What's the right level of cover for you?

Written by Specialist Adviser, Emily McMillan

When it comes to protecting your practice against staff absence, there are several options to explore, one of which being the NHS Sickness Reimbursement. The scheme was a welcomed initiative, though fails to provide as comprehensive a cover as an insurance-backed policy. Locum Insurance offers you that added level of protection when a staff absence occurs, is tailored to suit your individual business needs and can work in-line with the scheme. However, having something bespoke to you, as you can imagine, can be a time-consuming and confusing decision to make. As an expert in Locum Insurance, MIAB’s Specialist Adviser, Emily McMillan, writes about the main options that are available to help you make an informed decision.

A new care model announced as part of the Five Year Forward View from NHS England set out to provide a more sustainable and secure primary care. As smaller GP practices formed – and continue to form - partnerships on an industrial scale through vanguards, super-practices and federations, the amount of staff you rely on multiplies, increasing the need to have adequate cover against absence. However, Locum Insurance should be considered no matter how big the practice, as any long-term absence can have a devastating effect on the practices income and ability to meet patient demand.

All Staff Blanket-Style Plan

If you’re a part of a large-scale practice, providing information for 100+ employees can be an impossible task, so an all-encompassing plan is an attractive choice due to its ease of policy set up, minimal underwriting (details of the insured individuals) and cost effectiveness. However, a policy that doesn’t require underwriting has its downside. If you don’t read and fully understand the ‘Statement of Fact’ you may be disappointed when you come to claim. Equally as important, all pre-existing conditions are excluded some of which you may be able to cover with a medically underwritten plan.

Traditional Cover

Alternatively, the traditional ‘full cover’ plan is a fully medically underwritten policy. Understandably, the demand for this option has decreased since the introduction of the NHS Sickness Reimbursement Scheme, but it’s arguably the most robust policy, and often bespoke. You can arrange cover levels specific to each member depending on their individual requirements, while still reaping the benefits of a group plan including a group policy discount and sharing of broker fees. Fully medically underwritten policies provide comfort to the insured, because the full policy terms are laid out at the point of purchase, lowering the risk of a nasty surprise when making a claim. Some insurers also allow optional extras like family cover available for those who may take maternity/paternity/adoption leave in the future, plus there is the option to change the claims basis from indemnified (receipts required to claim) to benefit-driven (receipts not required to claim). However, a potential drawback to this kind of policy is that it can lead to higher premiums because independently of NHS cover, the policy has to finance the whole weekly benefit.

Top-Up Plan

The introduction of the NHS Sickness Reimbursement scheme in 2017 led MIAB to developing a policy that complemented the scheme whilst plugging the gaps in cover that the NHS couldn’t offer, referred to as a Top-Up plan.

This announcement was a monumental step for general practice that changed ‘discretionary’ sick pay to an ‘entitlement’ for all GP performers in England, Scotland, Wales and more recently Northern Ireland. The money offered by the NHS can provide repayment to cover the cost of a Locum GP, but it’s not as comprehensive as an insurance-backed plan, and in the majority of cases, practices find themselves short of funds if they rely solely on the reimbursement. This is because the money claimable is a fixed number of £1,751 per week at weeks 2-26, and £875 at weeks 26-52 for England, Scotland & Wales, or 1,734 per week at weeks 4-26 and £867 at weeks 26-52 for Northern Ireland. These figures rarely cover the full replacement cost for a full-time GP as total replacement costs can exceed £3000 per week*. Furthermore, cover for suspension whilst under investigation, compassionate leave, revalidation or jury service are not covered under the NHS contract changes, but are covered under an insurance policy.

The plans available that provide cover alongside the NHS reimbursement have proved to be very popular amongst practices. Policies such as the Top-Up plan allow you to claim the full NHS reimbursement offer, whilst also insuring for any costs which go over and above their fixed amount.

A further benefit is that lower premiums can be expected due to the insurer accepting far less of a risk in comparison to a traditional plan. Additionally, should the reimbursement cease at any point, you may be able to revert your cover back to a traditional (or full cover policy) subject to underwriting.

As part of this cover, it’s worth mentioning that if the NHS declines your claim, an insurance policy will not step in and offer to cover the full claim amount, as most of these kind of plans are designed to cover only the shortfall, and provide cover where the reimbursement will not.

Each policy has its benefits, it’s all about finding the right one for your business. Whether you’re a single practice, or multi-partnered venture, speak to MIAB’s Specialist Insurance Adviser, Emily McMillan on 01438 871710, or emily.mcmillan@miab.co.uk

*Based on locum cover costing £300-£350 per session.

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