You can download a pdf of the full report here: Benefits Expert Corporate Healthcare and Cash Plan Round Table
The panel
- Rashree Chhatrisha, rewards and benefits director, Saga Group
- Sush Dhonsi, associate director, international benefits, Galapagos Biotech
- Robyn Fisher, head of reward & performance, Mitie Group
- Paul Gambon, sales and marketing director, Medicash Healthcare
- Lorri-Ann Gillies, head of corporate new business, Bupa UK
- Kay Hewish, head of people services and governance, Aioi Nissay Dowa UK
- Gareth Jones, new propositions, insights, digital health and wellbeing, Bupa UK
- Gemma Robinson, people and culture director, Insure The Box/Aioi Nissay Dowa Europe
- Nathan Willcock, reward specialist Nationwide
Prime minister Rishi Sunak’s rather awkward encounter in January with a voter in Winchester – which subsequently went viral on social media – was predicated on her wanting access to NHS healthcare to “go back to how it used to be”.
With NHS waiting lists now well north of seven million people for elective treatment, and millions waiting a month or more even just to see their GP, and A&E waits in some cases topping 12 hours, her frustration with the state on the health service is perhaps all too understandable.
Yet, for health insurers and employers offering insurance-based healthcare benefits, there is little if any chance of things returning to how they ‘used to be’. Accelerated by the pandemic, demand for employer-based healthcare provision has continued to surge amid the NHS’s ongoing post-pandemic struggles.
Indeed, research by recruiter Robert Half in November suggested a majority of the UK workforce (51%) now wants access to private healthcare via their workplace, with access to dental insurance a key priority for many. The Private Healthcare Information Network has estimated that the numbers turning to PMI are at their highest since 2019, and the Association of British Insurers has argued a record 4.4 million people are now covered by health insurance through their employer.
Where next?
But where are things going next? How are PMI and cash plan providers performing, and where could they be doing better? How is private medical insurance supporting recruitment and retention? Or diversity and inclusion? What about new technologies such as AI, how will they change the delivery and performance – and cost – of healthcare insurance provision?
To try to unpick these questions, Benefits Expert, in association with Medicash Healthcare and Bupa UK, brought together a high-level panel of reward and benefits experts in January to discuss how, or even whether, employee benefits products are being effective in helping them to achieve their goals. Our panel, representing a broad spectrum of employer types and sizes, worked to drill down into where we are – and where we’re going – when it comes to employer healthcare provision over two roundtable discussions held at the House of Lords.
So how do employers feel PMI and cash plan providers are performing? What challenges were they experiencing and what would they like providers to be doing more, or less, of?
For Rashree Chhatrisha, rewards and benefits director at Saga Group, it was about striking that balance between rising demands and expectations and increasing costs. “From an HR perspective, we recognise that private medical insurance is a necessity. Where I challenge my providers is ‘what more can you do for us in that whole wellbeing lens?’
“What are the additional benefits, additional wellbeing tools, forums, or employee access that you can work with us, almost as a partner, to create?” she said, adding that she also wanted to see providers collaborating and working more closely together.
Ageing workforce
Needing to respond to the healthcare needs of ageing workforce was the key challenge for Sush Dhonsi, associate director, international benefits at Galapagos Biotech. “I am interested in how we can link, say, a cash plan to a healthcare scheme? We have a fully insured healthcare scheme, but I’m interested to know more about how we can perhaps link the two together. Obviously being mindful of costs as well,” she highlighted.
With some 60,000 employees in the UK, many of them front-line workers and often relatively low paid, the priority for Robyn Fisher, head of reward & performance at Mitie Group, was how to put in place whole-workforce provision beyond just access to a virtual GP service – without it being prohibitively expensive.
“What we have is a virtual GP for everybody. Yet my interests are in things are getting harder for people in the UK in terms of accessing NHS support. The virtual GP, we get amazing feedback that people aren’t having to wait; they can get real help when they need it,” she said.
“But I think for large employers, there’s not much else – that next step – without breaking the bank. And that’s the bit we’re struggling with because we’ve had internal conversations around what we could do. That’s where I see something’s got to develop, there’s got to be a provision in between, somehow a step up from the virtual GP,” Fisher added.
For Gemma Robinson, people and culture director at Insure The Box/Aioi Nissay Dowa Europe, while accessing cash plan support was relatively straightforward for its 600 UK employees, accessing PMI was often seen as something that had too many hoops to jump through. “People just in the end don’t bother,” she pointed out.
“The challenge for us is around how providers can help us to promote what people can use. From the PMI provider we went with we get emails through but, because that is only for a certain percentage of our population, it’s not something we want to put out on the intranet. But the healthcare plan has lots of excellent benefits and bolt-ons, especially with the app. So, I think we could do with some help there,” she added.
Stuck in the middle
With 18,000 UK employees, healthcare at building society Nationwide was offered on either a grade-related or legacy basis, highlighted reward specialist Nathan Willcock. But, like Mitie’s Fisher, he was concerned how to reach and support “that population in the middle”. Or as he also put it: “That lower-paid-but-in-need-of-treatment employee, and their access to the NHS is quite difficult at the moment.”
Willcock added: “We have huge utilisation of our EAP. Yet if somebody needs that next step, sometimes they fall off the journey. So we’re looking for that whole-of-workforce lower-cost option. Maybe something that isn’t the goldplated PMI.”
These were challenges providers fully recognised, agreed Lorri-Ann Gillies, head of corporate new business at Bupa UK. “We are seeing an emerging trend of clients that are looking for full medical plans. And then the price lands and they fall off their chair and say, ‘we can’t afford that’. So you’re right, what is the next step? At Bupa, what we’ve been developing over the last 12 months is a suite of benefits, essentially, that is going to bridge that gap.”
“It’s bridging that grey area really from digital GPs to PMI,” added Gareth Jones, new propositions, insights, digital health and wellbeing at Bupa UK. “How can we make it go further for the whole of workforces? Can we add a mental health pathway to a digital GP? Or a physio MSK pathway? And also wellbeing resources to help the whole workforce? That’s something that we’re working on at the minute to try and address to offer people like yourselves to your employees.”
Could, for example, providers perhaps stop charging for access to virtual GPs, suggested Kay Hewish, head of people services and governance at Aioi Nissay Dowa UK. “That would be a real big thing for us. I know when Covid came out, we offered the virtual GP services free of charge, and then we started to get people seeing what this meant in terms of cost.”
“It’s a difficult one,” conceded Paul Gambon, sales and marketing director at Medicash Healthcare. “Because it’s such a popular benefit, adoption has skyrocketed. But at the same time that, of course, comes with a cost. And that cost is probably a lot more significant than you would believe, because, you know, these are doctors at the end of the day you’re paying for, for their time.
“Whereas before usage was very low, now people tend to use it as a first port of call rather than Googling their symptoms, which was the old way of doing it. Now people go straight to, ‘well, I’ll just use that virtual GP’, but that sometimes means people are using it multiple times a day, and the cost to us every single time someone uses that is significant,” he added.
Greater personalisation
The panel discussed the feasibility of alternative models, such as wrapping more nuanced self-fund options into PMI. Mitie’s Fisher even highlighted an example from the veterinary world where, for her dog, she pays a monthly fee to get a certain range of treatments for free. “But then if there’s an operation you just get a discount on the cost, but you pay for the treatment.
“So you could get up to six physios, up to six other treatments like complementary therapies or whatever. But if you then need a costly thing, like an operation, you get, I don’t know, 50 per cent off or whatever it could be,” she added.
What was needed was simply greater personalisation of products and delivery, argued Nationwide’s Willcock. “We have a lot of people come to us and ask why they can’t just buy, say, the ADHD piece? Rather than add it on to the plan, we have loads of employees come through and go, ‘I just want to get my children diagnosed, can I just buy this section?’. Our struggle is we don’t offer PMI to everybody. So if we add it to the plan, we’re automatically excluding a big portion of people that would happily pay for it as a benefit,” he said.
The industry was looking to come up with creative thinking around self-pay models, said Bupa’s Gillies, highlighting an example around urgent care. “We’re piloting at the moment the ability for people, rather than go to A&E, to pay £150 and go and sit in a private hospital and be seen by a doctor, and then be directly referred into your medical plan if needed. It’s those kinds of interventions on the self-care basis that I think we’ll start to see more of.”
Finally, as the first discussion drew to a close, delegates debated how well designed private medical insurance and health cash plans supported talent recruitment and retention. “If you know you need to attract good people and talent you have to think about PMI and healthcare,” said Saga’s Chhatrisha.
“When you talk to new hires, all of a sudden it’s about, ‘I want to work from home; have you got healthcare; what’s the wellbeing and what’s the ESG?’ And I’m thinking, ‘well, how about asking about the base salary?’”
“Healthcare is a huge expectation,” agreed Willcock. “I think people are very aware of what they can’t get through the NHS and they want to know not just what we offer, but what the levels are, what the limits are, what the excess is. I think people are very clued up to how a healthcare plan works now.”
“The other point I’ve seen more of in the past year,” highlighted Fisher, “is where senior people are leading the business maybe through restructuring or redundancies, and they realise how valuable their private healthcare is. As part of that consultation period, we’ll say ‘speak to the provider and you can arrange something with them privately’. They come back and go, ‘you know, I didn’t realise what an amazing deal I had’.”
“The way I look at it is if you’ve got two job offers on the table with identical salaries, and one has a health benefit in it and one doesn’t, it’s not the value necessarily of that health benefit [that’s important],” agreed Paul Gambon in conclusion. “It’s the perception of the employer as someone who’s going to invest a bit into that individual, who has a more caring approach, who is going to actually look at overall welfare across the people in the business.
“So I think, for me, it’s not the value, it’s more you need to offer something because it is definitely an expectation. It’s only when you try to take something off people, people start to value it that bit more again, don’t they?” Gambon added.
You can download a pdf of the full report here: Benefits Expert Corporate Healthcare and Cash Plan Round Table
