In international private medical insurance (IPMI), we earn retention through process and trust — particularly at renewal and when a client needs to claim. Premium changes, benefit updates and day-to-day claims friction are often the point at which clients decide whether we are adding value. We cannot change an insurer’s underwriting or claims decisions, and we never promise outcomes — but we can provide structure, clarity, advocacy and service excellence that supports long-term relationships.
If we want client relationship management to feel consistent (rather than reactive), we make sure the following are in place before renewal season and before the next claim arrives:
- A renewal calendar with policy dates, typical renewal notice windows and decision deadlines (timing varies by insurer and policy).
- A renewal review framework: documents to request, questions to ask, and a consistent way to present options and trade-offs.
- A claims support workflow: intake → triage → documents → submission → follow-up → escalation → resolution (process-focused, no promises).
- A secure way to handle health data (special category data) and written consent/authority templates for sharing medical information.[2]
- A documentation discipline: file notes, confirmations in writing, client approvals, and clear “who said what, when” records.
- An escalation/complaints route: how we request a review, what we can say, and what we must avoid (no guarantees).[3]
- Renewals drive retention: renewal is when clients reassess value and “policy fit” — our process matters as much as the outcome.
- Start early (timing varies): we plan backwards from the renewal date to avoid rushed decisions and incomplete documentation.
- Claims support is advocacy, not authority: we can help with documentation, communication and escalation, but the insurer’s decision remains the insurer’s.
- Be clear, fair and not misleading: regulatory principles expect clarity in how we explain premiums, benefits and next steps.[1]
- Handle health data carefully: health information is sensitive (“special category data”) and needs secure handling and appropriate consents/authority.[2]
- Document what matters: renewals and claims can become disputes when records are thin — we keep an audit trail showing reasoned advice and informed client decisions.
- Use tools to deliver consistently: CRMs, trackers and checklists help us provide service excellence across our book.
We use these definitions in client conversations (plain language helps reduce disputes).
- Renewal notice: the insurer’s document setting out the renewal premium, policy terms, any benefit changes, and acceptance/payment deadlines.
- Rate increase: a premium increase at renewal; drivers can include age-banding, medical cost trends, portfolio experience, geography and other pricing factors.
- Benefit change: any change to benefits, limits, definitions, exclusions, or process requirements (not just price).
- Deductible / excess: the amount the member/policyholder pays before benefits apply; it may apply per policy year, per claim/condition, or in another way (policy-specific).
- Moratorium vs full medical underwriting: moratorium typically excludes pre-existing conditions for a defined period; full medical underwriting assesses medical history and applies terms/exclusions at the outset.[7]
- Pre-authorisation: the insurer’s prior approval that a treatment meets its criteria (often including medical necessity). It is commonly required for certain services and is not a guarantee of settlement/payment.[6]
- Direct billing vs reimbursement: direct billing is where the provider invoices the insurer (where arrangements exist); reimbursement is where the member pays first and then claims back eligible costs (policy rules apply).
- Escalation: requesting that a claim or service issue is reviewed at a higher level; we can support the process but cannot guarantee outcomes.
- Complaint: an expression of dissatisfaction requiring a response; good practice includes accessible channels, fair handling and proper record-keeping.[3]
- Special category data: sensitive data including health information; this requires stronger safeguards and an appropriate legal basis/consents depending on the jurisdiction.[2]
Why renewals are critical to client relationships
Renewal is the annual “moment of truth” in IPMI. Our client receives a new renewal premium and (sometimes) updated policy terms, then decides whether to renew, adjust cover, or move insurer. This is where client relationship management becomes tangible: clients judge our value less by confidence, and more by how prepared, clear and responsive we are.
Most brokers can explain an excess/deductible. Where we differentiate is by running a structured renewal review that reduces surprises, records the rationale for decisions, and leaves the client feeling in control. That structure is a retention asset — even where premiums rise and the most suitable outcome is to renew on broadly the same basis.
Renewals are where clients judge “fit”, not just price
Clients rarely leave solely because the premium has changed. More often, they leave because the policy no longer feels like a good fit (or they do not understand what has changed). Our renewal review is designed to separate:
- Price pressure: the premium no longer sits comfortably within budget, or it has increased sharply year on year.
- Policy fit issues: geography, provider access, outpatient structure, chronic condition expectations, or family needs have changed.
- Process friction: claims frustration, poor communication, or confusion about pre-authorisation/direct billing.
Regulatory principles support a structured renewal approach
In many markets, distribution rules emphasise acting in the customer’s best interests and communicating in a way that is clear, fair and not misleading. In the EU context, the Insurance Distribution Directive (IDD) is commonly summarised in those terms, and supervisors expect insurance distributors to reflect that in both process and communication.[1]
From a practical brokerage perspective, our renewal process is built to evidence:
- what we reviewed (documents, changes, deadlines),
- what options we presented (and why they were relevant),
- what risks and trade-offs we highlighted (for example, higher out-of-pocket costs), and
- what the client decided (with confirmation in writing).
A well-run renewal review can reduce reactive switching driven by frustration, particularly after a difficult claim.
Complaint/claims record-keeping is a consistent theme across best-practice guidance and model rules.[4][5]
Renewal decisions often hinge on how supported the client felt when care was needed — not just the renewal premium.
Proactive renewal reviews
Our broker renewal support works best when it is predictable. We aim to make it clear what happens, when it happens, and what we need from the client. The goal is not to “fight the insurer” — it is to run a clean, documented review that helps the client make an informed decision within the insurer’s deadlines.
Renewal notice windows and cut-off dates vary by insurer, product and jurisdiction. We use the timeline below as a planning framework, then confirm the actual deadlines in the renewal notice and policy wording.
Renewal touchpoint checklist (timeline-style)
| Time before renewal (illustrative) | Touchpoint | What we do | What we document |
|---|---|---|---|
| 120 days | Pre-renewal “health check” | Confirm the renewal date, typical renewal notice window, and any known policy constraints (for example, when plan design changes are permitted). Ask about relevant life changes (country of residence, travel, dependants, employer reimbursement, visa/residency needs). | Updated client profile; key changes since inception/last renewal; consent/authority status for any medical information we may need to handle. |
| 90 days | Data + documents pack | Pull the policy schedule, table of benefits, endorsements, last renewal documents, and a simple usage snapshot. Set expectations for the review call (agenda + decision deadlines). | Renewal file checklist completed; meeting agenda sent; confirmation of non-negotiables recorded. |
| 60 days | Options modelling | Request “what-if” scenarios where available (for example, deductible/excess, area of cover, optional modules). Start a like-for-like market comparison if appropriate (to reduce last-minute underwriting surprises). | Options requested; rationale for scenarios; early warnings about underwriting triggers or limitations (policy-specific). |
| 30 days | Decision meeting | Review the renewal offer line by line (premium + terms + benefit changes). Present options and trade-offs. Confirm the acceptance process and payment method to avoid any break in cover. | Client decision + reasons; risks explained (for example, higher out-of-pocket costs); client approvals in writing; action list. |
| 7–14 days | Close-out and continuity | Confirm premium payment, policy documents for the new policy year, and key contacts/portal access. If switching, confirm the new cover is in force before cancelling the existing policy (to avoid gaps). | Proof of payment/confirmation; policy documents stored; client confirmation of any cancellation; final file note. |
Our renewal review agenda (30–45 minutes)
- Confirm what changed: premium only vs premium + terms/benefits/process requirements.
- Confirm the client’s position: what the year looked like (usage, travel, dependants, ongoing care).
- Confirm constraints: what can/cannot be changed and by when (policy-specific).
- Model options: 2–3 scenarios the client can understand (not 12 variations).
- Confirm risks/trade-offs: excess/deductible, network access, exclusions, geography, waiting periods.
- Confirm next steps: decisions, forms, deadlines, and how we will record approvals.
Claims advocacy and escalation
Claims support is where our service is most visible. When a client is unwell (or facing a sizeable medical bill), they are more sensitive to delays, missing paperwork and unclear instructions. Our role is to guide, prepare, communicate and keep the process moving — while staying compliant and avoiding promises.
We are also explicit with clients: we cannot override claims decisions. Insurers decide in line with the policy terms, medical evidence and their internal assessment processes. Where we add value is structured claims assistance: reducing avoidable friction and helping the client understand what is happening.
Our claims support playbook (process-focused)
- Capture the essentials: policy number, member details, provider, country, treatment type and dates.
- Confirm whether the care is emergency or planned (this affects pre-authorisation expectations).
- Agree who the insurer should communicate with (client, broker, provider) and what consents/authorities are in place.
- Check the relevant benefit category: inpatient/outpatient/maternity/dental/evacuation (policy-specific).
- Confirm whether pre-authorisation is required; explain that it is not a promise of payment.[6]
- Identify the likely settlement route: direct billing (where available) versus reimbursement.
- Request itemised invoices, medical reports, referrals and proof of payment (as applicable).
- Ask for provider details and any pre-authorisation reference numbers.
- Minimise sensitive data: collect and share only what is needed to assess the claim.[2]
- Submit via the insurer’s preferred channel (portal/app/email) and keep a complete copy.
- Include a short covering note summarising the claim and what is attached.
- Record the date of submission and any reference numbers.
- Track status with a clear next-action date (for example, 7–14 days depending on complexity).
- When the insurer requests documents, respond promptly and confirm what remains outstanding.
- Update the client in plain language: what’s happening, what’s needed and what happens next.
- If delayed/declined, request clarification and, where appropriate, a review supported by evidence.
- Use respectful language: we are asking for reconsideration/clarity, not demanding an outcome.
- Keep a complaints/issue log and record all dates and responses.[3]
Communication best practices
Communication is where retention is won or lost — not because we “talk more”, but because we make complex processes easier to understand. It also supports compliance: many distribution principles expect information to be clear, fair and not misleading.[1]
How we communicate as a high-performing, compliance-aware brokerage
We avoid “Don’t worry” and use “Here’s what we know, what we don’t know yet, and what happens next.”
Facts: renewal terms, deadlines, insurer requests. Options: plan design changes, submission routes, escalation steps.
After calls, we send a short summary email and ask the client to confirm decisions. This reduces future disputes.
Managing expectations and difficult conversations
Difficult conversations do not damage relationships — surprises do. Setting expectations early (and repeating them calmly) is one of the most reliable retention behaviours we can adopt as brokers.
Expectation setting: what we say early (and repeat)
- Renewal outcomes vary: we can model scenarios and explain trade-offs; we can’t promise pricing, underwriting terms, or acceptance of changes.
- Claims outcomes vary: we can help prepare and escalate; we can’t promise approval, payment speed or reimbursement amounts.
- Insurers ask for documents for a reason: they assess eligibility against policy terms, medical necessity and claims rules; incomplete evidence slows decisions.
- Confidentiality matters: medical documents are sensitive; we handle them securely and share only what is necessary.[2]
High-level: “medical necessity” and “reasonable & customary”
These concepts are defined in the policy wording and can vary by product. In practice, clients often interpret them differently from insurers. We reduce friction by explaining the intent:
- Medical necessity: insurers typically look for clinical justification that treatment is appropriate for diagnosis/treatment and consistent with accepted medical practice. Pre-authorisation may be required for certain services and is not a guarantee of payment.[6]
- Reasonable & customary: insurers may benchmark charges to prevailing rates for similar treatment in a given location/provider category. If charges exceed benchmarks, reimbursement may be capped (policy-dependent).
Realistic timelines (renewals + claims)
| Scenario | What’s realistic | What we say (client-safe) |
|---|---|---|
| Renewal terms arrive late | Short decision window; limited time for market comparison or underwriting | “Let’s prioritise: confirm changes, model 2–3 options, and decide by the deadline. If we want a market comparison, we can run it in parallel, but we won’t rely on it unless we can confirm terms in time.” |
| Claim needs extra evidence | Assessment pauses until documents arrive | “The insurer is waiting on [documents]. Once submitted, they can continue the assessment. We’ll track and follow up, but timing depends on complete evidence.” |
| Escalation / complaint | Formal pathways often have stated response time targets, but complexity matters | “We can request a review and clarification and follow the insurer’s process. We’ll document everything and keep you updated, but the insurer determines the outcome.” |
Case studies
These anonymised examples show the logic and process behind broker renewal support and claims assistance. They are not guaranteed outcomes. Each case depends on policy terms, insurer decisions, medical evidence, provider behaviour, and local rules.
Case 1 — Renewal retention through structured options (family policy)
Context: Family of four; renewal premium increased materially. The client’s immediate reaction was “we should switch”.
Process: We started more than 90 days out (timing varies by insurer). We built a renewal file: documents + usage snapshot + non-negotiables. We requested 2–3 “what-if” scenarios (deductible/excess, area of cover, optional modules) and compared the trade-offs in a one-page summary.
Decision logic: Remove a non-essential feature the family had not used, and adjust cost-sharing to align with budget tolerance. We avoided promises and recorded the client’s acceptance in writing.
Result: The client renewed with an adjusted structure that better matched usage and budget. The relationship improved because the process felt controlled, not rushed.
Case 2 — Mid-term change (adding a dependant) with underwriting constraints
Context: The client requested adding a newborn mid-term and assumed automatic inclusion.
Process: We checked the policy rules and insurer process. We set expectations: adding dependants can trigger underwriting steps and deadlines. We collected the required documents and submitted them within the relevant timeframe.
Decision logic: Prioritise timeliness and completeness to reduce the risk of delays or gaps in cover. Confirm the insurer’s position in writing and explain any restrictions as policy-driven.
Result: The dependant was added on the insurer’s terms. The client valued the clarity and the absence of false reassurance.
Case 3 — Complex claim: documentation-driven escalation (no guarantees)
Context: A high-cost claim was delayed and partially declined due to missing clinical information and questions about eligibility.
Process: We followed our playbook: intake → triage → document checklist → submission → tracked follow-ups. We ensured the client understood pre-authorisation and that it is not a guarantee of payment.[6]
Escalation: We requested clarification and review in a respectful note (no demands, no outcome promises), attaching additional clinical evidence. We maintained a complete timeline and document register.
Result: The insurer issued a clarified outcome after review. Whatever the final decision, the client felt supported because communication was regular and factual.
Case 4 — Difficult conversation: claim declined under an exclusion
Context: The client expected reimbursement for a procedure the insurer treated as excluded under the policy wording.
Process: We reviewed the policy wording and insurer rationale, then explained the decision in plain language. We set out realistic next steps: request clarification, submit additional evidence if relevant, and follow the insurer’s complaints route if the client wished.[3]
Result: The outcome did not change, but the relationship was preserved because we stayed calm, avoided blame, and managed expectations with integrity.
Get Started
If we want to strengthen client retention through structured renewals and reliable claims support, we start with a repeatable service framework. BIG supports brokers and partners with renewal reviews, claims process support, and practical comparison work — without over-promising.
- Visit Brokers & Partners to understand how BIG supports partner-facing service models.
- For renewal-focused policy reviews on existing cover, use Review my existing Policy (Already Covered).
Further reading (internal): Renewal strategies: managing premium increases and improving your cover and Choosing the Right Insurer for International Health Insurance: how to compare what actually matters.
Points to verify
- Regulatory duties/disclosure rules: licensing, advice standards, disclosures and documentation expectations in our market(s).
- Claims escalation scope limits: what we are permitted to do (and say) when requesting review or lodging complaints on behalf of clients.
- Insurer renewal mechanics: notice periods, benefit amendment rules, underwriting at renewal, payment grace periods, and cancellation/non-renewal rules.
- Claims requirements: time limits, document formats, originals vs copies, translations, medical reports, and submission channels.
- Data sharing rules: cross-border transfers of health data, consent requirements, secure communication expectations, retention and deletion rules.
- Complaint/escalation pathways: insurer complaint procedures, local ombudsman/regulator processes, timelines and required disclosures.
