Analysis: Healthcare trusts - unusual benefits

From sex changes to IVF - we explore some of the more unusual treatments on offer in some schemes

While private medical insurance policies typically do not cover conditions not classed as illnesses, healthcare trusts can be used to pay for anything from IVF to the harvesting of stem cells. Emily Borkowska investigates.

IVF and sex change are not the first things that spring to mind when thinking about healthcare benefits, but employers are using self-funded schemes to cover these more unusual treatments.

Traditional private medical insurance (PMI) excludes these benefits because they are not classed as illnesses, but self-funded healthcare schemes are extremely flexible and allow employers to include whatever treatments and services they want.

"A company can put anything they like in a healthcare trust," says Alan Grinnell, managing director of trust administrator New Vision Healthcare. "As long as the benefits are to do with health, the company can have a tailormade package based on their own specific needs."

Sex change operation is the least common benefit covered by trusts. Of the providers that Health Insurance spoke to, only Simplyhealth had a client who had included it in their trust deed.

"I don’t know what the rationale for including sex change operations was, but the company paid for three of them," says Howard Hughes, Simplyhealth’s sales and marketing director.


Several companies include IVF in their healthcare schemes, enabling employees to have treatment up to a financial limit of, say, £10,000 in any one year. This differs from PMI, which may cover the cost of diagnosing a fertility problem but not the cost of treating it. Unusually, Simplyhealth had a client who set up a trust scheme for IVF alone.

"They may have had traditional PMI as well, but felt that IVF treatment was particularly important to them," says Hughes.

Including IVF treatment is not always straightforward. Naomi Saragoussi, principal at Mercer, says both partners need to be members of the trust for the full investigation and treatment to be covered. Similar benefits covered by healthcare trusts include pregnancy and childbirth. Traditional PMI covers a pre-defined list of maternity-related complications, but some employers choose to mirror international PMI maternity benefits, which typically include scans, pre-natal and immediate post-natal check-ups and childbirth.

Some other trust scheme benefits not covered by a traditional PMI policy are HIV, alcoholism and addictions, dangerous sports, cosmetic treatment, dentistry, health screening and complementary therapies. Saragoussi has also seen pharmaceutical companies including their own drugs in their scheme and she had one client who provided for the harvesting of stem cells.

"The trust deed covered the harvesting of stem cells and the use of them if they were required, but it did not cover the cost of actually keeping the cells in case the person subsequently left the company," she says.

Employers sometimes use healthcare trusts to extend cover for cancer, so that employees have access to a wider range of drugs and therapies. However, Nick Reynolds, head of intermediary sales at Aviva UK Health, says the cover provided by PMI is usually sufficient.

"Given that the major insurers have all moved their position on cancer over the last 12 to 18 months and there is more choice on the extent of cover, employers don’t have to go down the trust route. Cancer cover is more readily available in the insured market," he says.

Private GP

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