Guided options explained

Most leading insurers offer a ‘guided option’ which members can apply to their policy, resulting in lower premiums for their health insurance. With this option, the insurer offers you a select list of consultants and hospitals to choose from rather than the full list. Often with the ‘guided option’ the insurer will guarantee no shortfalls for the member to pay.

The ‘guided option’ is a great way to save money on your health insurance if you are happy for the insurer to choose the consultants you can see. By negotiating with certain consultants and hospitals, insurers can reduce the cost of treatment and hospital charges. They pass on some of these savings, reducing the premium you will pay.

In this guide we will explain the various ‘guided options’ offered by the leading UK health insurers.

AXA Health Guided Option

On average, members who use the ‘Fast Track Appointments’ service are seen twice as quickly as those whose GPs have referred them to a named specialist.

AXA Health offer the Guided Option on both their individual and business health plans. This option still gives you full access to the AXA Directory of hospitals, but you will be offered a choice of up to three specialists chosen by AXA Health. They will only ever be a consultant, never a junior doctor or a registrar.

With the Guided Option, you agree to use the ‘Fast Track Appointments’ service every time you need to see a specialist. You will need to ask for an ‘open referral’ from your GP. With an open referral your GP does not name a particular specialist, but instead gives you the type of specialist you need to see. AXA Health will provide appointment details with one of the specialists offered by the end of the next working day, if not before.

If you have a suspected cancer or heart condition and your plan covers you for this, AXA Health will arrange an urgent appointment with a specialist.

As you will be using specialists AXA Health have negotiated with, they can pass on the savings to you with a reduced premium.

How to use AXA Health Guided

Once you have your ‘open referral’ from your GP, you call AXA Health using the ‘fast-track appointments’ service.

You will be given a choice of up to 3 specialists. Appointments will be made by AXA Health by the end of the next working day.

If you have used their chosen specialist, AXA Health will settle all eligible bills in full. There will be no shortfall for you to pay.

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AVIVA Health Expert Select

AVIVA Health offer a ‘guided option’ called Expert Select, it is available on their individual and business policies and aims to deliver sustainable, quality healthcare at an affordable price.

Using clinical knowledge and independent quality data, AVIVA Health will signpost you to an appropriate treatment provider. Expert Select uses an ‘open referral’ approach, this means your GP will refer you to a type of specialist rather than a named consultant.

AVIVA Health will offer you a choice of hospitals when you make a claim. You will be offered between four or five quality assured medical facilities including leading hospitals, all local to you, with several specialists to choose from.

The hospital choices under Expert select are based on Care Quality Commission (CQC) and Health Improvement Scotland (HIS) ratings.

Under Expert Select, AVIVA Health guarantee to settle all bills in full. There will be no shortfalls for the member to pay on any eligible hospital or specialist charges for consultations, tests, or treatment.

How to use AVIVA Expert Select

Once you have your ‘open referral’ from your GP you call AVIVA Health. You will be given a choice of 4-5 hospitals and their specialists.

AVIVA Health can give you further information on the facilities offered and even transfer you to book an appointment there and then.

Once you have had your treatment, AVIVA Health will settle all eligible bills in full. There will be no shortfall for you to pay.

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Bupa Guided Care

93% of customers who used the Bupa ‘open referral network’ said the quality of their care was ‘excellent’ or ‘very good’.

87% of customers who used the Bupa ‘open referral network’ rated their consultant as ‘excellent’.

Bupa Guided Care is available on both Bupa By You and Bupa Fundamental policies. This option aims to give members access to the healthcare they want for a lower price, without compromising on quality.

When you choose this option Bupa will offer you a shortlist of consultants from their ‘open referral network’. This means instead of your GP referring you to a named consultant they will refer you to the type of specialist you need. Bupa will then offer you a choice of three consultants from within the network.

With over 18,000 consultants, the Bupa ‘open referral network’ is the largest network of healthcare professionals of all leading UK insurers.

With the ‘guided care’ option you can use Bupa’s ‘Direct Access’ service, giving you access to a specialist over the telephone without the need to see your GP.

If you choose the Guided Care option, Bupa will guarantee all costs are covered in full and members will not face any shortfalls from consultants. This is when you use the ‘open referral network’ or ‘Direct Access’ service, and you call Bupa for pre-authorisation of treatment.

The ‘Direct Access’ service is available for:

Any suspected symptom of cancer.

Muscle, bone, and joint problems.

Mental health conditions.

How to use Bupa Guided Care

When you need to see a consultant, you call Bupa first if the ‘Direct Access’ service is available or ask your GP for an ‘open referral’.

For GP referrals, you then call Bupa to pre-authorise any consultations, tests, or treatment you need.

If you have a GP referral to see a surgeon for certain muscle, bone or joint conditions, Bupa will offer you a telephone appointment with one of their Advanced Practice Physiotherapists who can explain your treatment options, including any that do not involve surgery.

Bupa will offer you two or three consultants to choose from. They guarantee that all costs will be covered, and you will not face any shortfalls.

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VitalityHealth Consultant Select

Customer satisfaction increased by 22% when using Consultant Select.

Re-admission for treatment for the same condition reduced by 9.4% when using Consultant Select.

VitalityHealth offer a ‘guided option’ called Consultant Select on their individual and business plans. This treatment pathway uses an intelligent consultant ranking tool that means you will see a consultant who has a track record of excellent treatment outcomes and positive feedback from patients.

VitalityHealth believe that good treatment outcomes lead to lower long-term claims costs, which means they can charge a lower premium without compromising on quality.

The VitalityHealth member care team will support you in finding an appropriate consultant, and you will be guaranteed to be offered an appointment within 10 days, often sooner.

The ‘Consultant Panel’ is formed by Alliance Health Group, an independent doctor owned organisation. They are the biggest national group of UK consultants in private practice and are all reviewed and audited by their peers. They also undergo customer satisfaction assessments to ensure you receive the highest standard of care. All Alliance Health Group consultants are acknowledged experts in their fields, working across 65 specialisms and 34 sub-specialisms of medicine.

The Consultant Select network provides coverage across all regions, specialities, and hospitals and VitalityHealth guarantee you will not need to travel more than 40 minutes for a consultation, except in special circumstances.

The ‘Consultant Panel’ fully manage the claim, including prompt authorisation of further treatment if needed, without you having to obtain further authorisation from VitaltyHealth.

The VitalityHealth ‘Patient Charter’ ensures you have the right to change to another preferred consultant if you are not happy.

As with all insurer guided options, the cost savings achieved through efficiencies in the process, and negotiated rates with consultants on the panel result in lower health insurance premiums for the member.

How to use VitalityHealth Consultant Select

Once you have been referred for further treatment or advice you call Vitality. You can also make a claim online or via the Vitality GP app.

The ‘Consultant Panel’ looks at your symptoms and medical history, then recommends the best consultant, based on their expertise for your needs.

The ‘Consultant Panel’ fully manage the claim, including the authorisation of further treatment if needed.

Once you have had your treatment, VitalityHealth will settle all eligible bills directly and in full. There will be no shortfall for you to pay.

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Cost savings

Choosing the guided option when taking out health insurance can result in lower premiums. You can also consider adding this option at your renewal if you are looking to reduce your health insurance premium. If you are happy for the insurer to choose the specialist or hospital for you, it can be a great way to have affordable health insurance whilst still accessing quality private health treatment.

Morehealth can compare the leading UK insurers for you and provide various quotes based on your requirements and budgets. We are also able to support you in choosing the best option based on the hospitals local to you and tell you which policy includes them.

We have provided some examples below of the price difference between the leading UK health insurer policies with and without their guided option selected. All prices have been based on a 35-year-old female, living in Warwickshire, with a fully comprehensive policy and a £200 or £250 excess. The prices are indicative only and each insurer has different core policy benefits. They are also based on the standard pricing and do not include any ‘price matching’ offers that are available with some insurers.

Without the Guided Option the premium would be approximately £870 per year.

Without the Guided Option the premium would be approximately £870 per year.

Without Expert Select the premium would be approximately £625 per year.

With Expert Select the premium would be approximately £460 per year.

With Expert Select the premium would be approximately £460 per year.

With Expert Select the premium would be approximately £460 per year.

Without Consultant Select the premium would be approximately £520 per year.

Without Consultant Select the premium would be approximately £520 per year.

On average the saving on your health insurance policy for adding the guided option will be 20%, with the highest saving with AXA Health and the lowest with Vitalityhealth.

You may decide you prefer to have full access to all hospitals and specialists, but it is still worth letting Morehealth check the savings available by comparing your health insurance policy with the market. Our friendly advisors are available at the end of the telephone to discuss your options.

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