Alison Green: How to manage PMI costs

Employers can take a number of simple, targeted measures to keep the costs of offering employees a private medical insurance scheme under control.

The wide range of private medical insurance (PMI) products available means there has never been more, or better, ways of managing their cost.

There are also myriad ways employers can manage these costs, from introducing an excess, so staff pay, say, the first £200 towards their treatment, to setting an annual limit on the amount they can claim.

Employers can also limit PMI cover for specific conditions, such as mental illness or cancer. For example, an employer could stipulate that cover starts only when an employee has waited a certain period for treatment, say six weeks.

But the development of innovative PMI products means employers can save costs without reducing the level of benefit they provide. Healthcare treatment can be tailored for the right treatment at the right time. For example, employers can choose health insurance that offers treatment for psychological and musculoskeletal health.

Appropriate treatment

By intervening at an appropriate stage in the treatment process and providing the most appropriate treatment, providers can help employers and staff deal effectively with health conditions before they worsen.

Take an employee suffering with stress. Psychological health treatment can give them immediate help through access to telephone counselling. This means that instead of waiting for an appointment to see a psychologist or psychiatrist, an employee can speak to a trained counsellor quickly.

Such targeted treatment, including open referral, whereby neither a specialist nor treating hospital may be identified, may also help manage treatment costs. This can also be a better experience for employees if the open referral model includes additional services, such as booking the first appointment with a specialist or a 24/7 medical advice line.

Work closely with insurers

Employers can also control costs by working closely with their health insurer to control premiums, and ensure they are appointed a dedicated case manager for complex and expensive treatments. This can keep their premium under control. Expert case management can also mean employees get more joined-up treatment.

Employers should always scrutinise their claims management processes to ensure they are designed to contain costs, and check their record on investigating fraudulent claims. Employers should also review how they manage their suppliers: the specialists, hospitals and scanning centres in their networks. They should have robust processes to check the quality and value of services they procure.

Employee education

Finally, employers should ask their provider what it does for the health and wellbeing education of staff. Employers that work with a single provider might find opportunities to cut costs further by reducing product and service overlap. Similarly, employers working with multiple providers should implement robust processes to ensure they are working together effectively.

Benchmarking themselves against their competitors or businesses with similar employee profiles from other industries might also be a useful way for employers to establish best practice.

Every business is different, so employers should discuss their objectives with their healthcare provider, including how best to devise a communications strategy that will help their employees receive a benefit they will value.

Above all, employers must ensure their provider can offer any treatment their employees require when they require it, to help rehabilitate them as soon as possible.



  • Private medical insurance (PMI) product availability makes it easy for employers to manage costs.
  • Employers can consider limiting PMI cover for specific conditions, such as mental illness.
  • Claims management processes should help contain costs.


Alison Green is head of marketing at Axa PPP Healthcare