of support for those with cardiac and musculoskeletal conditions.
This development is certainly welcome and gives us an additional option to consider for clients who are experiencing particular problems with employees with chronic conditions. But the fact that it involves an extra cost does mean that it will not be suitable for everyone.
Nevertheless, the publicity surrounding this launch has, in our opinion, still been immensely valuable even to employers who can’t afford these enhanced covers, simply by highlighting the standard exclusion.
Employee education on chronic cover
We are always coming across clients who appear to have no idea that chronic conditions aren’t covered by their scheme, and it stands to reason that most of their employees will therefore have no idea either.
This could result in real problems at the claims stage as employees wanting treatment for chronic conditions could feel that they have somehow been misled. So, even if employers can’t afford the new Bupa covers, indulging in a little expectation management is likely to prove a valuable exercise.
They should analyse the precise terms and conditions of their scheme and spell out to employees exactly what is and isn’t covered. Most schemes will cover conditions initially for diagnosis and treatment but once they reach the point of being diagnosed as chronic, the cover will stop.
Employees should, however, still be covered for any ‘acute’ (non-chronic) conditions they may develop or for new treatment options that may become available for their chronic condition. They should also continue to be covered for cancer in the later stages – even though it could in many ways be considered a chronic condition. 2*