Insurers play a vital role in supporting new advisers and intermediary firms entering the private medical insurance (PMI) market.
Building collaborative relationships and working closely with insurers is crucial to securing good customer outcomes and managing a successful PMI advice business.
Furthermore, understanding how insurers support claims and the role of care pathways enables advisers to guide customers confidently and effectively when they need support most.
How important is it for advisers entering the PMI market to build strong relations with insurers?
Robert Bain: Building strong adviser insurer relations is fundamental to success in the PMI market. It enables insurers to better support advisers not only with products and processes, but also in how they engage with us strategically and operationally. Strong partnerships create a more seamless way of working, helping both parties to deliver better outcomes for more customers.
What are the best methods to build those relationships?
Karl Rudolph: Successful relationships are built through consistency, openness and two-way engagement, rather than just transactional interactions.
In my experience, advisers who invest time in building relationships early tend to achieve stronger long-term outcomes because they see insurers as strategic partners, rather than just someone they contact for a quote.
Advisers who clearly communicate their philosophy and ambitions also tend to build deeper partnerships, because we can build our support around their business.
Engaging beyond day-to-day sales conversations is equally important, while involvement in insurer-led forums, feedback sessions and industry events help build credibility and trust.
Ultimately, it’s not just about placing business, business development managers (BDMs) often act as the gateway into the wider organisation, and building relationships with them can help connect advisers to the right people at the right time, and benefit from broader expertise.
How can insurers support intermediaries who are new to the market?
RB: For new entrants, an easy and efficient onboarding process is essential. They will be nominated a dedicated BDM as well as given access to a third-party control hub to help guide them through the early stages of the relationship and navigate the activity involved in establishing their business, including ensuring appropriate remuneration structures are in place.
I also encourage new entrants to join the Association of Medical Insurers and intermediaries (AMII). Its academy plays an important role in supporting professional development within the industry, and the standards it has established continue to drive excellence for those entering the market.
How can BDMs help advisers to build their businesses?
KR: A good BDM acts as a trusted partner, adding value far beyond quoting and transactional support. Our
role is to help advisers grow their confidence through deeper product knowledge, market insight, and ongoing strategic support. That includes sharing intelligence on trends, proposition developments and market changes, while helping intermediaries to position and promote themselves effectively.
Support can also extend to training, case management assistance and helping advisers navigate complex underwriting scenarios.
Do insurers understand the different strategies and personalities of advisers and their customers?
RB: We understand how competitive and fast-paced the market is for advisers and how efficient they need to be.
Processes that are overly complex slow them down, so it’s crucial that insurers provide the right tools and can adapt to the different ways advisers work. No two advisers are the same, nor are their clients.
Advisers are often managing relationships across multiple providers, products and evolving customer needs, which means a one-size-fits-all approach simply doesn’t work.
That’s why conversations with advisers need to be tailored in order to understand their needs, and the needs of their customer, in order to deliver the right support.
Can you outline the claims process from a customer perspective?
KR: The claims process is designed to be as simple and seamless as possible for customers. It often begins with the customer seeing a GP, whether that’s through the NHS or digital GP via Bupa Blua Health.
Once they have a referral, they contact their insurer’s claims team who will assess the claim and confirm what’s covered.
If approved, the customer will receive an authorisation code, which they take to the appropriate consultant or specialist. In most cases, the consultant will invoice the insurer directly, subject to any policy excesses or claims benefits.
For Bupa customers, I would advise using our digital GP service available through Blua, which connects directly with our claims team to help streamline the process further. Bupa customers accessing cancer care, musculoskeletal and mental health support can also benefit from direct access to treatment pathways without requiring a GP referral.
How might advisers get involved in a customer’s claim and how do insurers keep them informed?
RB: Advisers can play an important reassurance role for clients during their claims journey, explaining what to expect during the process and helping them to understand their cover.
Many advisers want to be closely involved in supporting their customers, and that guidance can provide real confidence during what is often a stressful time.
However, ultimately it’s the customer’s health, so the primary relationship remains between the customer and insurer. That’s why adviser education and onboarding is so important, ensuring they know and understand the claims process and can support clients effectively without complicating matters or adding to an already emotional and stressful experience.
What key roles do insurers play in the claims process?
RB: The key responsibility for insurers is ensuring customers access the right treatment, at the right place, at the right time – helping them to return to full health as quickly as possible.
That’s our ambition at Bupa. A good insurer doesn’t simply fund treatment, they take on a central role in guiding customers through their healthcare journey, helping them to navigate care pathways and creating a seamless, connected healthcare experience that’s efficient, effective and personalised from the start.
What are claims pathways and how do they work?
KR: Claims pathways are structured, clinically-led routes designed to guide customers from their initial symptoms through to diagnosis, treatment and recovery.
Rather than approaching each stage of the claim in isolation, pathways ensure care is joined-up and consistent, helping customers navigate the process with clarity and confidence.
For example, through Bupa’s specialist cancer pathways, customers can use direct access to reach our claims team straightaway when they have a concern, without needing a GP referral.
Our team will then quickly coordinate appointments and diagnostics, with test results usually returned within a couple of days. If the results indicate cancer is present, the customer is immediately advised on next steps and can start treatment within 31 days.
The objective is to create a simple, efficient and seamlessly connected end to-end healthcare experience for customers, that’s fast, personalised to their needs, and achieves the best possible health outcomes.
What are the main benefits they offer to customers and advisers?
RB: Pathways offer a range of benefits, though these will vary depending on the insurer.
Generally, one of the biggest advantages is the reassurance they provide to customers, giving them confidence they are being guided toward the right care, specialist or treatment pathway quickly during what is often a stressful and uncertain time.
Pathways also help to improve the speed and certainty of care. For example, we’re seeing a rising demand for young people’s mental health support.
Services are stretched nationally and appointments can be difficult to get, but for those using Bupa’s young people’s mental health pathway, they are guaranteed to be seen by a mental health professional within 48 hours.
