As an FCA-authorised expert with over 800,000 policies arranged, WeCovr specialises in private medical insurance for UK businesses. This guide explains how PMI can safeguard your most valuable asset—your team—by providing swift access to high-quality healthcare, reducing sickness absence, and boosting morale.
Comprehensive PMI for SMEs looking to support staff
In today's competitive landscape, attracting and retaining top talent is a major challenge for small and medium-sized enterprises (SMEs). While competitive salaries are crucial, a comprehensive benefits package can be the deciding factor for a potential employee. Private Medical Insurance (PMI) is one of the most valued employee benefits, demonstrating a genuine commitment to your team's health and wellbeing.
This guide will walk you through everything you need to know about private health insurance for your small business, from understanding the core benefits to navigating the tax implications and choosing the perfect plan for your budget and your people.
Why Should a Small Business Invest in Private Health Insurance?
Offering private health cover is more than just a 'nice-to-have' perk; it's a strategic investment in the resilience and productivity of your business. With NHS waiting lists remaining a significant concern, PMI offers a tangible solution.
According to the Office for National Statistics (ONS), a record 185.6 million working days were lost to sickness or injury in the UK in 2022. For a small business, the impact of even one key team member being absent for an extended period can be profound.
Key benefits of offering business PMI:
- Reduces Sickness Absence: PMI provides fast access to diagnostics, consultations, and treatment for acute conditions. This can drastically shorten the time an employee is away from work compared to waiting for NHS treatment, minimising disruption and lost productivity.
- Attracts & Retains Top Talent: In a tight job market, a strong benefits package sets you apart. PMI is consistently ranked as one of the most desirable employee benefits, showing prospective and current staff that you value their wellbeing.
- Boosts Morale & Loyalty: Investing in your team's health fosters a positive company culture. Employees feel valued and supported, which leads to increased loyalty, engagement, and motivation.
- Supports a Duty of Care: As an employer, you have a duty of care towards your employees. A health insurance plan is a clear demonstration of this commitment, particularly for roles that may be physically or mentally demanding.
- Access to Specialist Care & Mental Health Support: Many modern PMI policies include extensive mental health cover, providing access to therapy and counselling services often with shorter waiting times than publicly available services.
A Real-World Example
Imagine your lead graphic designer, Sarah, develops severe back pain. On the NHS, she might face a lengthy wait for a specialist consultation and an MRI scan, followed by another wait for physiotherapy or treatment. During this time, she may be unable to work or work at a reduced capacity.
With a company PMI policy, Sarah could see a private specialist within days, have her scan the same week, and begin a course of treatment immediately. She's back on her feet and back to work sooner, and she feels incredibly supported by her employer.
Understanding Business Private Medical Insurance (PMI)
Private Medical Insurance, also known as private health cover, is an insurance policy designed to cover the costs of private medical treatment for acute conditions. For businesses, a 'group scheme' covers two or more employees, often at a more competitive rate than individual policies.
The Crucial Distinction: Acute vs. Chronic Conditions
This is the most important concept to understand about UK private health insurance.
- Acute Condition: A disease, illness, or injury that is likely to respond quickly to treatment and lead to a full recovery. Examples include joint replacements, cataract surgery, hernia repair, and treatment for most infections. PMI is designed to cover acute conditions.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs long-term monitoring, continues indefinitely, has no known cure, or is likely to recur. Examples include diabetes, asthma, high blood pressure, and arthritis. Standard PMI policies do not cover the routine management of chronic conditions.
The Rule on Pre-Existing Conditions
Alongside chronic conditions, standard PMI policies also exclude pre-existing conditions. This refers to any illness or injury for which you have experienced symptoms, received medication, or sought advice before your policy began.
How insurers handle this depends on the type of underwriting you choose, which we'll explore next.
How Underwriting Works for Small Business PMI
Underwriting is the process an insurer uses to assess risk and decide whether to offer cover, and on what terms. For SME health insurance, there are three main types.
| Underwriting Type | How it Works | Best For |
|---|
| Moratorium (MORI) | The most common type for small groups. No medical questionnaire is needed upfront. The policy automatically excludes treatment for any condition that existed in the 5 years before the policy start date. However, if an employee goes 2 full, continuous years without any symptoms, treatment, or advice for that condition after joining, it may become eligible for cover. | Simplicity and speed. Ideal for small businesses who want to get a policy set up quickly without intrusive medical forms. |
| Full Medical Underwriting (FMU) | Each employee completes a detailed medical history questionnaire. The insurer then reviews this and specifies exactly what will and won't be covered from the outset. Exclusions are permanent unless you can get them reviewed later. | Clarity. You know precisely what is excluded from day one. It can sometimes result in a slightly lower premium than a moratorium policy if the group is generally healthy. |
| Medical History Disregarded (MHD) | This is the premium option. The insurer agrees to cover eligible acute conditions, regardless of any pre-existing medical history. There are no medical questionnaires. | Maximum inclusivity. It's the most comprehensive option but is also the most expensive and typically only available to larger groups (often 15-20+ employees), though some insurers may offer it to smaller businesses. |
An expert broker, such as WeCovr, can help you understand which underwriting option is the most suitable and cost-effective for your specific business and team.
Core Components of a Business PMI Policy
While policies vary between insurers, they are all built around a core set of features, with optional extras you can add to tailor the plan.
1. Core Cover (In-patient and Day-patient)
This is the foundation of every PMI policy and typically covers:
- In-patient Treatment: When you are admitted to a hospital and occupy a bed overnight. This includes hospital accommodation, nursing care, surgeon and anaesthetist fees, and specialist consultations.
- Day-patient Treatment: When you are admitted to a hospital or clinic for a planned procedure but do not stay overnight.
- Cancer Cover: This is a vital part of modern PMI. Most policies offer extensive cancer cover, including diagnosis, surgery, chemotherapy, and radiotherapy. It's essential to check the level of cover provided as it can vary.
2. Out-patient Cover
This is often the first major add-on to consider. It covers diagnostic tests and consultations that do not require a hospital admission.
- Specialist Consultations: Seeing a specialist like a cardiologist or dermatologist.
- Diagnostic Tests: MRI scans, CT scans, X-rays, and blood tests.
- Therapies: Post-operative physiotherapy or osteopathy.
Most insurers offer different levels of out-patient cover, for example, a capped limit of £500, £1,000, or a fully comprehensive option. Choosing a lower limit is a common way to manage the premium.
You can further enhance your policy with a range of additional benefits:
- Mental Health Cover: Provides access to psychiatrists, psychologists, and therapists. Given the rising awareness of mental health challenges, this is an increasingly popular and valuable addition.
- Dental & Optical Cover: Contributes towards the costs of routine check-ups, dental treatments, and prescription eyewear.
- Therapies Cover: Expands the range of therapies covered to include things like chiropractic, podiatry, and acupuncture, often with a limit on the number of sessions.
- Travel Cover: Some policies allow you to add European or worldwide travel insurance.
How to Choose the Right PMI Policy for Your SME
With so many options, choosing the right plan can feel daunting. Here’s a step-by-step approach.
- Define Your Budget: Decide how much you can realistically afford to spend per employee, per month. This will be the single biggest factor in shaping your policy.
- Assess Your Team's Needs: Consider the demographics of your workforce. A younger team might value mental health support and wellness benefits, while an older workforce may be more focused on comprehensive cancer care and out-patient diagnostics.
- Decide on the Level of Cover: Do you want a budget-friendly plan that primarily covers major in-patient procedures, or a comprehensive policy that includes extensive out-patient and wellness benefits?
- Understand Policy Levers: Familiarise yourself with the options that affect the price:
- Excess: This is the amount an employee pays towards a claim each year. A higher excess (e.g., £250 or £500) will significantly lower the premium.
- Hospital List: Insurers have different tiers of hospitals. Choosing a more restricted list that excludes expensive central London hospitals can reduce costs.
- 6-Week Wait Option: This popular option reduces your premium. It means that if the NHS can provide the required in-patient treatment within six weeks, the employee will use the NHS. If the wait is longer, the private policy kicks in.
- Speak to an Expert Broker: This is the most effective way to navigate the market. An independent broker doesn't work for an insurer; they work for you. They will take the time to understand your business and find the most suitable policy from across the market.
Comparing Major UK PMI Providers for SMEs
Here is an overview of some of the leading providers in the UK market. The best provider for you will depend entirely on your specific needs and budget.
| Provider | Key Strengths & Features for SMEs | Unique Selling Point (USP) |
|---|
| AXA Health | Strong core product with excellent mental health pathways. Known for its 'Doctor at Hand' 24/7 digital GP service and dedicated support for SME clients. | Focus on proactive health support and a streamlined digital user experience. |
| Bupa | The UK's largest insurer with a vast network of hospitals and specialists. Offers a wide range of customisable plans and strong brand recognition. | Unmatched scale and a comprehensive direct settlement network, meaning they often pay hospitals directly. |
| Aviva | Provides a strong, straightforward core product with excellent cancer cover. Their 'Expert Select' hospital option is a well-regarded guided care pathway. | Often highly competitive on price for its core cover, making it a great value choice for many SMEs. |
| Vitality | Unique wellness-linked model. Actively rewards employees with discounts and perks (like cinema tickets and coffee) for staying healthy and active. | The 'Shared Value' insurance model. It actively encourages healthy behaviour, which can lead to a healthier workforce and lower long-term premiums. |
Working with a broker like WeCovr allows you to receive and compare quotes from all these leading insurers and more, ensuring you get the best possible terms at no extra cost to you.
The Tax Implications of Business Health Insurance
Understanding the tax treatment of PMI is crucial for any business owner.
- For the Business: The premiums your company pays for an employee health insurance scheme are generally considered an allowable business expense. This means you can deduct the cost from your pre-tax profits, reducing your Corporation Tax bill.
- For the Employee: Private medical insurance is treated as a 'benefit in kind' (BIK). This means the employee has to pay income tax on the value of the benefit (the premium). The company also has to pay Class 1A National Insurance Contributions (NICs) on the value of the premium. The cost is reported to HMRC on a P11D form for each employee who is part of the scheme.
Example Calculation
Let's say your company pays a £600 annual premium for an employee who is a basic-rate taxpayer (20%).
- Employee's Tax: The employee will pay 20% of £600, which is £120 per year in income tax, usually collected via a change in their tax code.
- Employer's National Insurance: The company will pay Class 1A NICs (13.8% for 2024/25) on the premium. 13.8% of £600 is £82.80 per year.
Even with the BIK tax, most employees see PMI as a highly valuable benefit that would cost them significantly more to purchase individually.
Beyond PMI: Creating a Holistic Employee Wellness Programme
While PMI is a powerful tool for reactive care, the most forward-thinking businesses also invest in proactive wellbeing. A holistic strategy addresses the complete health of your team.
Mental Health First Aid
Train designated employees to become Mental Health First Aiders. They can act as a point of contact for colleagues experiencing mental health issues, offering initial support and signposting them to professional help, such as services available through your PMI policy or an Employee Assistance Programme (EAP).
Small, consistent changes can make a huge difference to your team's energy, focus, and overall health.
- Nutrition: Encourage healthy eating habits. Simple initiatives like providing a fruit bowl in the office or offering healthy lunch options can have a positive impact. As a WeCovr client, your team can also benefit from complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app, to help them manage their dietary goals.
- Physical Activity: Promote movement throughout the day. This could involve organising team walks, offering discounts on gym memberships, or running a 'steps challenge'. Some PMI providers, like Vitality, build this directly into their model.
- Sleep: Educate your team on the importance of good sleep hygiene. Poor sleep is linked to reduced productivity, poor decision-making, and long-term health problems. Encourage a culture where employees are not expected to answer emails late at night.
When you purchase a private medical or life insurance policy through WeCovr, we're pleased to offer you discounts on other types of insurance, helping you protect your business and your family more affordably. Our high customer satisfaction ratings are a testament to our commitment to delivering exceptional value and service.
What is the difference between an acute and a chronic condition for PMI?
An acute condition is a disease or injury that is expected to respond quickly to treatment and from which you can make a full recovery. Examples include a bone fracture, a hernia, or the need for a joint replacement. UK private medical insurance is specifically designed to cover the diagnosis and treatment of acute conditions that arise after your policy starts. A chronic condition, like diabetes or asthma, is one that requires long-term management and has no known cure. The routine monitoring and treatment of chronic conditions are not covered by standard PMI policies.
Is private health insurance a taxable benefit for my employees in the UK?
Yes, when a company pays for an employee's private medical insurance, it is considered a 'benefit in kind' (BIK). This means the employee must pay income tax on the value of the premium. The employer is also required to pay Class 1A National Insurance contributions on the premium amount. The benefit must be reported to HMRC on a P11D form for each covered employee. However, for the business itself, the cost of the premiums is typically an allowable business expense, which can be offset against corporation tax.
Can a small business health insurance policy cover pre-existing conditions?
Generally, standard small business PMI policies do not cover pre-existing conditions. If you choose 'Moratorium' underwriting, any condition that existed in the five years prior to the policy start date will be excluded. If you opt for 'Full Medical Underwriting', specific exclusions will be applied based on each employee's medical history. The only exception is 'Medical History Disregarded' (MHD) underwriting, which does cover pre-existing conditions. However, MHD is more expensive and typically only available to larger groups, though some insurers may offer it to smaller SMEs.
How many employees do I need to set up a group health insurance scheme?
You can set up a group private medical insurance scheme for as few as two employees, which can include the director. This makes it a highly accessible benefit even for the smallest of UK businesses, including start-ups and family-run companies. Group schemes often provide better value and more comprehensive cover options compared to individual policies.
Take the Next Step for Your Business
Investing in your team's health is one of the smartest decisions you can make for the future of your business. It protects your people, your productivity, and your bottom line.
Navigating the private medical insurance market can be complex, but you don't have to do it alone. The expert team at WeCovr is here to help. We'll compare plans from all the UK's leading insurers to find a policy that fits your needs and your budget—all at no cost to you.
Contact WeCovr today for a free, no-obligation quote and discover how affordable it can be to give your team the protection they deserve.