
TL;DR
As an FCA-authorised expert with over 900,000 policies of various kinds arranged, WeCovr helps UK businesses navigate the world of private medical insurance. This guide explains how PMI for SMEs works in 2025, empowering you to make the best choice for your company and your team. Clear guide to group policy setup, employee perks, cost-saving tips, and navigating SME insurance regulations In today's competitive landscape, attracting and retaining top talent is a major challenge for Small and Medium-sized Enterprises (SMEs).
Key takeaways
- Acute conditions are illnesses or injuries that are new, short-term, and likely to be resolved with treatment (e.g., a hernia, cataracts, joint pain requiring replacement).
- Chronic conditions are long-term issues that require ongoing management but typically have no cure (e.g., diabetes, asthma, high blood pressure). These are managed by the NHS.
- Reduced Sickness Absence: Faster access to treatment means employees return to work sooner. The Office for National Statistics (ONS) reported that 185.6 million working days were lost due to sickness or injury in 2022, the highest on record. PMI directly tackles this issue.
- Boosted Productivity: A healthy, present workforce is a productive one. Addressing health concerns promptly minimises the impact of "presenteeism"—where employees are at work but not fully functional due to illness.
- Talent Attraction & Retention: In a competitive job market, a health insurance plan is a highly sought-after perk. It shows you care about your team's wellbeing, making your company a more attractive place to work.
As an FCA-authorised expert with over 900,000 policies of various kinds arranged, WeCovr helps UK businesses navigate the world of private medical insurance. This guide explains how PMI for SMEs works in 2025, empowering you to make the best choice for your company and your team.
Clear guide to group policy setup, employee perks, cost-saving tips, and navigating SME insurance regulations
In today's competitive landscape, attracting and retaining top talent is a major challenge for Small and Medium-sized Enterprises (SMEs). A robust employee benefits package is no longer a luxury—it's a necessity. At the heart of a modern benefits package lies business health insurance, also known as Private Medical Insurance (PMI).
This comprehensive guide will walk you through everything you need to know about setting up a group PMI policy for your SME in 2025. We'll explore the tangible benefits for your staff, provide actionable cost-saving tips, and demystify the regulations and tax implications.
What is Business Health Insurance and Why is it Vital for UK SMEs in 2026?
Business health insurance is a private policy taken out by an employer to give their employees access to private healthcare. Its primary purpose is to diagnose and treat acute medical conditions quickly, helping your staff get back on their feet and back to work sooner.
Crucially, standard UK PMI does not cover pre-existing or chronic conditions.
- Acute conditions are illnesses or injuries that are new, short-term, and likely to be resolved with treatment (e.g., a hernia, cataracts, joint pain requiring replacement).
- Chronic conditions are long-term issues that require ongoing management but typically have no cure (e.g., diabetes, asthma, high blood pressure). These are managed by the NHS.
With NHS waiting lists remaining a significant national concern, the value of PMI has never been clearer. According to the latest NHS England data, the waiting list for consultant-led elective care stood at around 7.5 million cases. For an SME, an employee facing a long wait for diagnosis or treatment can mean months of lost productivity and uncertainty.
Key Benefits of PMI for Your Business:
- Reduced Sickness Absence: Faster access to treatment means employees return to work sooner. The Office for National Statistics (ONS) reported that 185.6 million working days were lost due to sickness or injury in 2022, the highest on record. PMI directly tackles this issue.
- Boosted Productivity: A healthy, present workforce is a productive one. Addressing health concerns promptly minimises the impact of "presenteeism"—where employees are at work but not fully functional due to illness.
- Talent Attraction & Retention: In a competitive job market, a health insurance plan is a highly sought-after perk. It shows you care about your team's wellbeing, making your company a more attractive place to work.
- Improved Employee Morale: Providing health cover demonstrates a genuine investment in your employees' health and happiness, fostering loyalty and a positive company culture.
NHS vs. Private Medical Insurance: A Quick Comparison
| Feature | NHS Route | Private Medical Insurance (PMI) Route |
|---|---|---|
| Referral & Diagnosis | GP referral, then join NHS waiting list for specialist appointment and scans. Can take months. | Fast GP referral (often via a digital GP app), prompt specialist appointment, and swift access to diagnostic tests. |
| Treatment | Join another NHS waiting list for treatment or surgery. The wait can be extensive. | Treatment scheduled at a time and place convenient for the employee, often within weeks. |
| Choice & Comfort | Limited choice of hospital or consultant. Treatment is typically in an NHS ward. | Choice of leading consultants and a UK-wide network of private hospitals. Often includes a private, en-suite room. |
| Cost | Free at the point of use, funded by taxation. | Paid for via monthly or annual premiums. |
| Cover Focus | Covers all medical needs, including chronic conditions and emergencies. | Covers eligible acute conditions that arise after the policy begins. |
Setting Up Your SME Group Health Insurance Policy: A Step-by-Step Guide
Implementing a group health policy might seem daunting, but it can be a straightforward process, especially with expert guidance. A group scheme covers multiple employees under a single policy, making it more cost-effective and easier to manage than individual plans.
Here's how to get started:
1. Assess Your Company's Needs and Budget
Before you look at policies, consider:
- How many employees will you cover? Most insurers require a minimum of two or three employees for a group scheme.
- What is your budget? Premiums are paid per employee, so you need a clear idea of what you can afford.
- What are your goals? Are you trying to reduce sickness absence, attract new hires, or both? Your goals will influence the level of cover you choose.
2. Understand the Underwriting Options
Underwriting is how an insurer assesses risk and decides on the terms of your policy. For SMEs, there are three main types:
| Underwriting Type | How It Works | Pros | Cons |
|---|---|---|---|
| Full Medical Underwriting (FMU) | Employees complete a detailed health questionnaire. The insurer then lists specific exclusions for any pre-existing conditions. | Clarity from day one. You know exactly what is and isn't covered for each person. | Can be administratively heavy. May result in multiple personal exclusions. |
| Moratorium (MOR) | No medical questionnaire is needed upfront. Instead, the insurer automatically excludes treatment for any condition an employee has had symptoms of, or sought advice for, in the 5 years before joining. | Quick and easy to set up. | The "2-year rule": if an employee goes 2 continuous years on the policy without any symptoms, treatment, or advice for that condition, it may become eligible for cover. This can create uncertainty. |
| Medical History Disregarded (MHD) | Available for larger groups (typically 20+ employees). The insurer agrees to cover eligible acute conditions, regardless of previous medical history. | The most comprehensive cover. No personal medical exclusions. Simple to administer. | The most expensive option. Only available for larger SME schemes. |
An expert adviser at WeCovr can help you determine which underwriting method is most suitable for your business size and budget.
3. Choose Your Core and Optional Benefits
Most PMI policies are built around a core offering, which you can then enhance with optional extras.
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Core Cover (Standard):
- In-patient treatment: Covers costs when you're admitted to a hospital bed, including surgery, accommodation, and nursing care.
- Day-patient treatment: Similar to in-patient, but you aren't required to stay overnight.
- Comprehensive Cancer Cover: A vital component, providing access to specialist treatments, drugs, and therapies that may not be available on the NHS.
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Optional Add-ons:
- Out-patient cover: Covers consultations and diagnostic tests that don't require hospital admission. This is a very popular and useful add-on. You can often choose a limit (e.g., £500, £1,000, or unlimited).
- Mental Health cover: Provides access to counsellors, therapists, and psychiatrists. Increasingly seen as an essential benefit.
- Therapies: Includes physiotherapy, osteopathy, and chiropractic treatment.
- Dental and Optical cover: Helps with routine check-ups, treatments, and prescription eyewear.
4. Implement and Communicate the Policy
Once you've chosen your policy, the final step is to roll it out to your team. Clear communication is key. Explain what the benefit is, how it works, what's covered, and how to make a claim. This ensures your investment is understood and valued by your employees.
The Real Perks for Your Employees: More Than Just Fast-Tracked Treatment
While skipping the queue is a major draw, modern PMI policies offer a wealth of additional benefits that support an employee's overall wellbeing. These "value-added services" are often available to use from day one, without needing to make a claim.
- Digital GP Services: 24/7 access to a GP via phone or video call. This is incredibly convenient for getting quick advice, prescriptions, or referrals without having to take time off work for an in-person appointment.
- Mental Health Support: Many policies now include access to confidential helplines, therapy sessions (often via video call), and self-help apps for managing stress, anxiety, and other mental health challenges.
- Wellness Programmes & Apps: Insurers are increasingly focused on proactive health. This includes access to nutrition advice, fitness plans, and health tracking apps. For example, all clients who purchase PMI or Life Insurance through WeCovr receive complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app.
- Health and Lifestyle Rewards: Some providers offer discounts on gym memberships, fitness trackers, and healthy food to incentivise a healthy lifestyle.
- Second Medical Opinions: The ability to get a second opinion from a world-leading expert if an employee is diagnosed with a serious condition.
- Discounts on Other Insurance: When you arrange your business health cover with us, your team may also be eligible for discounts on other policies like life insurance or travel insurance.
These perks transform a health insurance policy from a simple safety net into a day-to-day wellness tool, creating a healthier and more engaged workforce.
Mastering the Costs: Smart Tips for Affordable SME Health Cover
The cost of a business health insurance policy depends on several factors: the average age of your employees, your location (premiums are higher in London), your industry, and the level of cover you choose.
However, there are several effective ways to manage the premium without compromising on quality.
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Introduce or Increase the Excess: An excess is a fixed amount an employee pays towards their claim each year (e.g., £100, £250, £500). A higher excess means a lower premium for the business. You can choose to set the excess level for the whole group.
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Opt for the '6-Week Wait' Option: This is one of the most popular cost-saving levers. With this option, if the NHS can provide the required in-patient treatment within six weeks of when it's needed, the employee will use the NHS. If the wait is longer than six weeks, the private medical insurance kicks in. As it reduces the number of claims, it can significantly lower your premium.
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Choose a Guided Hospital List: Insurers offer different tiers of hospital lists. A comprehensive national list is the most expensive. You can reduce costs by:
- Choosing a list that excludes expensive central London hospitals.
- Opting for a "guided" or "consultant-led" option, where the insurer provides a choice from a smaller panel of pre-approved specialists, which helps them control costs.
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Tailor Your Out-patient Cover: Full, unlimited out-patient cover is expensive. Consider setting a limit (e.g., £1,000 per person per year) or asking employees to get a GP referral before seeing a specialist to keep costs down.
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Review Optional Benefits: Carefully consider which add-ons are essential for your workforce. While mental health cover is highly valued, you might decide that routine dental and optical cover is a lower priority.
Example: How Different Choices Affect Premiums
Here is a simplified example for a fictional SME with 10 employees (average age 40) based outside London. These are illustrative figures only.
| Policy Options | Estimated Annual Premium Per Employee | How it Saves Money |
|---|---|---|
| Full Cover (Unlimited out-patient, no excess, full hospital list) | £1,200 | N/A (Baseline) |
| With £250 Excess | £1,050 | The excess reduces the insurer's liability on smaller claims. |
| With 6-Week Wait Option | £850 | Shifts some treatment back to the NHS, reducing claims. |
| With £1,000 Out-patient Limit | £900 | Caps the insurer's spending on diagnostics and consultations. |
| All cost-saving options combined | £650 | Layering these options provides the most significant saving. |
Working with an expert PMI broker like WeCovr allows you to model these different scenarios and find the perfect balance between comprehensive cover and an affordable premium.
Navigating the Rules: SME Insurance Regulations and Tax Implications
Understanding the financial and regulatory side of business health insurance is crucial for compliance.
Tax Implications for Your Business
Good news: the cost of your company's health insurance premiums is generally considered an allowable business expense. This means you can deduct the full cost from your taxable profits, reducing your overall Corporation Tax bill. It's a tax-efficient way to invest in your team.
Tax Implications for Your Employees
Because the company is paying for a personal benefit, private medical insurance is treated as a 'benefit in kind'.
- This means the value of the premium is added to the employee's income for tax purposes.
- As the employer, you are required to report this on a P11D form for each employee who receives the benefit.
- The employee then pays income tax on the value of the premium at their marginal rate (e.g., 20% or 40%).
- The business also pays Class 1A National Insurance Contributions (NICs) on the value of the benefit.
It's important to communicate this clearly to employees so they understand the small personal tax implication of this valuable perk.
Regulation and Your Peace of Mind
The UK's private health insurance market is regulated by the Financial Conduct Authority (FCA). This ensures that insurers and brokers (like WeCovr) adhere to strict rules on fairness, clarity, and treating customers properly. Working with an FCA-authorised firm gives you confidence that you are receiving professional, regulated advice. All premiums also include a standard rate of Insurance Premium Tax (IPT), which is currently 12%.
Frequently Asked Questions (FAQs) about SME Health Insurance
What is the minimum number of employees for a group health insurance policy?
Is mental health covered by business health insurance?
Do my employees have to declare their full medical history?
Can we add family members to a company PMI policy?
Protect Your Team, Protect Your Business
In 2025, offering private medical insurance is one of the most powerful statements an SME can make. It's a strategic investment in the health of your employees, the resilience of your business, and your reputation as a top employer.
By understanding the options, utilising cost-saving strategies, and working with an expert adviser, you can implement a high-value scheme that fits your budget and delivers real peace of mind.
Ready to explore the best private medical insurance options for your SME?
Contact WeCovr today for a free, no-obligation quote. Our expert advisers will compare the UK's leading providers to find a policy that's perfectly tailored to your business needs.











