Being in charge of a company's healthcare policy is a little like being St Peter at the Pearly Gates, deciding who can come in and who can't.
But how do you decide who to admit to the benefits of free private healthcare and who should be excluded?
Jason Drew, a corporate consultant at Bupa, explains the dilemma: 'There have been a number of cycles over the years. Initially, admission to free private healthcare was restricted to senior management. In the last decade, it was opened up to middle management and even lower management - a tax-efficient way of passing on the benefits of the boom years. But now, it seems to have come full circle with people exercising caution in who they admit.'
Caution is the watchword. Once you choose to admit staff to a private scheme, it is very hard to take the benefit away again. John Gillman of Watson Wyatt, employee benefits and HR consultants, says he cannot remember an incidence of employees' private healthcare benefits being retracted by the company. 'You have to get it right, first time,' he says.
The group of staff selected also has to be clearly defined, says Michael Sargent of Corporate Medical Insurance Consultants, a medical insurance broker. 'With the majority of these schemes, the providers will expect the company to demonstrate some system in the way in which people are selected - they worry they're going to end up treating only ill people. They have to be a definable group such as "people on the board" or "people who've been with the company for more than a year".'
Modern schemes tend to combine these two criteria, says Sargent. 'In the main, companies cover senior management but often embargo entry for one or two years as an incentive to get people to stay.' But, Gillman says, it depends what you're trying to achieve with your company healthcare plan. 'If you want to respond to the competitive pressures of the marketplace, and offer your healthcare scheme as part of "an attractive package of benefits", then you have to look at what other companies are doing.' If a rival firm is offering middle management and their spouses private healthcare then, according to Gillman's theory, it might be worth taking a similar approach.
But he also stresses there is another way of looking at healthcare - what he calls the 'protecting-your-business approach'. Adopting this approach means looking at private medical insurance as a way of keeping the workforce healthy, and therefore ensuring the productivity of your organisation.
Obviously, if you want to implement this kind of 'caring culture' in your firm, then it pays to offer the benefits of healthcare to as many staff as possible.
Drew says this approach is increasingly common. 'Wellness as opposed to illness has become the motto for many firms,' he enthuses.
'They've come to realise that cost containment is a false economy and have started to look at the sickness rate as something they can actually manage.' Sometimes, however, the 'wellness' approach can mean looking at options other than just private healthcare. As Gillman says: 'For young people, you might be as well to sign them up to a gym as to offer them private healthcare.'