How Equipsme works:  how to get treatment

How Equipsme works: how to get treatment

How Equipsme benefits work

If you’re looking at health benefits and insurance for your workforce for the first time, or if you’ve never come across a model like Equipsme before, it’s good to know how it all works in practice for the people at the sharp end – your workforce.

That’s why this guide shows how to use an Equipsme plan in real life, step-by-step.

A bit about us

Hi. We’re Equipsme. We thought health benefits and insurance should be better, and work for more people, so we built something different. We’re backed by AXA Health, so you know you’re in safe hands and getting the best care. We’ve just made it more affordable and more accessible.

At Equipsme, we LOVE the NHS - but there’s no pretending it isn’t under enormous pressure right now. Your Equipsme plan is here as your back-up plan, helping you beat the queues and get back to being fighting (and working) fit as soon as possible.

Unlike other health benefits and insurance, we actually want people to USE their plan. It’s not supposed to sit in your back pocket and do nothing. Which is exactly why we’ve put together these practical guides.

How to get treatment

Sometimes you can’t hang around waiting to get treatment on the NHS. Sometimes you need it now, or you need a second opinion, or different options. With your Equipsme plan it’s easy to access treatment, without having to pay up front.

Help. I need to get some treatment. How do I make an appointment?

You can check to see if treatment is part of your Equipsme plan by visiting the Equipsme portal. All your benefits appear as buttons on your homepage.

If you’ve already used your Equipsme plan to get diagnosed by a consultant, they will suggest whether you need further treatment and if it should take place in hospital. All you need to do is call up AXA Health and let them know what’s been suggested, so they can assess whether your condition is eligible for cover and help you find a hospital/clinic on their approved network.

My GP/consultant says I need treatment – how do I make an appointment?

Very much the same way you get to see a consultant for diagnosis. You’ll need an Open Referral letter from your current Dr and your AXA Health membership number (which appears on your portal).  Call up AXA Health, and they’ll check your referral, assess whether your condition is eligible for cover and if so, send you through the details to contact one of their private consultants.

I want to move from the NHS onto my consultant’s private list – how do I do that?

Your GP will decide if a specialist referral is necessary and if so, can provide you with an open referral letter. These are accepted by AXA Health (if you have Diagnosis cover on your plan), and the claims team will assess whether your condition is eligible for cover under the Equipsme plan or not. If authorised, AXA Health will help you make an appointment with one of their recognised specialists or a hospital/clinic for treatment.

If the condition you are claiming for might be pre-existing, you may need to obtain additional information from your own GP first (as only they can access your medical history records).

Where will I be treated?

There is an approved medical network of the medical professionals, diagnostic centres and hospitals you’re covered to use. The aim is always to limit your travel distance.

The AXA Health nationwide network of more than 100 hospitals/clinics includes BMI Healthcare, Nuffield Health and Spire Healthcare hospitals, as well as the London Clinic and Aspen Healthcare, plus private patient units in some NHS facilities. Typically, our members will find that they live or work within 15 miles of a provider – and just 5 miles in London.

Can I choose my own Dr, physio or clinic?

Just call AXA Health and they can help organise appointments with you as they need to pre-authorise your treatment to make sure it is covered. You don’t want to pick a person or clinic that isn’t recognised under your plan and risk your bills not being covered!

How quickly will I be treated?

Your treatment will depend on your condition and your consultant’s list of patients, but is usually within weeks, and often faster than the NHS waiting list.

Is there anything I won’t be able to get treatment for?

You won’t be able to get treatment for any conditions you’ve had symptoms, medication, treatment or advice for in the three years before your Equipsme plan started. Like all health insurance policies, there are things that are also not covered by our plans. That includes mental health treatment, routine pre and post natal care, and the treatment of ongoing, recurrent and long term chronic conditions – for instance Crohn’s Disease.

Also, we don’t cover cancer. You can get diagnosed swiftly through your Equipsme plan, which is often the most important step, and once diagnosed you can access dedicated nurse support helplines to help with any questions as you return to the NHS for your treatment. The NHS is brilliant at cancer care, and brilliant in a crisis, and they’re best able to co-ordinate whatever you might need.

It means we can keep our prices low, and help more people access wider private healthcare in a way they wouldn’t have been able to before.

To find out more about what is and is not covered under your chosen Equipsme plan, see your Membership Handbook which you can download from your members portal or App.

Will I have to pay upfront for my treatment?

If AXA Health approve your treatment and give you a reference number, the claims team will confirm exactly what they will pay for so that you don’t need to pay upfront, but it’s important to check back with them at every stage of your treatment.

Remember, your plan may have a small excess of £150, which is the amount you are expected to pay towards a claim. You will usually receive an invoice for settlement from the treatment provider, for you to settle direct. The excess does not apply to claims under your Physiotherapy benefit. Only if you claim under Diagnosis or Treatment benefits.

What do I do when I get to the hospital?

Report to reception, and they’ll direct you to the right place. At the department reception, you’ll be given a form to fill in with all your details – including the claim number reference from AXA Health.