Discover Fertifa

In March 2026, we invited Matthew Law of Connor Broadley Benefits Consulting to join a Fertifa webinar to discuss Private Medical Insurance (PMI) exclusions, and how Fertifa is working to plug these gaps to help companies provide truly comprehensive support for their employees.

The webinar focused on how Fertifa and other providers are filling gaps in PMI schemes, particularly in the UK, the impact of NHS waiting lists, and the need for employer-funded support.

If you would like to watch the webinar in full, you can do so here:

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Fertifa fills the gaps between PMI provision and general practice healthcare to provide wrap-around care when employees need it the most

Fertifa operates as a specialist employee benefits provider, complementing existing Private Medical Insurance (PMI) and Employee Assistance Programmes (EAPs) by addressing the gaps that these traditional offerings often leave unmet. Through a team of in-house clinical specialists, Fertifa supports employees across a range of nuanced and often underserved health areas, including reproductive, hormonal and sexual health - encompassing assisted fertility, egg freezing, menopause and men's health - as well as neurodiversity, lifestyle health (including medically supported weight management), non-urgent infant care and mental well-being.

The common thread across all of these areas is that they represent coverage gaps within standard PMI plans, and Fertifa provides wrap-around care to ensure employees are not left without support when they need it most. Beyond clinical care, Fertifa also handles the administration of employer reimbursement allowances across any of these health topics, and offers a Fertifa payment plan to help ease the direct financial burden on employees.

What are some common exclusions in PMI policies?

Private Medical Insurance (PMI) has shifted from a "senior-only" benefit to an essential tool for bypassing NHS wait times. However, understanding why certain gaps exist is key to managing expectations.

The "gaps" and why they exist

Common exclusions include:

• Chronic conditions: Ongoing issues like diabetes or asthma are usually excluded or capped because they require indefinite care.
• Hormonal and reproductive health: Traditionally, menopause and fertility treatments fall outside standard policy scopes.
• Neurodiversity: Historically a "blind spot" although some insurers are starting to offer limited support for assessments.

Acute vs. chronic health conditions

PMI was built for acute conditions - short-term illnesses with a clear start and end. The goal of PMI for these conditions is to get diagnosed, treated, and back to work as quickly as possible.

How employee expectations around healthcare benefits are changing

Beyond the basics: While standard PMI is important, employees are looking for support in areas traditionally left out, such as:

- Reproductive health: Fertility and menopause support (including assissted fertility treatment and egg freezing)

- Family planning: Enhanced paternity and maternity provision

- Life stages: A holistic approach to health that follows them through different life events.

The PMI gaps dominating conversation between organisations and insurers

As employee needs evolve, two specific areas are dominating the conversation between businesses and insurers: neurodiversity and the management of long-term health.

Neurodiversity

Neurodiversity support has moved from a niche request to the number one gap identified by employers over the last year. Increased awareness has led many employees to realise they may be neurodivergent triggering a surge in demand for assessments and diagnostic support.

Some insurers have responded by introducing "bolt-on" cover to meet this need—though it remains an emerging area of the market.

Chronic conditions

While most people accept that the NHS handles long-term conditions (like diabetes or heart disease), the conversation is shifting. Most employees still expect to use the NHS for chronic care, but "what if" questions are becoming more frequent during plan design.

Some private plans now offer chronic care "bolt-ons," but these are typically heavily capped at a set financial amount rather than providing open-ended treatment.

For HR and People teams, these aren't just medical questions—they are talent strategy questions. Designing a modern benefits package now requires a choice: rely on standard PMI or actively seek out these extra layers of support to fill the gaps.

Reproductive healthcare exclusions

Historically, IVF and fertility treatments have been standard exclusions in PMI policies. While insurers are beginning to offer some mental health support and guidance for those on a "lifestyle journey," direct clinical cover remains rare.

Business case

Unsupported reproductive health issues can cost a company in several ways, for example:

- Losing a mid-to-senior level employee due to a lack of support can cost a business 50% to 200% of their annual salary in recruitment and retraining.

- Treatments like IVF are physically and emotionally grueling. Without proper support or flexibility, people may feel forced to leave.

It's crucial that companies who want to remain competitive and foster loyalty provide comprehensive coverage that recognises the impact of reproductive health issues, and the need to look beyond PMI schemes in order to treat them.

What drives employee enrolment?

One question we get asked often at Fertifa is around employee enrolment. When medical insurance is optional, why do some employees jump at the chance while others look the other way? Enrolment rates vary wildly, and the reasons often come down to three key factors: age, sector, and communication.

Age

- Younger demographics are historically the hardest to enrol. Many younger employees feel they don't need medical cover because they’ve never been seriously ill, overlooking benefits like mental health support or physiotherapy for sports injuries.

- With the shift toward payrolling benefits, employees now see a specific line on their payslip showing the tax cost (Benefit in Kind). For a younger employee on a budget, that monthly deduction can push them to opt out before they ever use the service.

Sector and salary trends

Where you work often dictates how you value health benefits.

- High uptake industries: Professional and financial services consistently see the highest enrolment.

- The income link: Higher average salaries in these sectors often make the associated tax liabilities feel more manageable.

Internal communication

Low enrolment is often a symptom of poor internal promotion. Often, employers and employees don't actually know what the plan covers. If the opt-in process isn't clear or the relevance isn't explained, employees will naturally default to "no."

Guidance for HR

Boosting enrolment isn't just about offering the benefit; it’s about signposting and promption. To reach a diverse workforce, employers must move past "one-size-fits-all" emails and explain the specific value of the plan, outlining its relevance to each age group and pay bracket.

The importance of surveys and employee feedback

While data from PMIs or EAPs (Employee Assistance Programmes) is great at showing engagement levels, it also can show an employer what is missing, or highlight cases where someone has had to seek treatment elsewhere because their health issue wasn't covered.

Don’t wait for an employee to come to you in a crisis (for example, struggling with the immense financial stress of going through fertility treatment) before addressing gaps. Use internal HR tools, polls, and focus groups to ask your employees what the challenges they are experiencing at that moment in time, so as an employer you can actually assess the comprehensiveness of your coverage and devise a plan to plug any gaps.

The psychological impact

When employees have unresolved worries - whether about health or money - they aren't performing at their best. Even giving your employees access to a 30-minute call with a financial planner or a specialist health coach can resolve a worry that has been distracting them for weeks.

Providing the right support isn't just a "nice-to-have"; it's about clearing the mental hurdles that prevent people from being efficient and engaged.‍‍

‍Focus groups

The most successful benefit strategies aren't designed in a vacuum. Reaching out through focus groups or anonymous check-ins can be incredibly effective to ensure your benefit spend actually hits the mark.

The reputational risk in 2026

In today’s market, a benefits package that only works for a "healthy, neurotypical employee in their 30s" is no longer considered inclusive.

Comprehensive support sends a clear message to your employees that you care about their health and wellbeing in a meaningful way. It is fast becoming the benefit that gives organisations an advantage in an increasingly competitive market for the best talent.

Fertifa's clinically led programme gives employees fast and easy access to expert care for neurodiversity, fertility and family-forming, menopause, men’s and women’s health, gender identity, mental wellbeing, lifestyle health and infant care. Get in touch with the team if you would like to learn more.