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Bupa Global announces removal of their general pandemic exclusion during their first digital event
Bupa Global took the opportunity to make this a global event, attended by key intermediaries from all over the world from the comfort of their own home / office. I’m getting quite used to sitting down with a cup of coffee for these, rather than jumping on a train for half a day, although I do miss the chance to catch up with a few old faces and in this case, some of my previous colleagues.

Bupa Global speakers;
- Paddy Watt, Commercial Director at Bupa Global
- Dr Paula Franklin, Chief Medical Officer at Bupa Group
- Sheldon Kenton, CEO at Bupa Global / GeoBlue
- Rebecca Kett-Young, Head of Operations at Bupa Global
This event was the start of a new series called ‘Perspectives’, aimed to increase communication with the International Health Insurance market, and will be held regularly with the next session in September.

Session 1: Exploring our new reality

COVID-19 has, and will continue, to lead to disruption in the International Health Insurance industry and Bupa Global discussed three topic areas, showcasing how they have felt this impact and how they have dealt with it.

How Bupa Global are supporting customers through the crisis

Sheldon Kenton – CEO, Bupa Global and GeoBlue
- The business stood up well to the immediate challenges created. It is a diverse organisation with many different operations and it saw the initial impact earlier than most other European headquartered businesses via its operations in in China and Hong Kong. This allowed Bupa to road test what would go on to become their global response and provided some advantages in maintaining their customer capability, allowing all 3,000 employees to work remotely while maintaining their turnaround times.
- Despite the challenges faced, the NPS (Net Promoter Score) results, by which Bupa measure customer satisfaction, have continued to rise throughout this period.
- With customers all over the world facing different access to, and capabilities of, care, Bupa worked hard to help steer members through this by creating a digital COVID-19 Hub. This is proactively supporting International Health Insurance customers with regular updates and is supported right across the Bupa Group.
- Another response was to give every customer access to Global Virtual Care and they extended mental health benefits across all customers.
- Between January and May Bupa Global’s Virtual Doctor service saw a 49% month on month registration increase
- While International Medical Insurance claims have been suppressed during these month, core claims still continued, Bupa babies were still being born and cancer is still being covered as usual
- A dedicated case manager has been assigned to every case of COVID-19, or which is suspected to be COVID-19 to help ensure the best support and clinical advice, as well as helping to manage some high cost International Health Insurance claims.
- Bupa Global has also announced today that they are permanently removing the general pandemic exclusion from their International Health Insurance products moving forward.
- Although they quickly announced that they would cover this pandemic in full, they wanted to reassure customers that this would continue, and that they would also now cover any future pandemic. This is good news for both their members and the market in general by removing uncertainty and bringing Bupa Global into line with the other major International Health Insurance providers.
- There was an acknowledgement to the market feedback early on that Bupa Global didn’t come out to the market with their initial stance on COVID-19 as quickly as they might have done, however as a large organisation working through a lot of change, it was difficult to come out with an overview of their position, however they feel that now is the right time to make sure that they are providing more regular updates moving forward.
- What can customers do if they are experiencing financial difficulties? Bupa Global already have processes and protocols in place for this scenario within their service team. They are sensitive to the issues and have had low levels of enquiries about ability to pay already. It will effective different customers in different ways and so a blanket statement isn’t possible, however Bupa are willing to try and support customers through this period where possible.
The Global Picture

Dr Paula Franklin – Chief Medical Officer, Bupa Group
- Dr Franklin provided a recap on the symptoms of the virus and how it has emerged over the initial months, acknowledging that information and details of the disease are still evolving daily.
- Reiterated that those at greatest risk are those
  - With an immune deficiency,
  - over 70,
  - under 70 with chronic heart, lung and kidney issues
  - with a BMI over 40.
- Ethnicity and lower income populations are also reported to have had a worse experience with the virus, seemingly having experienced a higher risk of catching it, catching it more severely. Dr Franklin explained that this experience is driven by socio-economic factors, rather than clinical ones, with a range of reasons still being researched, but including;
  - Limited access healthcare
  - Densely populated living conditions
  - Cross generational housing
  - Populations with a higher level of chronic illnesses
- Numerous government restrictions to reduce the spread of the virus have taken place around the world, mainly focused on restrictions on movement and increasing levels of testing.
- The UAE and Saudi Arabia were two countries called out by Dr Franklin which had led the way, with establishing high levels of testing very early on.
- By the 25^th of January the UAE had already tested over 1 million people. With two locations within the Emirate conducting door to door testing helping to identify, localise and contain the virus.
- High levels of testing, used alongside contact tracing appears to be the most effective way to combat the spread of the virus.
- The development of a vaccine, or vaccines, is being conducted at a pace truly unprecedented in medical history. A vaccine can usually take a decade, or longer to develop in normal times, even fast tracking is usually around 5 years. The aim of 12 – 18 months is extraordinarily fast and has been driven by high level of collaboration, not seen before, between both pharmaceutical companies and countries.
- There are currently 150 vaccines in development and 19 already in clinical trials across the world.
- Once, and if, a vaccine has been found, it then needs to be produced on scale, funded and distributed, so there is still a long way to go. How this further steps will be achieved remains to be seen
- There will be ongoing consequences from the pandemic, not only economic, but broader health implications also. The delay in screening services, preventative treatment and potential chronic implications for some patients after having COVID-19 will all have an impact.
- There is also a particular impact on mental health which is already starting to come through in research. The impact of being isolated and limitations on activities which people usually use to ‘decompress’ have had an impact and there is already clear evidence there will be a mental health burden due to the pandemic. This will be have both a short term impact with stress and anxiety, but also longer term impacts where families and friends that have passed away and they are dealing with bereavement. People in the provision of care in general, not just hands delivery of care, are also expected to be impacted significantly. Experiencing trauma like this can often see a delay in mental health issues arising, sometimes an anniversary is a trigger, meaning we are likely to be dealing with this issues for a long while to come.
- What happens to a vaccine if the virus mutates? This is common, the seasonal flu vaccine is annual for this reason and COVID-19 is being monitored and has already mutated, however these have not affected the behaviours of the virus so won’t impact the current vaccine work. If it does mutate significantly then yes, the vaccine would need to change and or adjust to respond to this.
Impact to services and operational highlights

Rebecca Kett-Young – Head of Operations, Bupa Global
- Bupa Global experienced a sudden drop in International Health Insurance claims from February onwards, particularly in outpatient claims as private facilities shut around the world.
- They saw a steady month on month decline, particularly in April which was 53% lower than March and 65% lower than January which was the last month with a normal claims trend.
- Claims for May experienced a 35% increase compared to April, however were still 50% less than January.
- Customers did still make claims and access cover, however, maternity and cancer claims were largely unaffected while some countries did continue almost as normal with no national lockdown.
- To date, just under 250 Bupa Global members have been admitted into hospital with COVID-19, globally. All of which have been case managed and supported clinically.
- All regions saw an increase in International Medical Insurance claims in May.
- Most regions claims are still 50 – 60% down, other than China which is now back up to 95% of where it is expected to be.
- During the pandemic 3,000 customers downloaded and accessed Bupa Global’s Virtual Doctor app and has proved a very popular tool from the feedback received.
- Additional claims costs are expected moving forward as hospitals increase the use of PPE and cleaning regimes.
- Uncertainty remains over what future claims will look like after they experienced a spike in claims in Beijing after the lockdown was eased there.
- Bupa does expect a claims bounce back with many member accessing treatment which was delayed. They expect this could happen later this year or at the start of 2021 and are planning to ensure they have the employees in place to be able to maintain services levels at this time.
- Bupa Global recorded a record score of +60 in their NPS claims feedback in June which has been consistently high, scoring +53 in March and April and +57 in May.
- While some of the inpatient COVID-19 treatment has been expensive, this high claims impact is likely to be balanced out by a fall in claims elsewhere.
- Bupa processes over £1Billion of International Health Insurance claims each year and this large scale helps in these scenarios and means the pandemic is unlikely to have a large impact on pricing moving forward.
- The Bupa UK domestic business has offered members a financial rebate, however Bupa Global is unable to make the same commit at this time as their products and scope of coverage is very different. However they stated a clear priority to customers and will be fair and transparent with what they do commercially and are not looking to make any financial gains form the pandemic.
Engage International is the specialist International division at Engage Health Group, supporting expatriates and high net worth clients with International Health Insurance UK, as well as offering a full range of broking and consultancy for businesses with an international footprint.

If you have any International Health Insurance needs, wish to discuss this article, or would like to discuss the broader International Employee benefits market in further detail, please get in touch.
July 8, 2020
COVID-19 Claims Trends: International Health Insurance (Aetna)
Aetna International, one of the leading International Health Insurance providers, hosted their first virtual conference last week to their key partners.

As well as being a great day and a chance to connect with the Aetna International team, we were provided updates on claims trends being seen during COVID-19 as well as details on how Aetna are working to simplify and improve member resources for their International Health Insurance members.

Key updates
- Donal O’Leary, Vice President International Actuarial & Underwriting, talked us through Aetna’s commercial experience to date and their view of the situation moving forward.
- COVID-19 presents a complex and moving picture when it comes to assisting the commercial impact on the International Health Insurance market.
- Firstly, in a pandemic situation there is ultimately a finite exposure as there is only a certain number of private beds and treatments available. There are a few factors that vary the impact seen as the pandemic rolls through over time and in difference regions;
  - Chronic conditions – it is still unclear which chronic conditions will develop and linger on after the initial illness and we are unlikely to fully understand this impact for a year
  - How long the pandemic lasts for – clearly the longer the situation goes on for, the higher the commercial exposure
  - Government support – This varies greatly by region and can also fluctuate, however good levels of government support allows firms to maintain benefits and staffing levels, holding up the revenue line.
- The claims experience has varied significantly between countries with some markets experiencing significantly depressed claims for the first half of 2020, but others less so. Elective treatments have had the largest drop in March and April and are now returning to normal levels in markets initially heavily impacted.
- Asia and the EMEA (Europe Middle East & Africa) regions have experienced the largest impact in H1 and this has driven some key learning;
  - Between March and May Aetna were seeing the stockpiling of medicines, what would usually be a 30 day prescription was coming in as a 90 day prescription,
  - The claims mix changes with less small claims, however more serious, high cost claims were less suppressed, particularly for cancer, heart conditions, strokes etc.
  - There has been some evidence of providers looking to recoup some of their losses via overcharging, an example given was a Russian hospital looking to charge for a CT scan for routine dental work. Their teams are now particularly vigilant to ensure they pick up this type of behaviour.
  - Evacuation benefit is included in all of Aetna’s International Health Insurance plans and these costs have been the main unplanned increase. Usually evacuations would be a mix of commercial flights and specialised medical transport which is much more expensive. Due to the lockdown of main countries, medical transport has been one of the only ways to move patients driving a significant increase in the use of private jets and a spoke in claims cost.
- Aetna hasn’t experienced any bad debt yet, however if there is a second wave them government support will play a large pat in if that continues to be the case.
- While claims have been lower, they aren’t as low as they had expected due to the reasons outlined above.
- In the 2^nd half of the year there is an increasing financial risk as delayed treatments catch up, although this may be a fairly smooth increase as people will still be anxious about going to some hospitals.
- Supporting the increase in claims in H2 will be the adjustments that private hospitals have made in the last few months are initially being caught cold by the virus. They have now successfully introduced social distancing and introduced safe practises to be able to reopen within the current rules and well as significantly increase virtual client support.
- Aetna expect there will be a significant increase in testing this winter as symptoms of common cold and flu are confused with COVID-19.
- Aetna’s V health Virtual Doctor solution has, as you would expect seen an increase of almost 800% since global lockdown’s were put in place. This is partly fuelled by their decision to offer this to all of their members, whether it was originally included in their International Health Insurance plan.
- Aetna expect this to drop off as lockdown’s ease, however they expect this to stay much higher than it was previously as the NPS score and feedback from the service has been so positive, so they foresee a behaviour change moving forward.
- In EMEA Aetna have been providing premium credits to community rated SME clients to reflect the reduction in claims between April and June. They are committed to dealing with this as fairly as possible and pass back any profits they were not planned to make.
- Aetna is focused on long term pricing sustainability and supporting their client relationships at this time.
- For larger experienced rated groups they will be deducting April – June form the experience for that year and looking tin introduce profit shares to pass back unplanned profit.
To round off…

The experience has varied by country and Aetna haven’t experienced the drop in claims that they would have expected to, given the lockdowns in place, this has been driven by the broadly stable serious health claims and a spike in evacuation cost. Aetna are committed to not making any financial gains from the pandemic and will pass back any additional profits they make.

Engage International is the specialist International team at Engage Health Group, supporting expatriates and high net worth clients with International Health Insurance, as well as offering a full range of broking and consultancy for businesses with an international footprint.

If you have any International health Insurance needs or which to discuss this article, or the broader International Employee Benefits market in further detail please get in touch.
July 7, 2020
Engage Health Group appoints The Insurance Boutique as Appointed Representative

Engage Health Group is pleased to announce that it has recently appointed The Insurance Boutique as an Appointed Representative, with its two business owners, Ian Abbott and Nick Hale, also taking up Non-Executive and shareholder positions in the start-up broker.

The Insurance Boutique launched this month and has set out to be leading specialist in the health and protection markets. In a marketplace where acquisition has been prevalent in recent years, the prime focus of The Insurance Boutique is to get back to the basics of impartial advice with fantastic personal service.

The company is headed by Penny Jackson, who has 20 years of experience in individual and business protection, most recently as a successful Franchise Director at Vitality where she managed the Essex region for 4 years with her team of Business Consultants.

The Insurance Boutique will assist clients with UK and International Health Insurance, Individual Protection, Business Protection, and Employee Benefits.

Nick Hale of Engage Health Group commented

“Having worked with Penny for a number of years and being a first-hand witness to her fantastic work ethic and client focused nature, we moved very quickly to accommodate her new venture. We are delighted to be working with Penny and look forward to supporting the inevitable growth The Insurance Boutique will no doubt experience”.

Said Penny Jackson, Director of The Insurance Boutique,

“I am delighted to join Engage Health Group, and having seen their success and growth over the years really got me thinking about my new venture. The partnership was the perfect fit and encouraged me to take the next step. Leaving Vitality wasn’t an easy decision but was made much easier at the prospect of working with Engage.”

For more information please visit www.theinsuranceboutique.co.uk.

Engage Health Group specialises in UK and International health insurance as well as the broader Employee Benefits landscape, as an independent whole-of-market brokerage and consultancy.

For more information contact: enquiries@engagehealthgroup.co.uk

01273 974419

June 23, 2020
Engage Health Group Offers Free Health Cover to Brighton-based Suicide Prevention Charity

Engage Charity Health Fund extends free health cover to all employees of Grassroots Suicide Prevention.

Funded by employee benefits specialist, Engage Health Group, the fund is designed to provide employees of small charities with free dental and optical care, physiotherapy, massage, virtual GP, CBT and counselling services.

Employee benefit provision is commonplace in the private sector and has become a big area of focus in recent years, with many companies designing their benefits strategy specifically to attract and retain the best calibre of staff. An attractive benefits package has also been proven to improve productivity and morale, and to drive higher levels of employee engagement and loyalty.

Ian Abbott, Director at Engage Health Group commented,

“1 in 5 people think about suicide in their lifetime, and 1 in 15 go on to attempt suicide. Those numbers shocked me when I read them. It makes me even more grateful that we have fantastic charities like Grassroots Suicide Prevention to support people in need, educate, and influence change to help bring those numbers down. The work they do both locally and nationally is incredibly important and we are very pleased to be able to play a small role in supporting their team.”

Grassroots Suicide Prevention is a Brighton based charity with a simple but powerful goal: that no one should have to contemplate suicide alone. Their approach is to get people talking openly and effectively about suicide. Grassroots aims to break the stigma and teach people to identify those at risk in order implement effective suicide interventions. Their work involves a combination of evidence-based suicide prevention and Mental Health First Aid courses, as well as their pioneering Stay Alive App.

Alex Harvey, Head of Development at Grassroots commented,

“By empowering individuals, organisations, and communities to keep themselves safe from suicide, Grassroots helps to prevent suicide and the devastation it leaves behind. Our success in this mission largely depends on our team’s hard work. They work hard because they’re passionate about preventing suicide – but also because they feel valued as employees. Given the intensity of our workload and our small size, when staff are unwell or absent we feel it – more so than a bigger organisation with greater resources and disposable income. It can potentially halt ongoing projects and restrict future development. The Engage Charity Health Fund will mean Grassroots can put sustained physical and mental health support in place, supporting our team’s needs, and ultimately helping us to prevent suicide.”

You can learn more and support Grassroots by visiting their website: https://www.prevent-suicide.org.uk/

Engage Health Group specialises in UK and International health insurance as well as the broader Employee Benefits landscape, as an independent whole-of-market brokerage and consultancy.

For more information contact: enquiries@engagehealthgroup.co.uk

April 28, 2020
Engage Health Group Offers Free Health Cover to Local NHS Charity

The Engage Charity Health Fund extends free health cover to all employees of the Sussex Cancer Fund.

Funded by employee benefits specialist, Engage Health Group, this benefit is designed to provide the employees of small charities with free dental and optical care, physiotherapy, massage, virtual GP, CBT and counselling services.

Employee benefit provision is commonplace in the private sector and has become a big area of focus in recent years, with many companies designing their benefits strategy specifically to attract and retain the best calibre of staff. An attractive benefits package has also been proven to improve productivity and morale, and to drive higher levels of employee engagement and loyalty.

Nick Hale, Engage Health Group’s founding Director and developer of the Health Fund commented,

“The Health Fund has been in operation for almost two years now and it’s been fantastic to see how positively it has been received by the current recipients (Rockinghorse and Starr Trust). We had a number of submissions from worthy causes and we’re delighted that the Sussex Cancer Fund, who do such a brilliant job supporting local people in conjunction with the NHS, will now benefit.”

The Sussex Cancer Fund works alongside the NHS to provide the best possible cancer care to patients in Sussex. They assist with providing the day-to-day extras, to make treatment more bearable and to ensure that the treatment journey is as manageable and as stress-free as possible for patients. They have also been involved in bricks and mortar projects such as the Horizon Centre and refurbishment of the chemotherapy suite, as well as funding additional services such as clinical acupuncture and much-needed pieces of clinical equipment.

Joanna Godden from the Sussex Cancer Fund commented,

“Sussex Cancer Fund is really grateful for the support of the Engage Charity Health Fund, and we were so delighted to have been chosen as beneficiaries. We are a very small charity, and gestures like this from the business community make a real difference to the team. Being able to access the health and wellbeing benefits of the scheme goes a little way to thank our staff for their hard work and provides them some additional support so they can focus on the charity’s mission of providing the best possible cancer care in Sussex.”

You can learn more and support the Sussex Cancer Fund by visiting www.sussexcancerfund.co.uk

Engage Health Group specialises in UK and International employee benefits as an independent, whole-of-market brokerage and consultancy.

For more information contact: enquiries@engagehealthgroup.co.uk

April 22, 2020
Coronavirus – Is your Health Insurance Covered? We look at the different Health Insurance Companies

As you might expect, we are experiencing a significant number of enquiries from customers asking whether their health insurance policy covers any element of the recent COVID-19 outbreak…

The answer here is not always a straightforward one and depends on which insurer you’re with, and in which region of the world you are covered. International Private Medical Insurance (IPMI) offers a greater degree of cover by its very nature, but the stance can still differ significantly.

All major UK health insurers are holding the same position: That those diagnosed with COVID-19 will be best looked after within the NHS, as they are better equipped to manage these patients in isolation. Any patients testing positive would likely be within an NHS clinic or hospital for monitoring and/or temporary relief of symptoms as opposed to active treatment typically available under UK PMI plans.

That said, it’s expected that a small number of patients could develop more severe complications as a result, such as pneumonia, which would be covered by their health insurance plan in most cases. Whilst they couldn’t be moved to a private hospital or facility, most health insurers will consider applications for NHS cash benefit (where the option is included on their plan), but this may be on a case-by-case basis.

Now that the World Health Organisation (WHO) has declared COVID-19 to be a pandemic disease, this can also change how an insurer will treat a potential claim, as some insurers have general scheme exclusions for pandemic diseases.

We have provided a breakdown below:

Domestic (UK) Health Insurance Companies / Providers

AXA – No exclusions for pandemic diseases and may offer NHS cash benefit where applicable

Bupa – Pandemics are a standard scheme exclusion so no cover available

Cigna – Would consider NHS cash benefit and related conditions for cover

Freedom – Pandemics are a standard scheme exclusion so no cover for this or related conditions

PHC – No cover for Coronavirus, related conditions or NHS cash benefit

Vitality – COVID-19 classed as “Emergency Treatment” and thus excluded from cover. Will consider NHS cashback for related eligible conditions.

WPA – No exclusions for pandemics and will offer NHS cash benefit where applicable

International Health Insurance Companies / Providers

Aetna – No exclusions for pandemics and Coronavirus is covered

AXA Global – Healthcare benefits will apply as normal if members are diagnosed with Coronavirus

Bupa Global – Does have an exclusion for epidemics and pandemics but currently, this isn’t being enforced and they are covering Coronavirus at their discretion.

Cigna – No exclusion for pandemics and Coronavirus is covered

Generali – Does have an exclusion for epidemics and pandemics but currently this isn’t being enforced and they are covering Coronavirus.

Now Health – There is no exclusion for pandemics and Coronavirus is covered

William Russell – Members are covered in the same way as they would be for any viral infections

All insurers are within their rights to deny claims if customers have travelled against the advice of the Foreign & Commonwealth Office travel advice.

Engage Health Group has made every effort to ensure the accuracy of this information having spoken with its insurer partners, but as the situation is changing regularly, it is recommended that customers contact their insurer directly with any specific questions.

If you have any questions or would like to find out more, please get in touch.

March 18, 2020
Engage Health Group appoints Hooray Health & Protection as Appointed Representative

Engage Health Group is pleased to announce that it has recently appointed Hooray Health & Protection as an Appointed Representative, with its two business owners, Ian Abbott and Nick Hale, also taking up Non-Executive roles in the start-up digital broker.

Hooray Health & Protection launched this month and will be one of the only firms in the UK to offer financial reviews by WebEx and telephone, making it more cost-effective and time-efficient for SMEs seeking health and protection insurance for their employees.

The company is headed by Charlie Cousins, who has a background in managing key relationships at one of the world’s largest employee benefits insurers. Cousins saw a gap in the market where traditional insurance brokers were abstaining from technology and the ever-changing needs of business owners.

Charlie Cousins, Director of Hooray Health & Protection said,

“At the start of 2019, there were just 49,820 group life policies and 17,304 group income protection schemes in the UK, which is shocking considering there are approximately 1.3 million businesses that have employees. This signals a serious problem in the industry where brokers are not keeping up with today’s SMEs and their needs.”

For more information please visit www.hoorayinsurance.co.uk

September 30, 2019
Engage Health Group Offers Free Health Cover to Local Charity Employees

Engage Charity Health Fund extends free health cover to all employees of young people’s charity, Starr Trust.

Funded by local employee benefits specialist, Engage Health Group, the cover includes dental and optical care, physiotherapy, health screening, private consultations, scans and a 24/7 counselling and support line.

Employee benefits provision is commonplace in the private sector and has become a big area of focus in recent years, with many companies designing its benefits strategy specifically to attract and retain the best calibre of staff. An attractive benefits package has also been proven to improve productivity and morale, and to drive higher levels of employee engagement and loyalty.

Nick Hale, Engage Health Group’s founding Director and who developed the Health Fund commented,

“We are delighted to be extending this initiative further, which sees a greater number of truly deserving people receiving free healthcare provision. The purpose of the fund is to remove the financial barriers that exist with everyday healthcare costs, ensure speedy access/treatment when needed, and enable the recipients to spend their disposable income in other areas. Starr Trust is a fantastic local charity and we are thrilled to support them in this way”.

Rob Starr, founder and chairman adds,

“Providing free healthcare benefits to our staff is so generous and kind, and I am really so very grateful that Engage Health Group has chosen to support us in this way. Their kind initiative enables us to use our own funds to help the young people we champion and yet it means our staff can realise how valued they are. On behalf of the Starr Trust team a huge thank you!”

The contribution follows an announcement last summer to sponsor the team working at Brighton-based children’s charity, Rockinghorse. Engage Health Group has selected Starr Trust as its second recipient of the fund. If you are a small charity and would like your team to be considered, please email enquiries@engagehealthgroup.co.uk

April 10, 2019
First class service and tenacity from Engage Health Group

“I am immensely proud of our team this week in resolving a complaint for one of our corporate clients, which has been ongoing for 11 months. This is a great example of the unsung work we do for our clients, which many don’t realise is included as standard when you work with Engage.” – Nick Hale, Director.

Engage Health Group had been looking after the Private Medical Insurance policy for one of their small corporate clients for two years. This involved managing the renewal process each year, negotiating with the incumbent insurer around benefits and premium, and delivering employee presentations to ensure the benefit was well communicated.

An employee of the client called their Private Medical Insurer to begin a claim in December 2017, but was misadvised, resulting in the employee having to pay £4,500 towards their treatment. This was naturally a surprise to the employee, but confused by policy terms & conditions, the claims process in general, and not wanting to delay essential treatment, they went ahead and paid.

When this was discovered by Engage Health Group, they insisted upon a review of the claim which included listening to all calls between the insurer and employee, liaising with the specialist consultant and piecing together what was a complex number of interactions.

Following this process, Engage’s view was that the insurer hadn’t acted in an appropriate way and they therefore submitted a formal complaint to the insurer on two separate occasions, citing that the employee should be reimbursed. Both of these attempts were declined outright by the insurer who felt the claim had been managed adequately.

Having been dissatisfied by this response and the lack of urgency from the insurer in question, Engage escalated the complaint to the Financial Ombudsman Service (FOS) and after several months of back and forth dialogue, their entry level complaint assessors also sided with the insurer. The insurer did concede at this point, however, that it had taken an exorbitant amount of time to assist the claimant at the time, and as a gesture of goodwill, offered the employee £250 compensation to close the complaint.

Undeterred and buoyed by the belief that they were in the right, Engage made a final attempt and escalated the complaint further to a senior ombudsman at the FOS. Another three months of dialogue took place and Engage insisted that the senior ombudsman listen to the numerous telephone call recordings between the insurer and the employee, as they had. They also supplied an itemised breakdown of how the interactions unfolded, coupled with their own analysis of where the service failure had occurred.

After 11 months of rejection, Engage (and the client) were delighted to receive a call from the FOS in November 2018 confirming that they had reviewed the situation, listened to all calls, considered the detailed analysis and as a result, had agreed with Engage that the employee was misadvised by the insurer.

The FOS were apologetic for the difficulty faced during this time and admitted that very few complaints are pursued in this way, but that the final result was the correct one. From here, they instructed the insurer to immediately reimburse the employee the full amount, along with 8% interest for the 11 months the employee was unjustly without their money.

Word from our client…

“After handing the matter over to Engage Health Group, I asked if they could raise a complaint with my insurer after being given substandard information which had resulted in me paying approx. £4,500 in hospital fees. Despite their best efforts, all attempts to resolve the matter directly with the insurer were unsuccessful. Not one to give up easily, Engage suggested that I take the matter to the Financial Ombudsman Service, which I agreed to. They then prepared and submitted my complaint to the FOS. Over the next 8 months, Engage was constantly chasing the complaint to ensure it was progressing. At one point a junior investigator at the FOS issued a decision in favour of the insurer, however the rationale behind the decision indicated that she clearly had not understood the complaint. Engage insisted that the complaint was fielded by a senior person who finally agreed with the complaint and ordered the insurer to refund the entire contribution to me.

This was a tremendous result, and entirely down to Engage’s tenacity and determination. From start to finish the service provided by Engage Health Group has been extremely professional and personable, and I cannot recommend them highly enough.”

Final thought…

As a relatively small client, some might argue that the work put in here over 11 months was not commensurate with the clients’ “value”, and many may have given up at the first hurdle. Every client who chooses to work with Engage gets first class service, irrespective of whether they have 3 employees or 300, and when we make a commitment to offer great service to our clients, it’s imperative that we fulfil that promise when the time comes.

As an independent brokerage/consultancy, we work with and value all of our insurer partners, but importantly, we work for the customer. This is the great benefit of an independent intermediary and one that many perhaps don’t appreciate when sourcing their employee benefit provision via other channels.

Many customers utilise our service because they want to review their employee benefits packages and ensure they are getting the best possible value and coverage, but the ongoing service and continued advocacy we provide on their behalf is what really sets us apart.

At Engage Health Group, we work across the health and wellbeing marketplace to ensure you find the right policies at the right price, and ensure your whole benefits package provides prices from across the market.

Contact our expert team at enquiries@engagehealthgroup.co.uk or call 01273 974419 for FREE no-obligation advice and support.

December 12, 2018
2018 Sussex Business Awards Finalists Announced

The shortlist for the 30th annual Sussex Business Awards has been announced and hundreds of applicants have been whittled down to just fifty-one finalists. Engage Health Group is delighted to have been nominated for the Business in the Community Award.

Representatives from sixteen towns across the county make the shortlist and after a record-breaking number of nominations, judges had an enormously difficult task as the entries were of such a high standard.

The judging panel, chaired by Mike Herd, executive director of Sussex Innovation Centre, included representatives from Allied Irish Bank, HSBC, Mazars, Gatwick Airport, University of Sussex, Red7, Coffin Mew, Clearline Recruitment, CountyClean Group, Vantage Professional Risks, LMS Group and Rockinghorse.

Commenting on this year’s shortlist, Mike said:

“Each year the standard of entries gets better and better and this year was no exception.

“This year’s finalists are a stimulating mix of established businesses and new entrepreneurial ventures with a common thread running through them all – resilience and determination to succeed. Congratulations to all the shortlist!”

Winners will be announced at The Grand Brighton on November 29th.

Over 500 of the county’s leading businesspeople are expected to attend giving guests the perfect opportunity to network with peers, celebrate with colleagues and find out those all-important results.

October 19, 2018