Medical

Plan highlights

• Core Care (Benefits Paid in Full)
  • In-patient treatment – hospital costs including surgery, tests, drugs, dressings, and accommodation (fees for specialists and anaesthetists for in-patient or day-patient care)
  • Advanced scans (CT, MRI, and PET) on specialist referral 
  • Out-patient surgery (when referred by a specialist) 
  • Cancer care – radiotherapy and chemotherapy included with no time or financial limits 
• Consultations: No yearly limit for specialist consultations, including diagnostic tests upon specialist referral.  However, there are fees for practitioners including nurses, dietitians, orthoptists, speech therapists and audiologists. 
• Therapy: No yearly limit for out-patient physiotherapy, acupuncture, osteopathy or chiropractic treatment. Up to an overall maximum of ten sessions a year on GP referral. Extra sessions if your specialist refers you. 
• Private GP treatment: Up to £500 per year for Private GP Consultations 
• Mental health services: Face to face, email or phone counselling sessions through AXA’s mental health assessments and support service (available to members aged 18 and over). Psychiatric treatment as an in-patient or day-patient, including specialist fees. Out-patient fees for psychologists and cognitive behavioural therapists on specialist referral. 
• Doctor@Hand: unlimited video or telephone consultations with a private general practitioner
• Support for muscles bones and joints (previously known as “Working Body”) – Direct access to diagnosis and treatment for aches and pains; no need for a GP appointment. 
• Dedicated nurse and expert health helpline: 24/7 telephone access to nurses and health care professionals for advice on a heart condition or cancer diagnosis or to answer your health care questions
• AXA Health Dentist and optician cashback
  • To claim for dentist and optical cashback, you should first log in to your AXA Member Online Account. From there, locate the dental and optical benefit section to find the online claim form and upload copies of your itemised receipts or invoices from the dentist or optician. Submit the form to the AXA Health claims team, and they will process the claim and send reimbursement, usually within 14 days. 
  • Step-by-Step Claim Guide (dentist and optical cashback) 
    • Get an Itemised Receipt: After your appointment, ask your dentist or optician for a fully itemised receipt that shows what you paid for. 
    • Log In: Access your Member Online account. 
    • Find the Benefit Section: Navigate to the Dental & Optical benefit icon or section. 
    • Complete the Form: Fill out the online claim form provided. 
    • Upload Documents: Upload clear copies of your itemised receipts. 
    • Submit: Send the claim to the AXA Health claims team. You will typically receive your money back within 14 days of submitting a valid claim, although this can vary. 

Be sure to check your membership certificate to confirm which plan options you have.

How your membership works

Our scheme covers planned eligible treatment of acute medical conditions (something that responds quickly to treatment that leads to a full recovery or will return the condition back to a controlled state following a flare-up). 

Our medical insurance cover supplements the NHS. It doesn’t replace it. There are some conditions and treatments that are better handled by the NHS, including emergencies. Some illnesses and treatments are not covered such as pre-existing conditions and chronic conditions (long-term, incurable or requiring routine monitoring or maintenance). 

Any pre-existing medical conditions or symptoms you had in the five years before you joined aren’t covered until you have been a member for two years in a row, and you have had one continuous year trouble-free from that condition after you joined. (trouble-free means having not experienced any symptoms, taken medication or consulted a medical professional in this 12-month period). 

When you join the scheme, AXA Health do not ask you to give details of your medical history or make you undergo a medical examination. Instead, at the point of making a claim you may be asked to provide a medical report (or give consent for AXA Health to obtain this from your GP), which will allow them to determine whether your claim relates to a new condition, or a pre-existing condition. 

Cost of coverage

The employee plan is completely funded by Rivian. Most services are paid in full; however, excess costs are not covered. The cost of family cover for employees in levels RIV 1 to RIV 7 is calculated by AXA Health and deducted from your paycheque.

For complete plan details, including what is and is not covered, refer to your AXA Business Health guide

Making a claim

If your general practitioner recommends that you see a specialist, ask for an open referral to a private specialist. This allows the fast-track appointment service to make sure you’re covered, help you find the right specialist for you (which could be a specialist with the NHS), and make your appointment.

If you see a specialist or receive treatment without following this process, you may receive a bill for services that aren’t covered by your plan.

You can pre-authorise treatment by phone or online. If your claim is urgent, call AXA to make sure you’re covered for your claim before you have any treatment.