Available from March 2021 as part of its Healthier Solutions and Solutions cover, Aviva’s Expert Select option is a guided hospital option for individuals and SMEs, following its successful introduction for corporate customers last year. Aviva says it gives access to a nationwide choice of hospitals selected based on its clinical governance framework, alongside external clinical ratings from the Care Quality Commission and Health Improvement Scotland.
When claiming by phone, a claim consultant will assess the customer's needs and provide a choice of hospitals and specialists - on average three or four. Information is provided to help the customer decide and Aviva can then book appointments directly into a consultant's diary where available, or transfer the caller to book an appointment.
Once treatment has been received, Aviva will settle eligible bills direct with the treatment provider, so guaranteeing no shortfalls on any eligible hospital or specialist charges for consultations, tests or treatment.
In other changes, while cancer cover and support is already standard on Aviva Healthier Solutions and Solutions polices, the ten year limit on follow-up monitoring consultations has now been removed, so there is no longer a time limit on such consultations where recommended by a specialist.
Cover has also been extended to include preventative bisphosphonates, which studies show can help prevent certain cancers from recurring.
Additional changes include exemption of outpatient surgical procedures from outpatient limits. Policy excess will also no longer impact selected outpatient limits and/or other financial benefits limits. Policy excess will also no longer impact routine dental and optical benefit limits claimed against. In addition, the moratorium wording in customer and employee literature has been simplified to help explain how Aviva deals with pre-existing conditions.
Aviva has partnered with providers to enhance the mental health support given to employees of its SME clients as part of Solutions cover too. Benefits include self-referral for assessment by a mental health practitioner, followed by the route to the most effective treatment, including direct escalation to a practitioner if required.
Support is included for adolescents (including dependents from the age of 12) and treatment options including online CBT as well as phone, video or face-to-face talking therapies and psychiatrist assessment. There is a network of practitioners, including clinical psychologists, CBT therapists, psychiatrists and counsellors and EMDR consultants (for PTSD).
The Mental Health Pathway is exempt from reduced outpatient limits unless the £0 outpatient limit has been selected, when there is no mental health cover.
Comment: The main feature here is the Expert Select guided (or open referral) hospital option, which should result in lower and more sustainable premiums over time. Such ‘direction’ is often thought of as restricting patient choice but, managed well, it can help guide people who don’t know what they want or need towards what they do want or need.
The other changes are useful too, so overall this is a good update, although it will not suit everyone.
Plus points: A new guided option added; Could reduce premiums and improve sustainability over time; Range of additional changes and improvements too.
Not so plus points: Some see guided options as taking away too much patient choice; Won’t suit every client; As we enter a post-Covid time, does PMI need to offer more?
Rating (max 10): Overall: 8. Gold
Tags: PMI; Aviva
I Mark: No
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