HTI could develop 'new market' between cash plans and PMI, provider claims
Westfield Health has developed a new community-rated product for companies of five employees and more which it claims will open up a new market in the middle ground between cash plans and traditional private medical insurance (PMI).
"Hospital Treatment Insurance", being rolled out to intermediaries and their clients from next week, will give employees access to more than 1,300 surgical and medical procedures for a fixed cost of £16 per scheme member, Westfield said.
However, in a bid to offer employers more affordable hospital treatment cover than tradition PMI, cancer and heart conditions are excluded.
Westfield Health chief executive Jill Davies and Paul Shires, executive director – sales and marketing (pictured), told Health Insurance today that the NHS provides “excellent” care for life-threatening illnesses such as heart and cancer conditions.
But they added that as public spending cuts continue to bite and health service reforms kick in, gaps will emerge in NHS-funded access to non-urgent elective treatments.
With Westfield’s Hospital Treatment Insurance, following referral from a consultant, employees are allocated a case manager who will source and arrange a private treatment package to suit their needs. There is no hospital network and employees can choose to go to any hospital, Shires said, adding that while benefit limits may fall short of covering treatment – in central London hospitals for example – employees can “top up” the difference in the “rare” instances when that happens.
He added: “There is no excess to pay when a claim is made and premiums are community-rated, so everyone pays the same price regardless of age or location. No medical is required and a cash benefit is available if an employee receives NHS treatment.”
While the product will not provide cover for private consultations, it can be used “seamlessly” with the provider’s cash plan offering which does provide refunds for them, Shires said. Equally, the purpose of the product is to provide employees with fast access to hospital treatment after their condition has been diagnosed by an NHS-funded consultant, he added.
However, Shires and Davies stressed that while the product could be implemented as a cheaper option than traditional PMI for cash-strapped employers looking to downgrade, its primary aim is to develop a brand new market.
Westfield has been providing hospital treatment cover since it launched its Surgery Choices product, which funds the cost of 60 non-urgent surgical procedures, in 2007. Its acquisition of hospital treatment plan provider PatientChoice in 2011, which had administered Surgery Choices since its launch, had given it the underwriting and claims management capabilities in order to be able to roll out the new product, Shires said.
The majority of cash plan providers focus primarily on the traditional features of the product such as refunds for optical and dental care, although some offer low level "hospital benefits".
Bupa, meanwhile, currently offers a cash plan/PMI hybrid product called Patient Cash which gives employees cash back for up to 20 nights hospital inpatient stays and up to four days hospital day patient surgery, as well as refunds for consultations, diagnostic scans and therapies such as physiotherapy and osteopathy.
Look out for an analysis, including intermediary reaction, plus a product review in forthcoming issues of Health Insurance.