As an FCA-authorised expert that has helped arrange over 750,000 policies, WeCovr understands that offering private medical insurance in the UK is a powerful tool for businesses. This guide provides HR leaders with everything they need to know about choosing, implementing, and managing a corporate PMI scheme that truly benefits their team.
WeCovr's HR-focused guide to implementing PMI for employees
In today's competitive job market, a compelling benefits package is no longer a 'nice-to-have'—it's a business essential. At the heart of the most attractive packages lies Corporate Private Medical Insurance (PMI).
For Human Resources professionals, implementing a PMI scheme can feel like a daunting task, filled with complex jargon, budget considerations, and employee expectations. This comprehensive guide is designed to demystify the process. We'll walk you through every step, from building a business case to launching your scheme and beyond, ensuring you can make an informed decision that boosts employee wellbeing and drives business success.
What is Corporate Private Medical Insurance (PMI)?
In simple terms, Corporate Private Medical Insurance is a policy taken out by a business to provide its employees with access to private healthcare. It's designed to work alongside the NHS, offering quicker access to diagnosis and treatment for specific types of medical conditions.
Think of it as a way to bypass potential NHS waiting lists for eligible treatments, giving your team members prompt access to specialists, diagnostic scans, and high-quality private hospital facilities.
A crucial point to understand from the outset: Standard UK private medical insurance is designed to cover acute conditions.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include joint replacements, cataract surgery, or hernia repairs.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, is incurable, or is likely to come back. PMI does not typically cover the ongoing management of chronic conditions like diabetes, asthma, or high blood pressure.
- Pre-existing Condition: An ailment or injury for which an employee has experienced symptoms or received medical advice on before the policy starts. These are also generally excluded, though the specifics depend on the type of underwriting chosen.
Why Should Your UK Business Offer Private Health Insurance? The Key Benefits
Investing in PMI is an investment in your people and, by extension, your organisation's future. The return on this investment is seen in recruitment, retention, productivity, and overall company culture.
Benefits for the Business
- Attract and Retain Top Talent: In a candidate-driven market, a strong benefits package is a key differentiator. PMI is consistently ranked as one of the most desired employee benefits in the UK.
- Reduce Sickness Absence: Long waits for diagnosis and treatment can keep valuable employees out of work. According to the Office for National Statistics (ONS), an estimated 185.6 million working days were lost because of sickness or injury in the UK in 2022. PMI can significantly shorten this downtime.
- Boost Productivity and Morale: Employees who feel cared for are more engaged and motivated. Knowing they have fast access to healthcare reduces stress and anxiety, allowing them to focus on their work. This also combats 'presenteeism'—where employees are physically at work but mentally checked out due to health worries.
- Demonstrate a Strong Duty of Care: Offering PMI sends a powerful message that you value your employees' health and wellbeing beyond their professional contribution.
Benefits for the Employee
- Fast-Tracked Medical Care: This is the primary benefit. Employees can bypass long NHS waiting lists for consultations, scans (like MRI and CT), and non-urgent surgeries. As of early 2025, NHS waiting lists in England remain a significant concern, with millions waiting for routine treatment.
- Choice and Control: Employees often get to choose the specialist who treats them and the hospital where they receive care from a pre-approved list.
- Access to Specialist Drugs and Treatments: Some advanced drugs, therapies, or surgical techniques may not be available on the NHS due to cost or other guidelines. PMI can provide access to these.
- Comfort and Privacy: Treatment is delivered in a private hospital, which usually means a private room with an en-suite bathroom, more flexible visiting hours, and a quieter environment for recovery.
- Enhanced Mental Health Support: Most modern PMI policies include dedicated mental health pathways, providing access to counsellors, therapists, and psychiatrists far quicker than is often possible through public services.
Understanding the Core Components of a Corporate PMI Policy
When you build a corporate health insurance plan, you are essentially choosing a bundle of different cover elements. Understanding these components is key to designing a scheme that fits your budget and your employees' needs.
Policy Component | What It Typically Covers | Key Consideration for HR |
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In-patient & Day-patient Cover | Costs for surgery and treatment requiring a hospital bed, either overnight (in-patient) or for the day (day-patient). This includes surgeon fees, anaesthetist fees, and hospital charges. | This is the foundation of every PMI policy. All plans include this as standard. |
Out-patient Cover | Consultations with specialists and diagnostic tests (like blood tests, X-rays, MRI/CT scans) that do not require a hospital bed. | This is a major variable. You can choose a nil limit, a set monetary limit (e.g., £500, £1,000, or £1,500), or full cover. A higher limit means a higher premium. |
Cancer Cover | A comprehensive range of treatments including surgery, chemotherapy, radiotherapy, and biological therapies. It can also include aftercare support. | This is a critical and highly valued component. Most policies offer extensive cancer cover as standard, but it's vital to check the specifics. |
Mental Health Cover | Access to psychiatrists, psychologists, and therapists for conditions like anxiety, depression, and stress. | Hugely important for modern workforce wellbeing. Cover can range from limited counselling sessions to full psychiatric in-patient care. |
Therapies Cover | Physiotherapy, osteopathy, and chiropractic treatment for musculoskeletal issues. | Often included up to a certain number of sessions. Essential for tackling common causes of absence like back and neck pain. |
Optional Add-Ons to Enhance Your Scheme
Beyond the core components, you can add extra layers of protection to create a more comprehensive benefits package:
- Dental and Optical Cover: Contributes towards the costs of routine check-ups, dental treatments, glasses, and contact lenses.
- Travel Insurance: Provides worldwide medical cover for employees, often including their families, for both business and leisure trips.
- Wellness and Reward Programmes: Some providers, like Vitality, build their entire proposition around rewarding healthy behaviour with discounts on gym memberships, fitness trackers, and healthy food.
As a WeCovr client, your employees also gain complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, helping them build healthy habits. Furthermore, purchasing PMI through us can unlock discounts on other essential policies like life insurance.
Key Exclusions: What Isn't Covered by Corporate PMI?
Managing employee expectations is crucial for the success of your PMI scheme. Being transparent about what is not covered is as important as highlighting the benefits.
The most significant exclusions on any standard UK policy are:
- Pre-existing Conditions: Any medical condition for which an individual has sought advice, had symptoms, or received treatment for in the years leading up to the policy start date (typically 5 years).
- Chronic Conditions: Long-term illnesses that cannot be cured, such as diabetes, asthma, epilepsy, and high blood pressure. PMI is for acute, curable conditions. The NHS will continue to manage all chronic care.
- Emergency and A&E Visits: The NHS is unmatched for emergency care. If an employee has a heart attack, a stroke, or is in a serious accident, they should call 999 and go to an NHS A&E.
- Normal Pregnancy and Childbirth: Routine maternity care is provided by the NHS. PMI may, however, cover complications that arise during pregnancy.
- Cosmetic Surgery: Procedures that are not medically necessary.
- Self-inflicted Injuries: This includes issues arising from substance abuse.
The Step-by-Step HR Guide to Implementing a PMI Scheme
Follow these six steps to ensure a smooth and successful implementation.
Step 1: Define Your Objectives and Budget
First, ask why you are introducing PMI. Are you trying to:
- Gain a competitive edge in recruitment?
- Reduce sickness absence rates?
- Improve overall employee morale and wellbeing?
Your objectives will shape the type of scheme you design. Next, establish a realistic budget. The cost is typically calculated on a 'per employee, per month' basis. Decide on a budget you're comfortable with, but be prepared for it to be flexible as you explore your options.
Step 2: Decide Who to Cover
You have several options:
- All Employees: The most inclusive approach, fostering a great company culture.
- Management or Director Level Only: A more traditional approach, often used as a senior-level perk.
- Based on Length of Service: For example, employees become eligible after passing their probation or completing one year of service.
Remember, corporate PMI is considered a 'Benefit in Kind', which means it is a taxable benefit. The value of the premium paid by the company is subject to income tax for the employee, and the company must pay Class 1A National Insurance contributions on the benefit's value. You will need to report this on a P11D form for each covered employee each year.
Step 3: Choose the Right Level of Cover
This is where you balance your budget against your objectives. A typical tiered approach looks like this:
Level of Cover | Description | Best For |
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Basic | Covers in-patient and day-patient treatment only. Limited or no out-patient cover. | Businesses on a tight budget who want to provide a core safety net against major medical events. |
Mid-Range | Core cover plus a limited amount of out-patient cover (e.g., £1,000). May include some therapies. | The most popular option, balancing comprehensive cover with manageable costs. Speeds up diagnosis and treatment. |
Comprehensive | Full in-patient and out-patient cover, extensive cancer care, mental health support, and therapies. | Companies wanting to offer a top-tier benefit to attract senior talent or operate in highly competitive sectors. |
Step 4: Understand Underwriting Options
Underwriting is how an insurer assesses risk and decides on the terms of the policy, particularly concerning pre-existing conditions. For group schemes, there are three main types.
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Moratorium (Mori) Underwriting:
- How it works: No medical questionnaire is needed upfront. Instead, the insurer automatically excludes treatment for any medical condition that existed in the 5 years before the policy start date. This exclusion is lifted if the employee then goes 2 continuous years on the policy without needing treatment, advice, or medication for that condition.
- Best for: Small businesses (2-20 employees) who want a quick and simple setup.
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Full Medical Underwriting (FMU):
- How it works: Each employee completes a detailed medical history questionnaire. The insurer then reviews this and may place specific, permanent exclusions on the policy for any pre-existing conditions declared.
- Best for: When you want absolute certainty from day one about what is and isn't covered. Can sometimes result in lower premiums if the group is very healthy.
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Medical History Disregarded (MHD):
- How it works: This is the most comprehensive and sought-after type of underwriting. The insurer agrees to cover eligible acute conditions, regardless of an employee's prior medical history. Pre-existing conditions are covered (as long as they are not chronic).
- Best for: Larger businesses (typically 20+ employees). It's a major selling point for attracting senior staff who may have existing conditions they want covered. This is the most expensive option.
Navigating these options can be complex. An expert broker like WeCovr can advise on the best underwriting method for your group's size and needs, ensuring there are no surprises down the line.
Step 5: Compare the Market with an Expert Broker
You could approach insurers directly, but this is time-consuming and you won't get an impartial view of the whole market. Using a specialist PMI broker offers significant advantages:
- Whole-of-Market Access: We work with all the leading UK private health insurance providers.
- Expert Guidance: We translate the jargon and help you compare policies on a like-for-like basis.
- Time-Saving: We handle the quotes, paperwork, and negotiations on your behalf.
- No Extra Cost: Our service is free to you; we are paid a commission by the insurer you choose.
Based on high customer satisfaction ratings, our clients value our ability to find the optimal balance between cost and coverage.
Step 6: Launch and Communicate the Scheme to Employees
A successful launch is all about clear communication.
- Provide Clear Documents: Give every employee a membership pack with their policy documents and a simple summary of benefits.
- Run Information Sessions: Host a presentation (or webinar) to explain how the scheme works, what's covered, and how to make a claim. Answering questions directly builds confidence.
- Explain the Claims Process: Ensure everyone knows the first step is usually to see their NHS GP to get a referral to a specialist. They then call the insurer to get the claim authorised before booking any treatment.
How Much Does Corporate Health Insurance Cost in the UK?
The cost of a corporate PMI scheme is highly variable. The premium is affected by a range of factors.
Key Factors Influencing Your Premium:
- Average Age of Employees: Premiums increase with age.
- Location: Cover is typically more expensive in Central London due to higher hospital costs.
- Level of Cover: Comprehensive plans cost more than basic ones. The out-patient limit is a key cost driver.
- Policy Excess: This is a small amount an employee pays towards their first claim each year (e.g., £100). A higher excess lowers the overall premium.
- Industry: Some manual or higher-risk professions may attract higher premiums.
- Underwriting: Medical History Disregarded is the most premium option.
Here are some illustrative monthly costs per employee for a mid-range policy. These are for guidance only.
Employee Age | Location (Outside London) | Location (Central London) |
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25 | £30 - £45 | £40 - £60 |
40 | £45 - £65 | £60 - £85 |
55 | £70 - £100 | £95 - £130 |
Managing Your Company Health Insurance Scheme Post-Launch
Your role doesn't end after the launch. Good scheme management ensures you continue to get value from your investment.
- Annual Renewal: Don't just auto-renew. Your claims history, changes in employee demographics, and market shifts will affect your renewal price. A broker like WeCovr will conduct a full market review for you each year to ensure your premium remains competitive and your cover remains appropriate.
- Scheme Administration: Have a clear process for adding new starters and removing leavers from the policy to ensure your cover and costs are always accurate.
- Promote the Benefits: Regularly remind employees about the 'value-added' benefits included in their cover, such as virtual GP services, wellness apps, and mental health support lines. Higher engagement demonstrates the value of the scheme.
Going Beyond PMI: A Holistic Employee Wellbeing Strategy
While PMI is a cornerstone, a truly effective wellbeing strategy is multifaceted. Consider how PMI can be integrated with other initiatives to create a culture of health:
- Employee Assistance Programmes (EAPs): Offer confidential advice on a wide range of life issues, from financial worries to legal queries.
- Wellness Workshops: Host sessions on nutrition, sleep hygiene, stress management, and mindfulness.
- Flexible Working: Allowing for a better work-life balance is fundamental to reducing stress.
- Health Screenings: Offer on-site or subsidised health checks to help employees proactively manage their health.
By combining these elements, you show a deep-seated commitment to your team's overall wellbeing, making your company an employer of choice.
Is corporate health insurance a taxable benefit for UK employees?
Yes, it is. When a company pays for an employee's private medical insurance, it is considered a 'Benefit in Kind' by HMRC. This means the employee must pay income tax on the value of the premium. The company is also liable for Class 1A National Insurance contributions on the premium amount and must report the benefit on a P11D form for each employee.
Does company private medical insurance cover pre-existing conditions?
Generally, standard UK PMI does not cover pre-existing conditions. However, the approach depends on the underwriting type. On a 'Moratorium' scheme, conditions from the last 5 years are excluded for the first 2 years. On larger schemes with 'Medical History Disregarded' (MHD) underwriting, pre-existing conditions can be covered for new acute episodes. It is crucial to clarify this with your broker.
What is the difference between private health insurance and a health cash plan?
Private health insurance (PMI) is designed to cover the high costs of private diagnosis and treatment for acute medical conditions, such as surgery or cancer treatment. A health cash plan, on the other hand, helps employees cover everyday routine healthcare costs. It provides cashback up to an annual limit for things like dental check-ups, eye tests, prescriptions, and physiotherapy sessions. They are complementary products, not replacements for each other.
Can we cover employees' families on our company PMI scheme?
Yes, most corporate PMI schemes allow you to add cover for employees' family members (partners and children). You can decide whether the company pays for this additional cover or if the employee pays for it themselves, often at a favourable corporate rate. This can be a highly attractive benefit for employees with families.
Ready to Invest in Your Team's Health?
Implementing a corporate health insurance scheme is one of the most impactful investments you can make in your people and your business. It enhances your employer brand, supports your team when they need it most, and helps build a resilient, productive workforce.
The journey starts with a conversation.
Contact the WeCovr team today for a free, no-obligation quote. Our friendly, expert advisors will help you navigate the market and design the perfect private health cover for your UK business.