Group private medical insurance: Workplace medical | Swoop (2024)

With the healthcare system under growing pressure and waiting lists for treatments at an all-time high, many people in the US are considering private medical insurance. However, buying this protection as an individual can be expensive and certain medical conditions may be excluded. Instead, group private medical insurance is an affordable benefit that employers can offer to their employees, covering everyone in the organisation with a blanket policy that can help staff get medical care faster than waiting. This can speed their recovery and return them to work sooner, reducing any impact on the business.

Additionally, when provided free to employees, private medical cover is a proven motivator, helping to boost staff morale, retain top workers and support recruitment strategies.

Group private medical insurance is an employee benefit provided by businesses to their workers and is currently the top-rated employee perk in the US. Often more simply known as Private Medical Insurance (PMI), group private medical insurance covers all the employees within an organisation – typically free of charge, with the business paying the premiums, but sometimes at a discounted cost to staff. Employees may also be able to enrol a spouse or partner in the plan at extra personal cost.

PMI usually means your employees will receive medical attention faster for eligible conditions. This can help them to get back on their feet sooner and reduce days lost to sickness. Additionally, when offered as part of a remuneration package, PMI can provide a powerful talent attraction and retention tool – reducing your recruitment costs and lowering workforce attrition.

Why should you buy group private medical insurance for your employees?

• Affordable and tax-deductible benefit to the employer (employees who select the cover will pay personal income tax on the benefit)
• Can reduce days lost to sickness and get your workers back to work faster
• Boosts company morale – PMI is the US’ most desired employee benefit
• Supports your duty of care
• Supports a strong employer value proposition (EVP), helping to attract new talent and keep the employees you already have
• Can reduce recruitment costs and the loss of valuable worker experience

Group private medical insurance is meant to supplement, not fully replace the medical care. Some medical conditions will not be covered by PMI.

PMI can cover a range of costs, including physical and mental health treatments, dental care, optical appointments, physiotherapy, cancer treatment and more. Ultimately, employers choose the level of protection they want to provide for their workers, but cover is split into two main categories:

With outpatient cover

• Covers the costs of healthcare where a patient doesn’t need a hospital bed, for example diagnostic tests and scans
• Also covers costs where a patient needs a hospital bed overnight, for example post-surgery, plus day-patient treatment, where a patient needs a bed just for the day

Without outpatient cover

• Only covers costs where a patient needs a hospital bed overnight and where a patient needs a bed just for the day

Within the limits of these main categories, plans will typically cover:

• Acute conditions – short-term illnesses or injuries that respond quickly to treatment which leads to a full recovery
• Hospital charges and specialist fees – such as radiographers, surgeons and consultants
• Treatment for exoskeletal conditions – back, neck, muscle disorders
• Cancer cover – including chemotherapy, radiotherapy
• Diagnostic services – such as x-rays, MRI, ECGs, CT-scans and more

Digital GP services

Many group private medical insurance plans offer a digital GP service. This provides phone or video GP appointments (usually 24/7) at short notice. This service means employees do not need to wait for an appointment, they can discuss their medical conditions with a doctor outside of usual office hours, resulting in fewer days off work, or employees having to use unpaid leave to see their doctor.

Exact cover will be determined by the policy you select, but standard PMI exclusions include:

• Chronic conditions – this means long-term or incurable diseases such as diabetes, asthma or epilepsy. Cancer is not considered a chronic illness with most PMI policies
• Cosmetic procedures – plans will usually only cover cosmetic procedures that are deemed essential and immediately follow an accident or cancer treatment
• Addictions or substance abuse – this includes alcohol, drugs or substance addictions or misuse, and the treatment of any illnesses they may cause
• Pregnancy and childbirth – although some related conditions may be covered
• Emergency care – such as triage following an accident
• Kidney dialysis – this is considered a chronic condition
• HIV/AIDS – also deemed as chronic conditions
• Fertility treatment/IVF – relates to pregnancy and childbirth

Just as no businesses are the same, so no group private medical insurance policies are the same. The premium you pay will be determined by a number of factors unique to your organisation, including the type of business you run, the number of insured employees, the age of each insured employee, your location and the level of cover you choose to buy.

Because every organisation will need a policy that’s customised to fit their operation it makes sense to compare different offerings from different insurers before making any purchase. You can start the process here.