Your insurance renewal is approaching.
The broker presents a 15% premium increase. You, as the CEO or HR leader, negotiate to 12%.
Everyone feels like they've won.
But you've missed the real conversation...
While you focused on premiums and renewals at the tip of the iceberg, critical questions below the surface went unasked.
Questions that determine whether your insurance actually protects your people, or simply processes claims.
After over a decade advising hundreds of companies on group medical insurance, we've identified what separates strategic, future-focused CEOs and HR leaders from those making expensive guesses.
So here are the questions you should be asking, why they matter, and actionable steps for you to take.
Often, 30-40% of claims originate from just 3-5 facilities – typically the most expensive providers in your network. This concentration reveals important patterns about your workforce's healthcare needs and preferences.
Why it matters: Concentrated provider usage creates negotiation opportunities for direct contracts or indicates potential network inadequacies. When these facilities are the most expensive, the impact on premiums is significant.
Action step: Identify your top 5 facilities by claim volume and value. This data becomes leverage in renewal discussions.
Many companies apply identical coverage across all employee levels – from entry-level to C-suite. This wastes budget on unnecessary benefits while potentially leaving gaps where they matter most.
Why it matters: Tailored benefits improve satisfaction while controlling costs. Young employees might prioritise maternity and preventive care. Senior executives might need comprehensive chronic condition management.
Action step: Analyse utilisation data by employee category to identify misalignment between coverage and actual needs.
Companies invest thousands in comprehensive digital platforms, then discover fewer than 10% of employees have downloaded the app.
One Dubai tech company found 92% of their team didn't know telemedicine existed within their plan. They were paying for Ferrari's for their staff, but everyone was riding a bicycle.
Why it matters: Telemedicine can significantly reduce outpatient claim frequency and costs. Low adoption indicates poor communication or platform issues.
Action step: Survey employees on awareness and barriers. If adoption is below 30%, treat it as a communication gap to fix - not a technology issue.
Many companies discover that routine consultations under $200 make up a significant portion of their claims – often indicating poor preventive care understanding or benefit awareness.
Why it matters: A high amount of minor claims suggests employees don't understand their benefits or lack access to preventive care. This pattern drives up costs unnecessarily and indicates opportunities for wellness programmes.
Action step: Review your claims data for patterns in routine, low-cost consultations. High volumes of minor claims can often be remedied by employee education and preventive care initiatives.
Beyond total claims cost, patterns tell stories. Rising mental health claims? Increasing chronic conditions? Seasonal spikes in certain categories?
Why it matters: Trends identify preventable costs and benefit gaps. They reveal whether your policy is reactive or proactive.
Action step: Review 12-month data by category, frequency, and severity. Look for patterns that strategic benefit design could address.
The most overlooked metric? Employee satisfaction - not with the benefits themselves, but with how easy they are to access and use.
Why it matters: Poor insurance experiences drive turnover and productivity loss - both of which can dwarf premium costs. Frustrated employees become disengaged employees.
Action step: Conduct anonymous surveys focusing on claims experience, not benefit levels. Track satisfaction scores year-over-year.
Test this yourself: Ask five random employees for the pre-approval hotline number. Most won't know it.
Why it matters: Delays in pre-approval cause treatment delays, out-of-pocket expenses, and significant employee frustration during already stressful medical situations.
Action step: Mystery test your emergency response system. Create wallet cards with critical numbers. Ensure every employee knows the process.
Understanding your insurer's geographic reach is critical when employees work across multiple countries, travel frequently for business, or return to home countries for leave.
Why it matters: Global insurers typically have local offices and established networks worldwide, ensuring your staff receive support during emergencies abroad. Regional insurers may offer "worldwide coverage" on paper, but without an actual network, your employees face paying upfront and claiming later – exactly what you don't want during a medical emergency.
Action step: Don't just check if worldwide coverage exists – verify your insurer has actual provider networks and local offices in locations that matter to your workforce.
Most HR leaders can't name their TPA, yet this determines your employees' entire claims experience.
TPAs vary dramatically in performance. Some approve routine claims within 24 hours with 95% first-time approval rates. Others take weeks, initially reject claims, then approve on appeal – frustrating everyone involved.
Why it matters: Poor TPA performance leads to treatment delays, employee frustration, and increased costs as minor issues become major problems.
Action step: Request comparative metrics on processing times, approval rates, and dispute resolution before renewal.
Companies often remain on SME book-rated pricing when claims-rated structures would provide better control and transparency.
Why it matters: Claims rating can offer more predictable costs and better alignment between your actual risk profile and premiums paid.
Action step: Evaluate both options with your adviser. The right choice depends on your claims history and risk tolerance.
Answering these questions before renewal transforms your negotiating position. You move from defending against premium increases to strategically optimising your benefits package.
The most successful renewals we've facilitated started months before negotiations. Leaders who could answer these 10 questions achieved:
Can't answer these questions? You're negotiating blind.
Our advisers guide organisations through each element, helping translate insights into insurance cover that puts people first while managing costs effectively.
Insurance complexity isn't going away. Premiums will continue rising. But companies that understand these fundamentals negotiate from strength, not desperation.
Your employees don't care about your premium negotiations. They care about getting treatment when needed, claims paid without hassle, and support when facing health challenges.
Answer these 10 questions first. Then negotiate.
Ready to evaluate your insurance offering? Contact AES Health here for a complimentary review.