Private Medical Insurance: Employee vs Dependant Claims

We are all aware that private medical insurance costs are rising significantly and that many employers are questioning the sustainability of providing cover to their employees.

You may have even seen my previous blogs on effective triaging to utilise wider health benefits such as income protection and the NHS, as well as the merits of trust based cover over conventional fully insured private medical insurance. Recently a new issue which affects many companies has become apparent and one that we believe we have found an innovative solution for - employee vs dependant claims.

Employers tend to offer private medical insurance because they want their employees treated and returned to work quickly, however many employers also offer treatment for dependants of those employees under the same insurance plan. This is problematic where dependants claims outweigh those of the employee especially where the employer pays the premium for the employee and the employee pays the premium for their dependants. In this scenario (which is surprisingly common) the premium paid by the employer is being negatively affected by the claims made by the dependants. This is probably not a desired outcome when the employers primary concern is that of the employee’s health and not their dependants.

A simple solution involves splitting the claims funds between employee and dependant so that the employee claims affect the employee premium (paid by the employer) and the dependant claims affect the dependant premium (paid by the employee). Unfortunately this is not possible through the conventional private medical insurance market and instead this innovation again sits with us working closely with the trust market.

This blog post was written by Carl Chapman. For further enquiries please contact Damian Stancombe, Head of Workplace Health and Wealth.

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