TL;DR
As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr understands the intricate world of private medical insurance in the UK. This article reviews niche PMI options from Westfield Health and Healix, exploring their innovative workplace schemes and group plans for businesses seeking alternatives to mainstream providers. Reviewing workplace schemes, group plans, and innovation from non-mainstream PMI brands When UK businesses consider private health cover for their teams, names like Bupa, Aviva, and AXA often come to mind.
Key takeaways
- Westfield Health's unique not-for-profit approach, blending affordable health cash plans with streamlined hospital treatment insurance.
- Healix's corporate healthcare trust model, which offers an alternative to traditional insurance for medium and large businesses.
- How these models differ from standard private health cover and which type of business they suit best.
- The crucial role an expert broker plays in navigating this complex and varied market.
- 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, or treatment for an infection.
As an FCA-authorised expert broker that has helped arrange over 900,000 policies, WeCovr understands the intricate world of private medical insurance in the UK. This article reviews niche PMI options from Westfield Health and Healix, exploring their innovative workplace schemes and group plans for businesses seeking alternatives to mainstream providers.
Reviewing workplace schemes, group plans, and innovation from non-mainstream PMI brands
When UK businesses consider private health cover for their teams, names like Bupa, Aviva, and AXA often come to mind. These giants dominate the landscape, offering comprehensive policies that are a fantastic fit for many. However, the UK private medical insurance market is more diverse than it first appears.
Beyond the mainstream lie specialist providers like Westfield Health and Healix. These organisations offer innovative and often highly tailored solutions that can be a game-changer for businesses, particularly Small and Medium-sized Enterprises (SMEs) and larger corporations looking for greater control and cost-efficiency.
This article peels back the layers on these niche players. We will explore:
- Westfield Health's unique not-for-profit approach, blending affordable health cash plans with streamlined hospital treatment insurance.
- Healix's corporate healthcare trust model, which offers an alternative to traditional insurance for medium and large businesses.
- How these models differ from standard private health cover and which type of business they suit best.
- The crucial role an expert broker plays in navigating this complex and varied market.
For any business leader or HR manager, understanding these alternatives is key to building a benefits package that is not only competitive but also financially sustainable and perfectly aligned with your company's culture and needs.
Understanding the UK Private Medical Insurance Landscape
At its core, private medical insurance (PMI) is a policy you pay for that covers the cost of private healthcare for specific conditions. Its primary purpose is to help you bypass NHS waiting lists for eligible treatments, offering faster access to specialists, diagnostic tests, and surgery in a private hospital.
According to NHS England data, the median waiting time for consultant-led elective care stood at 14.5 weeks in July 2024, with hundreds of thousands waiting much longer. PMI provides a valuable alternative for those who want peace of mind and quicker access to care.
However, it's absolutely vital to understand what PMI is—and what it isn't.
The Golden Rule: Acute vs. Chronic Conditions
This is the most important distinction in all UK private health insurance. Standard policies are designed exclusively to cover acute conditions that begin after your policy starts.
- 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, or treatment for an infection.
- Chronic Condition: A disease, illness, or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring, has no known cure, is likely to recur, or requires palliative care. Examples include diabetes, asthma, arthritis, and high blood pressure.
Standard UK private medical insurance does not cover the ongoing management of chronic conditions. Similarly, it will not cover pre-existing conditions—any medical issue you had before the policy began. This is a fundamental principle of the market.
Mainstream vs. Niche Providers
The UK PMI market is dominated by a few large insurers. However, niche providers carve out specific areas where they excel:
- Mainstream Providers (e.g., Bupa, Aviva, AXA, Vitality): Offer a wide range of comprehensive policies for individuals, families, and businesses of all sizes. They are the "one-stop shop" for traditional insurance.
- Niche Providers (e.g., Westfield Health, Healix): Focus on specific market segments or alternative models. They might specialise in corporate plans, health cash plans, or innovative trust-based schemes, offering solutions that mainstream insurers may not prioritise.
Choosing between them requires a deep understanding of your organisation's specific goals, budget, and employee demographics.
Who is Westfield Health? A Deep Dive into their Approach
Westfield Health is not your typical insurer. With roots stretching back to 1919 as a hospital fund, it operates as a not-for-profit organisation. This means that instead of paying dividends to shareholders, profits are reinvested back into the business, used to enhance products, or donated to health and wellbeing charities like the NHS.
This ethos shapes their entire product range, which focuses on accessible, practical, and preventative healthcare for the workplace.
Core Offerings: More Than Just PMI
Westfield Health’s proposition is built on a blend of products designed to support everyday health and provide cover for more serious issues.
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Health Cash Plans: This is Westfield's signature product. A health cash plan is not PMI; it's a simple and affordable employee benefit that provides cashback for routine healthcare expenses. Employees pay for their treatment (e.g., a dental check-up or a new pair of glasses) and then claim a percentage of the cost back, up to an annual limit. It's highly valued by employees as it helps with predictable, everyday costs.
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Hospital Treatment Insurance: This is Westfield’s version of private medical insurance. It is often more streamlined and modular than comprehensive policies from larger insurers. The focus is on providing cover for essential surgical and medical procedures, giving employees a way to bypass long waiting lists for planned surgery.
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Mental Health & Wellbeing Support: Recognising the growing importance of mental health, Westfield heavily integrates support services into their plans. This includes access to 24/7 doctor and counselling helplines, mental health first aid training for managers, and resources through their dedicated apps and portals.
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Proactive Health Services: Their plans often include gym discounts, health screenings, and access to services that encourage a healthy lifestyle, positioning them as a partner in wellbeing, not just an insurer for sickness.
Who is Westfield Health For?
Westfield Health excels in the corporate market, particularly for:
- SMEs: Their affordable health cash plans are an excellent first step into health benefits for smaller companies that may find comprehensive PMI too expensive.
- Companies with a large blue-collar or operational workforce: The tangible benefits of a cash plan (money back for dental/optical) are often more immediately appreciated than a complex PMI policy.
- Organisations focused on building a culture of wellbeing: Their holistic approach, combining cash plans, mental health support, and preventative tools, aligns perfectly with a proactive HR strategy.
An expert broker like WeCovr can help a business analyse if a Westfield Health cash plan, their hospital treatment insurance, or a combination of both is the most effective way to support their team within their budget.
| Westfield Health Product | What It Is | Key Benefit for Employees | Best For Businesses Seeking... |
|---|---|---|---|
| Health Cash Plan | A policy providing cashback for routine healthcare (dental, optical, physio etc.). | Money back in your pocket for everyday health costs. Simple to use and understand. | An affordable, high-value benefit that all employees can use. |
| Hospital Treatment Insurance | A form of Private Medical Insurance focused on surgical and hospital care. | Faster access to planned surgery and medical treatment in a private hospital. | A cost-effective way to provide essential private medical cover. |
| Wellbeing & Mental Health | Integrated support services, including helplines, apps, and resources. | 24/7 access to doctors, counsellors, and tools to manage wellbeing. | To build a supportive culture and address mental health proactively. |
Exploring Healix Health Services: The 'Trust' Model Explained
Healix Health Services offers a fundamentally different approach to corporate healthcare. They are not an insurer; they are a manager and administrator of corporate healthcare trusts. This model is a sophisticated alternative to traditional insured PMI plans and is primarily aimed at medium to large-sized companies.
How a Healthcare Trust Works
Instead of paying a fixed premium to an insurance company, a business using a trust model sets aside its own funds to pay for its employees' medical claims.
Here’s a simplified breakdown of the process:
- The 'Trust Fund' is Created: The company estimates its likely annual claims cost (often with expert help from Healix) and places this amount into a dedicated trust fund, ring-fenced from the business's main finances.
- Healix Administers the Scheme: Healix acts as the third-party administrator. They handle all aspects of the scheme:
- Medical Expertise: Their team of nurses and doctors assesses claims, ensuring treatments are medically appropriate.
- Claims Management: They process claims and arrange payments to hospitals and specialists directly from the trust fund.
- Provider Network: They provide access to their extensive network of private hospitals and consultants across the UK.
- Stop-Loss Insurance is Added: To protect the company from a disastrously high-claims year (e.g., several employees needing very expensive cancer treatment), a "stop-loss" insurance policy is put in place. This policy kicks in and covers costs once a certain threshold is met, either for an individual claim or for the total claims pool.
- Surpluses are Retained: If claims in a given year are lower than the amount placed in the trust, the surplus money remains the property of the company. It can be carried over to the next year or even returned to the business, subject to the trust's rules.
Benefits and Drawbacks of the Trust Model
For the right company, a healthcare trust offers significant advantages over traditional insurance.
Advantages:
- Potential Cost Savings: By cutting out the insurer's profit margin and retaining any surplus, trusts can be more cost-effective over the long term.
- Ultimate Flexibility: The company sets the rules. You can design a bespoke plan that covers exactly what you want, from mental health to fertility treatments, without being limited by an insurer's standard policy terms.
- Transparency: You get detailed data on how your healthcare spend is being used, allowing for more informed decisions about the scheme's design year-on-year.
- Exemption from Insurance Premium Tax (IPT): Premiums paid to an insurer are subject to IPT (currently 12%). A trust is not an insurance policy, so contributions to the fund are not subject to this tax, providing an immediate saving.
Disadvantages:
- Financial Risk: The company bears the risk for claims up to the stop-loss level. A bad claims year could cost more than an insured premium would have.
- Scale is Required: The model only becomes viable for companies with a sufficient number of employees (typically 100+, often 250+) to create a predictable claims pool.
- Administrative Complexity: While Healix manages the process, it is inherently a more complex arrangement than simply buying an off-the-shelf policy.
Traditional Insured PMI vs. Healix Healthcare Trust
| Feature | Traditional Group PMI | Healix Healthcare Trust |
|---|---|---|
| Cost Structure | Fixed annual premium paid to an insurer. | Contributions to a trust fund + admin fees + stop-loss premium. |
| Financial Risk | Held entirely by the insurance company. | Held by the employer up to the stop-loss insurance trigger point. |
| Surplus Funds | Kept by the insurer as profit. | Retained by the company's trust. |
| Flexibility | Limited to the insurer's policy options and modules. | Highly bespoke. The company designs the scheme's rules. |
| Tax | Insurance Premium Tax (12%) is payable on premiums. | No IPT on contributions to the fund. |
| Best Suited For | Businesses of all sizes, especially those seeking budget certainty. | Medium-to-large companies (100+ employees) seeking cost control and flexibility. |
Westfield Health vs. Healix: A Head-to-Head Comparison
While both are niche players in the UK private health cover market, Westfield Health and Healix serve very different needs through distinct models. Understanding this difference is crucial for any business choosing a health benefits partner.
| Comparison Point | Westfield Health | Healix Health Services |
|---|---|---|
| Business Model | Not-for-profit provider of cash plans & insured PMI. | For-profit administrator of corporate healthcare trusts. |
| Primary Offering | Health Cash Plans, Hospital Treatment Insurance. | Fully managed Healthcare Trust schemes. |
| Target Market | SMEs and corporates of all sizes. Strong in non-office environments. | Medium-to-large corporates (typically 100+ employees). |
| Key Selling Point | Affordable, tangible benefits (cash back) and ethical, not-for-profit status. | Cost control, flexibility, transparency, and IPT savings. |
| Risk Model | Risk is held by Westfield Health as the insurer. | Risk is held by the client company (with stop-loss protection). |
| Employee Experience | Simple claims for everyday costs (cash plan) or standard PMI process. | Seamless experience managed by Healix nurses; feels like traditional PMI. |
In essence, a business might choose Westfield Health to provide a highly valued, low-cost benefit (the cash plan) that every single employee can use for their dental, optical, and therapy needs. It's a fantastic tool for recruitment and retention.
Conversely, a larger corporation might engage Healix to replace its traditional group PMI scheme. The goal would be to gain greater control over benefits, achieve long-term cost savings, and get transparent data on the health of its workforce, all while managing financial risk through a stop-loss policy.
Why Consider a Niche Provider for Your Workplace Scheme?
Stepping away from the default mainstream options can unlock significant advantages for your business and your employees.
- Tailored Solutions: Niche providers don't try to be everything to everyone. Healix's trust model offers unparalleled customisation, while Westfield's modular approach allows businesses to build a package that fits their budget.
- Cost-Efficiency: Whether it's the potential for retained surpluses in a Healix trust, the IPT savings, or the sheer affordability of a Westfield health cash plan, niche options often present a more financially efficient route to providing meaningful benefits.
- Focus on Employee Wellbeing: Many specialist providers are at the forefront of integrating proactive wellbeing into their services. They offer more than just a claims service; they provide tools, resources, and support to help employees stay healthy in the first place.
- Enhanced Employee Value: A health cash plan from Westfield is a tangible benefit that employees see the value of every time they visit the dentist or optician. This can drive higher engagement and appreciation than a traditional PMI policy that many may never use.
Navigating these choices can be complex. An independent, expert PMI broker like WeCovr is invaluable here. We can perform a full market analysis, comparing the comprehensive plans from mainstream insurers against the specialist solutions from providers like Westfield and the trust model from Healix, to find the perfect fit for your company's unique DNA.
The Role of an Expert PMI Broker Like WeCovr
The UK's private medical insurance landscape is varied and complex. For a business, choosing the right path—a traditional insured plan, a healthcare trust, a cash plan, or a combination—is a strategic decision with significant financial and cultural implications. This is not a decision to be made without expert guidance.
An independent broker like WeCovr acts as your specialist guide and advocate.
Why use WeCovr for your business?
- Whole-of-Market Expertise: We aren't tied to any single insurer. We have deep knowledge of the entire market, from the "big four" to specialists like Westfield Health. We can model the financial and practical implications of an insured plan versus a healthcare trust.
- Unbiased, Tailored Advice: Our first step is to understand your business: your budget, your employee demographics, and your goals. We then present the options that align with your needs, explaining the pros and cons of each in plain English.
- No Cost to You: Our expert advice and market comparison service is free for our clients. We receive a commission from the provider you choose, which is built into the provider's standard pricing. You get our expertise at no extra cost.
- Ongoing Support: We don't just find your policy; we help you manage it. At renewal, we'll re-evaluate the market to ensure you continue to have the best possible cover at the most competitive price.
- Added Value: At WeCovr, we believe in promoting genuine health. That's why clients who purchase PMI or Life Insurance with us receive complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app. We also offer discounts on other types of cover, helping you protect your business and your people more affordably.
With high customer satisfaction ratings and full authorisation from the Financial Conduct Authority (FCA), WeCovr provides the trusted expertise you need to make the best decision for your team.
Integrating Wellness: Beyond Just Treating Sickness
Modern health benefits are about more than paying for surgery. The most forward-thinking companies are building a culture of wellness that aims to prevent illness before it starts. This proactive approach not only leads to a healthier, happier, and more productive workforce but can also help manage the long-term costs of a health insurance scheme.
According to the Office for National Statistics (ONS), an estimated 1.8 million workers were reporting work-related ill health in 2022/23. Investing in wellness is investing in your business's most valuable asset.
Simple Wellness Tips for a Healthier Workplace
- Encourage Movement: Combat the effects of sedentary desk jobs. Promote "walking meetings," provide standing desk options, and share simple desk-based stretching routines. Even small bursts of activity can make a huge difference.
- Prioritise Mental Health: Create an open environment where mental health is discussed without stigma. Offer access to mindfulness apps, train managers as Mental Health First Aiders, and ensure employees know where to turn for confidential support, like the 24/7 helplines included in many modern health plans.
- Focus on Nutrition: Small changes can have a big impact. Provide healthy snacks in the office, run "lunch and learn" sessions with nutritionists, and encourage staff to use tools like the CalorieHero app to understand their dietary habits better.
- Champion Sleep: Educate your team on the importance of good sleep hygiene for cognitive function, mood, and physical health. Discourage a culture of late-night emails and promote a healthy work-life balance.
These initiatives, when combined with a well-chosen health benefits plan, create a powerful, holistic wellness strategy that shows your employees you truly care.
Critical Information: Pre-existing and Chronic Conditions
We must be exceptionally clear on this point, as it is the most common area of misunderstanding in private medical insurance UK.
Standard private medical insurance policies are designed to cover new, eligible medical conditions that arise after the policy start date.
They are not designed to cover:
- Pre-existing Conditions: Any illness, injury, or related symptom for which you have experienced symptoms, received medication, advice, or treatment before the policy began.
- Chronic Conditions: Long-term conditions that require ongoing management and have no known cure, such as diabetes, Crohn's disease, arthritis, or asthma. While the initial diagnosis of a new chronic condition may be covered, the long-term, day-to-day management of it will typically revert to the NHS.
Insurers use a process called underwriting to handle pre-existing conditions. The two main types are:
- Moratorium Underwriting: You don't declare your medical history upfront. The insurer will automatically exclude any condition you've had in the past five years. However, if you remain completely trouble-free from that condition for a continuous two-year period after your policy starts, it may become eligible for cover.
- Full Medical Underwriting (FMU): You complete a full health questionnaire when you apply. The insurer assesses your medical history and explicitly states what will and will not be covered from the outset. This provides clarity but may lead to permanent exclusions.
The purpose of PMI is to provide a solution for acute, unexpected health issues, complementing the vital services provided by our NHS, which remains the primary provider for accident and emergency, as well as chronic care management in the UK.
Is a healthcare trust better than a traditional group PMI policy?
What is the difference between a health cash plan and private medical insurance?
Does private medical insurance in the UK cover pre-existing conditions?
Do I have to pay to use a PMI broker like WeCovr?
Choosing the right health benefits strategy is one of the most important decisions a business can make. The market offers a wealth of options beyond the obvious, with specialist providers like Westfield Health and Healix presenting compelling alternatives.
To explore which approach is right for your organisation, speak to an expert. Contact WeCovr today for a free, no-obligation review of your needs and a personalised quote from across the market.
Sources
- Office for National Statistics (ONS): Mortality, earnings, and household statistics.
- Financial Conduct Authority (FCA): Insurance and consumer protection guidance.
- Association of British Insurers (ABI): Life insurance and protection market publications.
- HMRC: Tax treatment guidance for relevant protection and benefits products.
