Do I ever have to pay for Equipsme health benefits?

Do I ever have to pay for Equipsme health benefits?

Equipsme’s health insurance plans are designed to be transparent, practical and useable from day one, and unlike a cash plan you’re not expected to pay up front for your benefits – EXCEPT in 4 circumstances.

Here’s when you WILL be asked to pay from your own pocket for Equipsme services, and why.

1. Excess

Just like on your car or home insurance, on our level 2 diagnosis and treatment plan there’s an excess to pay. That means that you pay the first £150 towards the total cost of your consultations, diagnosis or hospital treatment bill, once per plan year. The rest of any eligibly treatment bills that have been authorised are paid for you and often directly to the treatment provider.

If you do have a level 2 plan and an excess to pay, arrange your hospital visit through AXA Health as normal (always checking with them BEFORE you make an appointment that they’ll cover your consultation/tests/treatment). Your AXA Health provider/hospital will then usually send you a bill for your excess amount after your first appointment.

Find out more about how to see a consultant for diagnosis.

Find out more about how to get treatment through Equipsme.

Find out more about what Excess is.

2. Dental and optical services

Our dental and optical service is an add-on benefit that employers can choose for their corporate plan. This is the only bit of Equipsme that works a bit like a cash plan. If you’ve got this benefit, you can make your own appointments with your usual optician or dentist, keep the receipts, and submit a claim to get money back. You can claim up to £200 per plan year for NHS or Private dental check-ups and treatment and up to £100 per plan year on prescription specs / lenses and £25 towards annual sight test.

Find out more about how our dental and optical service works.

3. GP report for investigation into health

At Equipsme, we have an exclusion of three-year pre-existing conditions. That means we don’t cover any physio, diagnosis or treatment for any conditions you have received medication, advice or treatment for in the three years before the start of cover, or have experienced symptoms of in the three years before the start of cover; whether or not the condition was diagnosed.

We do this so we can keep our exclusion/inclusions really simple, and so that we can keep overall costs value for money for everyone. (Obviously covering people who are already sick is a bit like house insurance for a property already on fire – not very sensible or fair to everyone else).

Sometimes, as part of the assessment of your claim, our provider for physio, diagnosis and treatment, AXA Health, will check on the three years exclusion. So, they’ll ask for clarification from your GP about when any symptoms, medication, treatment or medical advice first occurred. (This is particularly likely if you submit a claim within the first few months after your cover began with us, although can be requested at any time).

They’ll send you a Further Medical Information (FMI) form, with a page or so of information for you to complete and a page or so for your GP to complete. (Your NHS GP holds your personal medical records and are therefore the best source of this information).

Some GPs charge you for filling in an FMI form, because of the time it takes them to fill in. In our experience, that charge is usually around £30-£50, although some may charge you more.

Find out more about pre-existing conditions

4. Upgrades

We believe that Equipsme is the only health insurance provider that allows employee members to pay in personally to upgrade their cover and add family members, without the need for salary deduction.

You can add or remove family members during the plan year, which will obviously impact how much you pay for your Equipsme plan in a monthly direct debit. You can choose to upgrade your cover but only in the annual renewal window for your plan. We’ll write to you at renewal time to ask you to check your cover, and make a choice about any upgrades.

Find out more about adding family to your plan

Find out more about our plan levels

Date created: June 2024