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Last updated: 23/07/2020 | Estimated Reading Time: 4 minutes

Company health insurance

The term company health insurance applies to private medical insurance that is provided by a business for its employees. This insurance normally follows a similar pattern to that of individual health insurance but will have a few exceptions due to the nature of insuring what could be hundreds of employees. This guide will outline some of the things that you can expect to be covered for if you have medical insurance provided by your company. It will also outline what things are typically not included in company health insurance plans that are on offer.

In This Guide:

What is normally included in company health insurance?

Company health insurance plans are different to individual health insurance policies and family plans because of the way in which they are structured. You will often find that, when looking for an individual medical insurance plan, you will be able to identify some aspects or features of the plan that are common to most of the policies on the market - in other words it is easier to make generalisations about what will be covered by individual or family plans. This is not the case to the same extent when it comes to company health insurance.

The reason that company health insurance is more difficult to make generalisations about is the fact that companies vary in their size and nature to a much higher degree than individuals or families do. Some companies may only employ as many as six people, whereas others will have thousands of employees across numerous offices. It is for this reason that you will need to check with your employer in order to find out the exact details of your companies health insurance policy. Even though it may be harder to make generalisations when speaking about business medical insurance plans, there are still some things that are normally common to all.

Most company health insurance plans will cover their employees for in-patient charges - in other words when you are kept in hospital overnight. They will also cover their employees for any specialist scans that are required whilst an inpatient, this also extends to tests required for diagnosis such as X-rays or blood tests. Day patient unit charges and specialist fees are normally covered as well. It is important to remember that these levels of cover will vary from plan to plan, what is mentioned above is written only as a guide to a typical basic level of cover. For precise information please make an enquiry with your employer.

Although the basic level of cover does not offer as much medical support for outpatients, there are still situations when an outpatient's treatment may be covered by their company health insurance. Some of these instances include things such as treatment for surgical procedures whilst an outpatient, scans as an outpatient for things like an MRI, CT or PET when referred by a specialist. You are also likely to receive cover for outpatient chemotherapy and radiotherapy in order to treat cancer, you can also often be reimbursed in cash if you have to receive chemotherapy or radiotherapy on the NHS.

What is not normally included in company health insurance?

Whilst your company's health insurance is likely to cover you for a vast amount of different medical eventualities, there are still many things that you should not expect it to cover. Again this is different from plan to plan and company to company so if you want to find out the exact details of the business health insurance that you have, you should contact your employer and ask them directly.

One thing that is not normally covered by any private medical insurance, company or otherwise, is routine pregnancy and childbirth. There may be some sort of cover in place in the event of complication with the pregnancy but this is also unlikely. Your company's health insurance is also unlikely to provide cover for long term chronic illnesses such as asthma or diabetes. Cosmetic treatment will also not be covered as it is not seen as threatening to your health and is therefore not included on the plan. You can also generally not claim for treatment of conditions that you had previous to entering onto the insurance plan of your business.

One thing that many people do not expect to be excluded from their company's health insurance plan is any injury that you sustain whilst playing a sport or taking part in a physical activity for which you are paid by your company. This includes salary, grants or monetary reimbursements of any kind - with the exclusion of travel costs.

It is worth noting that you must also receive your treatment from one of the insurers listed directory of hospitals if you want to be covered for anything at all.