The global High-Net-Worth Individual (HNWI) population and their wealth are dynamic and expanding, posing unique challenges and opportunities for insurers. The United States has the largest HNWI population, with Asia-Pacific having the second largest.¹ Younger HNWIs will become more prevalent due to the largest intergenerational wealth transfer in history – of about $83 trillion occurring over the next 25 years, mostly in the U.S.²

This article aims to deepen insurers’ understanding of High-Net-Worth Individuals, creating new opportunities for coverage while providing balanced claims risk management. Global product, market, health, legal, and regulatory differences, and involvement of additional parties such as financial representatives need to be considered. Risk assessment decisions may be complex, including challenges with medical and financial data retrieval. Read on to explore health-related factors relevant to HNWIs that warrant consideration when assessing policies and claims.

The definition of a HNWI varies and was previously considered to include those with a net worth of USD 1 million or more in diversified portfolios. At present, most HNWIs assessed by insurers have a net worth greater than USD 1 million in liquid assets, focused upon diversified portfolios, tax efficiency, luxury asset maintenance, and preserving financial security. An UHNWI (Ultra-High-Net-Worth Individual) is generally defined as having USD 30 million or more in liquid assets, involving global asset allocation, private equity and hedge funds, estate planning, and philanthropy.

HNWI Life and Health claims, due to the insureds’ personal characteristics including global mobility, provide a unique opportunity for claims professionals to navigate complexity and employ best practices for balanced risk management.

Claims Assessment of HNWIs

Evaluating HNWIs mortality and morbidity varies significantly by country due to multiple factors including differences in prevalence of medical conditions, healthcare systems, regulatory environments, cultural and lifestyle factors, and environmental conditions. The claims risk assessment process for HNWIs differs from that for the general population primarily due to the complexity of risks associated with their assets, lifestyle, medical, and non-medical issues, and challenges accessing and retrieving data.

While wealth can provide access to better healthcare and living conditions, which may lead to a longer life expectancy, it also comes with its own set of risks. The following are points for consideration.

Product, Market & Service Differences

• Consider the differences in global markets, products, and client / policyholder expectations. Examples include differing contestability or non-disclosure periods, waiting periods, and definitions of Disability.
• HNWI are interested in combined investment and protection products, with tax benefits.
• Efficient, concierge service is expected.

Legal / Regulatory Challenges

• The issues vary in different countries and regions. Examples include U.S. state-specific legislative differences, within Europe and several South American countries the “Right to be Forgotten” legislation, and differing legislation regarding genetics, HIV, and “Death with Dignity”.³
• HNWIs must be vigilant against legal, litigation, and reputational risks, as their wealth can make them targets for lawsuits and other legal challenges.

Access to Advanced Healthcare

• In countries with advanced healthcare systems and higher socio-demographic indices, HNWIs may have access to better healthcare and preventive services, potentially leading to lower mortality rates and better management of chronic conditions.
• Conversely, in countries with less developed healthcare infrastructure, even HNWIs might face higher risks due to limited access to quality care and prevalence of chronic conditions.
• Access may not equate with adherence to advanced, evidence-based health care due to multiple factors including cultural beliefs (see below).

Medical Challenges

HNWIs often face unique health risks associated with lifestyle and environment (see below). In high-income countries, noncommunicable diseases (NCDs) such as cardiovascular disease are more prevalent. In low-income countries, NCDs and communicable (infectious) diseases are prevalent. Proactive health screenings, a balanced diet, regular exercise, and stress management are crucial steps that may aid mitigating these health risks.

• Wealth may be associated with increased stressors, which contribute to conditions such as cardiovascular diseases, mental health disorders, and substance use – along with a greater need for data privacy and protection.
• Mental health conditions such as depression and anxiety may be more commonly seen in HNWIs. Mental health distress is influenced by multiple factors including biopsychosocial determinants of health. For HNWIs, particularly teens and young adults, psychological distress needs to be considered in context, including cultural, social, and medical factors. Awareness, diagnosis, treatment, and comorbidities vary. Mental health stigma may represent a barrier to medical care in some countries.
• Substance use including alcohol, other drugs, and polydrug use may be more prevalent in HNWIs, particularly in younger ages.
• HNWIs may have a higher risk of certain types of cancer, which some studies suggest could be influenced by genetic and environmental factors.⁴
• HNWI youth and young adults may have increased health risk due to stressors and lifestyle including mental health issues and substance use disorders.

Environmental Factors

• Pollution levels and climate vary in different countries and regions of one country.
• Frequent global travel can expose HNWIs to infectious diseases and environmental hazards not commonly found in their home countries.

Lifestyle Factors

• HNWIs may have unhealthy dietary choices.
• Smoking may be prevalent and substance use may reflect access.
• Affluence may lead to a sedentary lifestyle, physical inactivity and poor dietary choices – or it could be to the contrary with extreme exercise and the potential for exercise anorexia.
• Avocations considered hazardous have evolved to include extreme, high-adrenaline physical activities and digital risks and can lead to increased risk of accidents and injuries threatening both life and fortune.
• Kidnapping / Extortion Risks: Due to high profiles, travel to certain regions for participation in hazardous avocations / hobbies may increase risks of kidnapping-for-ransom.
• Many HNWIs travel to and/or live in multiple countries, some of which may have territorial limitations or sanctions within insurance contracts, with potential risks including money laundering.

Cultural Factors

• Limited acceptance of some medical conditions (such as mental health conditions and HIV) may lead to diagnostic and treatment challenges.
• Cultural norms around modesty, gender roles, and taboos may discourage individuals from obtaining certain health screenings including gynecologic exams, for example.
• Fatalistic beliefs may impact adherence to evidence-based management.
• Preference for non-Western medicine approaches (e.g., Traditional Chinese Medicine) may occur.
• Prioritization of discretion and privacy could lead to delayed seeking of care or reluctance to disclose health issues.

The Global Burden of Disease Study and the World Health Organization's Global Health Estimates⁵ provide valuable insights into these variations.

Medical Data Sources

It is important for claims professionals to be aware of various types of healthcare accessed by HNWIs as they retrieve medical records. Comprehensive international healthcare coverage with tailored health insurance plans provides for the unique needs and risks of HNWIs with an international lifestyle. HNWIs often directly pay for medical care for themselves and/or family members.

• Personalized health insurance plans for HNWIs cater to their unique healthcare needs and lifestyles and may limit documentation of their care. They differ from standard health insurance options in several ways including:
  • Broad global coverage and access to an extensive global network of top-tier specialists and premium healthcare facilities and services.
  • Concierge-level service, including direct contact with healthcare managers who facilitate access to services.
  • Financial aspects aligning with HNWIs wealth management strategies with options for higher deductibles to lower premiums, reflecting the ability to pay out-of-pocket expenses.
  • Additional benefits may include private room hospital stays, exclusive medical networks, and services providing privacy and comfort.
• Executive health programs offer extensive health assessments and preventive care tailored to the individual's health profile and risks. These often include annual comprehensive check-ups including medical screening tests.

Financial Aspects

General Considerations:

• The COVID‑19 pandemic highlighted the importance of accurately evaluating risk.
• HNWIs may have different risk profiles compared to the insured population.
• Mortality and morbidity risk assessment of HNWIs may pose challenges, including assumptions about medical care, access and adherence to risk reduction strategies.
• With increased access to better healthcare options, HNWIs may have a slightly longer expected and actual lifespan compared to the insured population.
• 28% of HNWIs have been a victim of a cyber event in the past five years, with identify theft and financial fraud being most common.⁶

Financial Eligibility & Assessment:

• Assessing financial eligibility of HNWIs is complex, as they often possess a diverse range of investments, properties, and possessions. It typically involves a detailed analysis of their financial activities, including verifying the sources and legitimacy of their wealth, to identify potential risks of misrepresentation, fraud, identity theft, and other financial crimes.
  • This process may involve a comprehensive background check, a forensic examination of financial records and source of premiums, and use of alternative data sources to ensure compliance with anti-money laundering regulations.
• This heightened scrutiny is necessary to limit risk from the increased potential for illicit activities such as money laundering, STOLI (Stranger-Owned Life Insurance), and policy stacking. Using Life Insurance policies for asset concealment does occur.
• Third-party involvement such as international banks and brokers adds to complexity.
• One of the primary concerns for financial advisors when working with HNWIs is the management of their financial assets to preserve wealth, sustain their lifestyles during retirement, and provide a financial legacy for family members. This complex process includes navigating ever-evolving tax codes, multi-country regulatory requirements, and estate planning and investment strategies.
• Illiquidity of assets can pose risks, particularly in times of financial need or market downturns.
• Family dynamics are crucial, including the potential for international and intergenerational disputes over assets.
• Assets committed to philanthropy but not yet transferred may often be considered part of the individual’s assets, which may or may not be appropriate.
• Cryptocurrency, while not new, may be unfamiliar to claims professionals in some markets, making close collaboration with underwriting colleagues essential to ensure consistency between the initial risk assessment and the claims evaluation.

Philanthropy:

HNWIs approach philanthropy with a strategic mindset, using a combination of traditional and innovative methods aligned with their personal values and financial objectives. Many HNWIs prefer a lasting impact with fewer, larger grants, and may use innovative giving methods such as impact investing, which allows them to contribute to social and environmental causes while also achieving financial returns. This approach aligns their philanthropic goals with their investment strategies and creates a sustainable model for long-term societal benefits.

HNWIs may establish private foundations that provide a structured way to manage their giving and to involve family members in philanthropic decisions, thus fostering a legacy of giving across generations. They often also utilize donor-advised funds (DAFs) for the flexibility and tax advantages afforded by these funds. DAFs allow HNWIs to support a variety of causes over time. Privacy is also a major consideration; some HNWIs prefer to give anonymously to maintain their privacy and focus attention on the causes they support rather than on themselves.

Online Challenges

• Cybersecurity poses risks as HNWIs are prime targets for cyberattacks, identity theft, and fraud.
• Public profiles and media exposure are often proactively managed due to potential personal and professional impact.
  • Online Perception Management (OPM) involves controlling and enhancing their online reputation, and brands are often used. OPM includes acquiring domain names related to their identity, creating SEO (search engine optimized) websites, and establishing a comprehensive presence across social networks and directories.
  • HNWIs may work with public relations professionals to navigate media scrutiny and public perception.
  • They may also maintain a vigilant approach to their online presence, ensuring that their personal conduct and affiliations do not attract negative attention.
  • By managing their digital footprint, HNWIs aim to present a positive image that aligns with their values and professional ethos while also protecting their privacy and security from potential threats such as identity theft and fraud. Despite these efforts, their profiles and open-source data may not always be accurate. Publicly available information regarding HNWIs may be scant.

Final Thoughts and Guiding Principles

HNWI claims sit at the intersection of complexity, visibility and material financial exposure. Global mobility layered financial structures, privacy expectations and variable access to medical and financial data require claims professionals to move beyond routine assessment and apply disciplined judgment. These claims present an opportunity not only to pay legitimate claims but mitigate risk and demonstrate technical excellence, consistency and credibility. Rather than relying on a single approach, HNWI claims management is guided by a set of enduring principles that support balanced, defensible decision making across jurisdictions and products. Gen Re clients will have access to our quick reference tools on the guiding principles via our KNOW Learning platform. The guidelines drill down on:

1. Evaluate each claim on its own merits.
2. Apply consistent rigor in complex matters without bias, preconceived expectations about behavior, access to care or outcomes.
3. Maintain alignment with underwriting and other functional disciplines. Close collaboration with underwriting is essential to understand how medical, financial and non-medical risk were evaluated at policy inception.
4. Balance diligence with discretion. Investigative steps should be proportionate, respectful of privacy and consistent with applicable legal and regulatory frameworks.
5. Validate information across multiple sources. Medical, financial, occupational and alternative data should be assessed for consistency, credibility and corroboration.
6. Engage interdisciplinary expertise early. Complex claims benefit from timely involvement of medical, financial, legal, occupation and special investigation resources.
7. Remain alert to reputational and regulatory implications.

Ultimately, HNWI claims underscore the importance of discipline, critical thinking and collaboration. By applying these guiding principles, claims professionals can navigate complexity confidently supporting fair outcomes for policyholders while protecting insurers from financial, legal and reputational risk.

Conclusion

The dynamic population of High-Net-Worth Individuals (HNWIs) poses challenges for claims risk assessors, and opportunities for excellence. Our considerations include global mobility and geopolitical / economic differences, variable lifestyles and health, and differences in global healthcare infrastructure. HNWIs may have unique privacy concerns that impact disclosure of medical and nonmedical factors. Medical and financial data retrieval may be challenging.

The factors discussed in this article lead to HNWIs’ increased demand for specialized health insurance coverage, personalized healthcare, and concierge services. Insurers’ nuanced, complex work with HNWIs underscores the importance of interdisciplinary collaboration and reviewing each claim based upon its own unique set of circumstances.