As healthcare costs rise, life expectancy increases and customer expectations evolve, the traditional boundaries of health insurance are shifting. Insurers have an opportunity to move further upstream: supporting health education and wellness, prevention, earlier intervention, better navigation and stronger management of chronic conditions, while protecting the trust and long-term affordability that sit at the heart of insurance.
Q: The health insurance landscape in the Gulf is changing rapidly. What do you see as the most important shift taking place?
I believe we are reaching an important turning point in how we think about health insurance.
For a long time, the industry’s role was relatively straightforward. Someone became ill, received treatment and the insurer helped pay for that treatment. Being there at the moment of claim remains fundamental. It is the promise at the heart of insurance.
But today, we have an opportunity to start much earlier.
We know more about the factors that influence health. We have better data, more sophisticated technology and greater understanding of the importance of prevention, early diagnosis and effective management of chronic conditions.
At the same time, healthcare costs continue to increase. Put those two realities together and I think our industry’s question has to evolve. It is no longer only, ‘How effectively did we pay the claim?’ We should also be asking, ‘Could we have helped that person earlier?’
Q: What does helping someone ‘before the claim’ mean in practice?
It can mean many different things because people’s health journeys are different. But it starts with education. Health literacy is one of the most powerful forms of prevention: when people better understand risk factors, screening, nutrition, movement, mental wellbeing and how to manage an existing condition, they are better equipped to make informed decisions before a health issue becomes more serious.
For one person, it might be a reminder to complete a screening they have been postponing. For another, it might mean helping them manage hypertension or diabetes consistently. Someone facing a serious diagnosis may need help navigating the healthcare system, understanding treatment options or accessing another medical opinion.
And sometimes the most effective interventions are relatively simple.
Take medication adherence. If someone living with a chronic condition regularly misses medication, the consequences can eventually become much more serious for their health.
Translating that principle into daily practice, our Chronic Medication Refill Programme processed 1,384 refills during 2025, while new member enrolment more than doubled compared with the previous year.
The number itself is not the important part. What interests me is what sits behind it: when we make healthier behaviour easier, people engage.
That is where insurance can add value beyond financing treatment. Wellness should not be treated as an add-on that only appears during a campaign or after a diagnosis. It should be part of how insurers engage customers throughout the year, helping the making of healthier choices easier and more accessible.
Q: Is rising medical inflation driving this transformation, and can prevention also help protect affordability?
It is certainly accelerating it, but I would not want prevention to become simply another term for cost containment.
Healthcare affordability is a genuine challenge for insurers, employers and individuals. But restricting access or creating more friction around care cannot be the long-term answer. Prevention also has a financial dimension for customers: a serious or poorly managed condition can mean not only medical costs, but time away from work, disruption to income and additional pressure on families.
The impact extends further. For employers, poorer health can translate into absence and lost productivity; at a wider level, healthier populations support more resilient businesses and economies. Prevention cannot remove every health risk, but earlier intervention and better management of chronic conditions can reduce avoidable complications and the severity of some claims.
Over time, that can also support more sustainable insurance economics. Better-managed utilisation and claims severity across a portfolio can help moderate pressure on future premiums and support the long-term affordability of products. The goal is not simply lower cost; it is better health outcomes and more sustainable protection for customers.
We need to think more intelligently about where healthcare resources are being used and where earlier intervention could create better outcomes.
Our own medical claims provide a window into that challenge. Group medical claims reached $410m in 2025, compared with $343m in 2024 and $302m in 2023. Across the last three years, we have paid more than $1bn in medical claims.
Those figures are significant, but the more interesting questions are: What is driving that utilisation? Which conditions could have been identified sooner? Where can chronic diseases be managed more effectively? Which interventions genuinely improve health outcomes?
The objective cannot simply be to spend less on healthcare. It should be to create more health value from every dollar we spend.
Q: Does this mean insurers will increasingly become healthcare providers?
Insurers do not need to become hospitals or doctors. But we can become much better connectors, navigators and partners within the healthcare ecosystem.
We sit in a relatively unique position. We interact with individuals, employers, healthcare providers and intermediaries. We understand risk across populations. We can see patterns that an individual member may never see.
Used responsibly, those insights can help us connect people with the right support earlier. That might mean directing someone towards preventative care, supporting a patient through a complex diagnosis or helping a member better understand where to go for the care they need.
The traditional insurer was largely a payer within the healthcare system. I think the insurer of the future will increasingly be a health partner within that system.
Q: Data and AI are transforming almost every industry. What role do you expect them to play in health insurance, and how important is data security?
A very significant one, provided we remain focused on the problem we are trying to solve.
There is a tendency today to begin every technology conversation with AI. I prefer to begin with the customer.
What are they struggling with? Where is the friction? Where are we missing opportunities to intervene earlier or provide better guidance?
Data can help us identify patterns in healthcare utilisation and understand where populations may need additional support. AI can help analyse those patterns more quickly and, over time, allow interactions and interventions to become increasingly relevant to the individual, always within the framework of applicable laws, contractual requirements and customer permissions. But that opportunity comes with an equally important responsibility: protecting the data that makes it possible.
Health information is among the most sensitive data an insurer handles. For MetLife, data security, privacy, appropriate access and responsible data governance are fundamental to customer trust. They are also rightly a priority for regulators as insurers adopt more advanced analytics and AI.
Customers should never have to trade privacy for convenience. Any use of AI has to create genuine value while meeting rigorous standards for security, transparency and responsible use.
But there is an important balance. Healthcare is deeply personal. If someone has just received a cancer diagnosis, they are not thinking about digital transformation. They are thinking about themselves, their family and what happens next.
Technology should make that experience easier. It should remove administrative friction, surface the right information and enable our people to provide better support.
The best technology in insurance should ultimately make the experience feel more human, not less.
Q:What role will employers play in this shift?
A very important one, particularly in the Gulf where employer-sponsored medical insurance forms such an important part of the healthcare landscape.
Traditionally, the benefits conversation has focused heavily on premiums, network access, benefit limits and utilisation.
Those things will remain important. But I believe employers will increasingly ask a broader question: ‘Is our health investment actually helping our people become healthier?’
That changes the conversation. We start looking at engagement with preventative screening, management of chronic conditions, mental wellbeing, treatment adherence and other indicators that occur long before a major claim.
That creates an opportunity for employers and insurers to move from simply managing the cost of illness towards building healthier workforces.
And when employees are healthier, the benefit extends beyond insurance. It can mean fewer days away from work, less disruption to household income, stronger productivity and better quality of life. At scale, healthier workforces support healthier businesses and more resilient economies.
Q: As life expectancy increases, how should insurers think about longevity?
Living longer is not simply the number of years we add to life. It is the quality of those years: whether people are able to remain healthy, active and independent for longer.
For insurers, that means thinking about healthspan as well as lifespan. Prevention through education and wellness becomes essential. We can help customers understand their risks earlier, encourage screening and healthier habits, support the management of chronic conditions and connect people with the right care at the right time.
An insurer cannot determine how long someone will live, but it can help create the conditions for a healthier life journey. That is an important evolution of our role: from protecting people financially when illness happens to also helping them preserve their quality of life for as long as possible.
Q: With all this emphasis on prevention, does the claim itself become less important?
Never.
The claim remains the moment when the promise of insurance is tested.
In 2025, 97% of submitted claims were successfully paid across our Gulf business, and we returned $450m to customers through group medical and individual claims.
Behind those figures are people experiencing difficult moments in their lives. That responsibility cannot be diluted.
But I think our ambition as an industry should extend beyond being excellent when something goes wrong.
Imagine an insurance model where success is measured not only by how quickly a claim is settled, but also by whether someone identified a disease earlier, managed a chronic condition better, avoided an unnecessary complication or simply understood their health well enough to make a better decision.
That is a much broader definition of value.
Q: What, then, will define the leading health insurers of the next decade?
I think it will be the ability to combine three things.
First, trust. Customers must know that when they need their insurer, the promise will be honoured.
Second, intelligence. We need to use data and technology responsibly to understand risk, personalise support and make healthcare easier to navigate, with data security, privacy and strong governance built in from the start.
And third, prevention through education and wellness. We have to become more ambitious about giving people the knowledge, tools and support to stay healthier for longer, before their health reaches a point where major intervention is required.
The industry has spent decades becoming better at paying claims, and rightly so. But perhaps the biggest opportunity ahead of us is to redefine when our responsibility to the customer begins.
Being there when somebody becomes ill is fundamental. Helping them stay well for longer is where the next chapter of health insurance begins. M
Ms Maria Ángeles Amezcua is General Manager of MetLife Gulf.