Health Care Plans

Administration and Management

The healthcare benefits and rules of most private health care insurers have not really been reviewed for more than 25 years.

At HRM we design a Healthcare Plan around the needs of your business and the latest clinical developments.

Our plans are based on the latest evidence based clinical practise which means they operate in a different manner to a traditional scheme.

We do not require a patient to visit a GP to access treatment but we do guide patients to appropriate clinicians.

We also work closely with the NHS which, if used for complex medical care, can save your scheme a substantial amount of money.

However because we actively manage each and every case this is not simply about excluding private care for certain conditions but a far more sophisticated approach.

In addition because we manage each and every case your employees and their families receive close support every step of the way.

A sample of the services we provide in this area is listed below.

Third Party Claims Administration Services

This service may simply be an extension of our Case Management service or may operate as a stand alone benefit. It is designed to administer and manage private health care claims including:

Full Benefit Scheme –

e.g. similar to standard BUPA or PPP “Top of the Range” benefits.

Restricted Benefits Scheme –

e.g. similar to products offered by a variety of insurance companies including Standard Life; Pru Health; Norwich Union including: NHS pay bed schemes; inpatient only schemes; 6 week delay schemes; exclusion of high cost care (or care which is provided in reasonable timescales by the NHS) schemes; etc.

Return to Work Scheme –

designed to provide benefit to help an employee return to normal or modified duties.

Occupational Support Scheme –

designed to provide benefit to maintain a person at work; reduce occupational risks and to reduce sickness absence.

Careline Support Scheme –

specifically designed to support the Careline programmes chosen and high risk absence areas for example musculoskeletal and mental health.

We are able to offer the administration and management of healthcare schemes via a number of different legal vehicles including Offshore Captives and Medical Trusts.

Our preferred route is the Medical Trust which offers the following advantages:

An immediate reduction in Insurance Premium Tax (IPT) as the Healthcare Trust is exempt from IPT – this will save 5% off the cost of the premiums.
The ability to design the benefits and rules around the needs of business and its employees.
The reduction in the cost of insurance charges.
A reduction in administration charges if combined with Case Management
An opportunity to ensure that members of the scheme and their families are receiving advice on the latest evidence based practise and are avoiding unnecessary diagnostics and treatment which unfortunately is now not the case in the private health sector
An opportunity to manage complex cases such as cancer and cardiac via the NHS where clinically it is more appropriate to do so
A opportunity to substantially reduce claims costs, and hence the cost of the scheme, whilst improving the benefit to the members
The provision of a Case Manager to support the patient and their family through the treatment process whether NHS or private

The Healthcare Trust is very simple to set up as HRM has a standard template. This should remain valid for 8 years and meets all the necessary legal requirements.