Customer Promise

Applicable to UK Individual and SME PMI and Dental Schemes:

1. For all these members and groups with a policy in force on the 1 January 2020, and any new customers joining before 1 April 2020 the following will apply:
   • If the actual claim ratio during the period 1 January 2020 to 31 December 2021 is less than the claim ratio experienced in financial year 2019, then AXA PPP will rebate the total amount of claims shortfall between the 2019 vs 2020/2021 figure to all of these members and groups, in proportion to the premiums paid for their cover over the 24 month period. We would expect any rebate to be paid in Q1 2022 and for the calculation to be verified by an appropriate independent auditor

2. The calculation will be based on comparison of incurred claim ratios (including claims incurred but not yet paid) for the combined 2020/2021 period with a 2019 full year incurred claim ratio. If there has been a reduction in claim ratios in 2020/21 vs 2019 the total level of rebate will be calculated as the number of percentage points fall in claim ratio multiplied by the overall earned premium for the 2020/21 period (before Insurance Premium Tax)

3. Rebates to members/groups will be in proportion to their paid premiums over the 2020/21 period when compared with the total earned premium for the AXA PPP UK Individual and SME PMI and Dental portfolios. All AXA PPP, Health-on-Line, SecureHealth and PHC brands are included. Cashback, standalone travel and International policies are excluded.

4. The following is an example, given in example numbers only, to demonstrate the mechanics:

   a. 2019
     i. Income = £100m
     ii. Claims = £60m
     iii. Claim Ratio = 60%

   b. 2020/2021
     i. Income = £180m
     ii. Actual Claims = £90m
     iii. Claims at a 60%
     iv. Claim ratio = £180m x 60% = £108m

   c. Total customer rebate is £108m - £90m, ie £18m
     i. If actual claims were equal to or exceeded £108m, there would be no rebate

   5. For the calculation of the rebate if any, the associated premiums will be the earned premiums relating to the period on cover and not premiums paid. Premiums will have to be received to be eligible:
     a. Any rebate will be in the form of a partial rebate of premium and will include Insurance Premium Tax
     b. Members or groups who lapse during the period will still be entitled to a rebate if applicable, but their share will be considerably lower as their premiums earned will also be lower
     c. If members or groups have received a temporary reduction in premium after 1 April 2020, they will only be eligible for any part of the rebate which exceeds the temporary premium reduction already given.
     d. If the total size of the rebate to be paid out is less than £1million (circa £2 per main subscriber) then a single payment will be made to a suitable medical charity
     e. The refund may be deferred if in the opinion of the Board, and on the recommendation of the AXA PPP Chief Actuary it would endanger the solvency of AXA PPP and its ability to pay claims to existing members

INDIVIDUAL and SME:

We’re committed to doing the right thing by you. Any reduction in claims costs compared to 2019* arising from delays in treatment due to the Coronavirus crisis will be refunded in proportion to your premium paid.

We understand how much uncertainty you’re facing at this time. More than ever, we appreciate our role in helping you look after your [and your employees] health and wellbeing.

Though we can’t predict the future, we can plan for it.

We expect to pay significantly higher claims due to delayed treatment. However, once normality resumes, if the value of our health-insurance claims in 2020 and 2021 combined falls because of the current crisis, we’ll pass back to you, our customers, the difference compared with 2019 and 2020 period combined.

At this time, we expect to be able to pay any refunds to you before March 2022. The calculation will be verified by an appropriate independent auditor.

This assurance applies to all individual members and small or medium-sized companies who had an AXA PPP healthcare, Health-on-Line or PHC-branded private health insurance plan1 on the 1 January 2020. And any new customers who joined us before 1 April 2020.

If you can’t get the treatment you’re eligible for now, we’ll still authorise it for you and, when the staff and facilities are available, you can have the treatment straight away. You just need to maintain your policy and current benefits. 


LARGE CORPORATES:

Our contracts with large corporates are subject to individual negotiation with professional buyers and their advisors. Whilst seeking to apply the similar principles, we have concluded that we will need to approach the issue on a case by case basis, taking account of particular circumstances and contracts.

Our approach will differ between full insurance/profit share business and cost plus /trust schemes.

For the full insurance/profit share schemes, we intend to charge normal premiums, ignoring Covid, and offer all schemes the opportunity to enter into a 2 year profit share arrangement (talk to your normal account managers for further details). Any profit share payable at the end of two years would also be dependent on renewal

For cost plus and trust business, the premiums will be subject to negotiation, as the client may wish to have more control over the extent to which they wish to smooth payments over the two years, taking more savings in year one or not, as they prefer. For specific and general stop losses we will price on a specific basis based on the funding decisions made by the client.