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Private medical insurance (PMI) is a go-to solution for employers looking to provide employees with access to healthcare. Designed to reduce waiting times and provide private treatment, PMIs offer significant advantages over public healthcare services.

From inpatient care to outpatient consultations, these policies cater to a variety of needs, depending on the level of cover.

But even the most comprehensive health insurance policies often leave significant gaps in what they offer, limiting access to certain types of treatments or imposing restrictions on pre-existing conditions and chronic conditions. This is especially the case when it comes to reproductive health challenges such as fertility and family-forming and menopause.

In this article, we will look at the key gaps in PMIs and how Fertifa serves as an affordable health insurance add-on to address them.

The appeal of private medical insurance providers

PMIs provide employees with faster access to treatment in private hospitals, bypassing the long waiting lists often seen in public healthcare systems such as the NHS. The benefits include:

• Comprehensive cover for acute conditions and critical illnesses like a heart attack or stroke
• Access to private consultants and specialists
• Coverage for inpatient care, outpatient consultations, and some mental health care
• Enhanced health insurance coverage for medical emergencies and hospital charges

Employers offering private health insurance plans help their workforce feel secure and valued. However, health insurance providers face challenges in creating truly comprehensive policies, which often leads to unmet employee needs.

The current gaps in PMI policies

Even with a comprehensive plan, many PMIs will have significant gaps and limitations in comprehensive coverage- and this is especially the case when it comes to areas such as menopause and fertility.

The PMI gaps in menopause cover

13 million women in the UK are peri or post-menopausal – equivalent to a third of the entire female population. While some women will manage their menopause symptoms, the majority will experience severe symptoms, lasting an average of 7 years. Coverage for menopause support varies among providers, with some offering dedicated services, while others provide limited assistance.

Here are a few of the most common gaps that PMIs don't typically cover when it comes to menopause:

❌ Diagnostic consultations and follow-up appointments

Some PMI policies cover initial consultations to diagnose menopause-related symptoms, especially if they are severe. However, many PMIs don't cover follow-up appointments and will only cover the initial consultation. With 1 in 3 women experiencing menopause symptoms that last for more than 7 years, this leaves a significant gap in an organisation's employee support.

❌ Treatment, including Hormone Replacement Treatment (HRT)

Many PMI policies do not cover routine menopause treatments, including Hormone Replacement Therapy (HRT).

❌ Limited comprehensive support

Not all PMI providers cover all aspects of menopause care. This extends to everything from early menopause, which impacts 1% of women under the age of 40 years, to surgical menopause, which occurs when an individual's ovaries are removed before they have gone through natural menopause.

❌ Limited coverage and additional costs

Some PMI providers will offer enhanced menopause support at an extra cost, for what many menopause specialists consider the standard level of treatment. This enhanced support can be expensive and requires employees to pay an additional fee. Dr Gidon Lieberman, Fertifa's Medical Director and leading menopause specialist has said that PMIs are not "up to scratch to deliver patient care and outcomes".

❌ Limited mental health cover

Basic PMI plans often lack good mental health care options, pushing employees to look for other options. This is especially a problem when it comes to menopause, with many women reporting a significant impact on their mental health. Research has shown that women are 40% more likely to experience depression during perimenopause compared to women who are not yet menopausal.

The PMI gaps in fertility cover

In the UK, private medical insurance (PMI) coverage for fertility support varies among providers, but generally, most policies offer limited support.

We are proud to say that Fertifa is the official subcontractor of Aviva's PMI for fertility and family-forming support, so we are very familiar with the exclusions here. Fertifa works with Aviva to provide direct one-to-one messaging and consultations with fertility and family-forming specialists, as well as educational resources and on-demand webinars on the most common and complicated fertility challenges.

Here are a few of the most common gaps that PMIs don't typically cover when it comes to fertility and family-forming:

‍❌ Diagnostic testing

Initial diagnostic tests are covered, such as‍ hormone assessments, pelvic ultrasounds, and semen analyses. However, coverage for these investigations can be limited and may depend on factors such as age, existing health conditions, and relationship status (for example if someone is single or has children from a previous relationship or people in same-sex couples).

‍❌ Fertility treatment such as IVF or IUI

‍Coverage for fertility treatments, such as IVF or IUI, are not commonly included in standard PMI policies. A lot of insurers view these treatments as "lifestyle" choices rather than a medical necessity. Some PMIs may provide partial coverage, but the eligibility criteria is often very strict and not inclusive to all employees. As a result, approximately 84% of IVF patients fund their treatment privately. The cost of one IVF cycle, including medication, can exceed £7,000, placing a significant financial strain on patients.

‍❌ No coverage for donor or surrogacy treatments

Services involving egg, sperm, or embryo donation are typically excluded from PMI policies. Surrogacy-related medical costs are also not covered, leaving intended parents with significant financial burdens.

‍❌ Limited coverage and additional costs

Prescription drugs used in fertility treatments, such as hormonal therapies, are often not included in PMI plans. This omission adds to the overall cost of treatment, which is already substantial.

❌ Limited mental health cover

Basic PMI plans often lack good mental health care options, pushing employees to look for other options. Infertility can have a profound psychological impact, yet PMI policies rarely cover fertility-specific counselling or therapy.

What about the NHS?

With waiting times increasing and doctor shortages becoming more apparent, the NHS has significant limitations. When it comes to access too, fertility treatment is based on a "postcode lottery", where access to NHS-funded fertility treatment, particularly IVF, varies significantly depending on where you live in the UK. Employees in certain areas will have much better access to treatment compared to employees in other areas. If you have employees across the UK, not all of them will be treated equally.

How Fertifa can fill these gaps, working with PMI providers

Fertifa is an affordable insurance add-on that enhances your existing health insurance plan by addressing the gaps in private healthcare coverage. Our services complement traditional PMIs, offering targeted solutions for areas they typically overlook.

1. Coverage for pre-existing and chronic conditions
   Fertifa provides support for employees managing chronic conditions and those with pre-existing medical conditions, areas often excluded by health insurers—we are fully inclusive, and everyone is welcome here.
2. Enhanced mental health cover
   We offer tailored mental health care solutions, including access to specialists, like our partners Parenthood In Mind, and ongoing support, bridging the gap left by traditional private health insurance policies.
3. Cost-effective solutions
   With Fertifa, employers can add extra coverage without significantly increasing their annual premium. This makes it easier to balance healthcare costs while providing employees with meaningful benefits.
4. Faster access to treatment
   Fertifa offers faster access to private consultants, diagnostics, and medical treatments, reducing delays and enhancing employee satisfaction.
5. Comprehensive support for reproductive health
   Fertifa specialises in reproductive health, covering fertility, menopause, women's and men's reproductive health, maternity, neurodiversity, sexual health, and family-forming journeys, which are rarely included in health insurance coverage.
6. Flexible coverage options
   Fertifa works as an optional add-on to your existing base policy or base plan, offering scalable solutions to meet diverse employee needs.

The benefits of adding Fertifa to your health plan

By integrating Fertifa into your health insurance plan, employers gain several advantages:

• Improved employee satisfaction: Addressing unmet needs fosters job satisfaction and a positive employee experience. Plus, we have a 96.5% customer satisfaction score meaning that our patients (and your employees) are very satisfied with the top-tier clinical care we provide.
• Access to treatment: Fertifa provides seamless access to medical treatments often excluded by traditional PMIs.
• Comprehensive health insurance: With Fertifa, your employees enjoy a more complete level of cover without incurring excessive costs.
• Cost savings: Reduce healthcare costs by offering targeted solutions that complement your private health insurance plan.

A smarter, more inclusive approach

As the workforce evolves, so must private health insurance providers and employers. Fertifa enables you to build a benefits package that addresses modern employee needs, offering additional benefits that go beyond traditional medical insurance plans.

Fertifa’s services include:

• Support for reproductive health and family-forming journeys.
• Access to best-in-class specialists and private treatment for critical illnesses and chronic conditions.
• Coverage that complements comprehensive health insurance policies with minimal additional costs.

Why Fertifa is the ideal add-on

Fertifa is not just an enhancement to private health insurance—it’s a bridge to better employee engagement, wellbeing, and productivity.

By filling the gaps in traditional health plans, Fertifa ensures your employees have access to the types of treatments they need, when they need them. Most importantly, no one is excluded from receiving care, no matter their age, gender, relationship status, sexual orientation, race, or location.

If you're ready to redefine your health insurance coverage, Fertifa is here to help.

Book a call with our team and learn more about our health insurance add-ons and how we can work alongside your existing insurance company or health insurance providers. Let’s build a healthier, happier workforce—together.