Designing prevention into group insurance products

South Africa’s life insurers paid out more than R639 billion in claims in 2024. A significant and growing portion of these claims relate to severe illness, death and disability, with cardiovascular conditions consistently ranking among the leading drivers.

For insurers and employers alike, this is no longer simply a public health concern. It is a material risk issue that directly affects group insurance pricing, benefit sustainability and long-term scheme viability.

The claims curve is shifting

Non-communicable diseases (NCDs), including cardiovascular disease (CVD), are estimated to account for 43% of adult deaths in South Africa, with CVDs responsible for nearly 18% of these. Alarmingly, South African women aged 35–59 are one and a half times more likely to die from cardiovascular disease than their counterparts in the United States. One in three adults also lives with hypertension, significantly increasing the risk of heart attack, stroke, kidney disease and heart failure.

In group insurance schemes, cardiac events frequently occur during employees’ economically active years. This drives higher disability income claims, extended benefit durations and prolonged absences from work. As claims experience deteriorates, group risk pricing responds accordingly. Premiums increase, benefit structures come under pressure and forecasting becomes more complex. For employers, protecting scheme sustainability becomes increasingly difficult.

At the same time, a persistent protection gap remains. Severe illness benefits often fall short of covering the long-term financial consequences of a major cardiac event. When gaps exist, employers absorb indirect costs through lost productivity, extended incapacity and workforce instability.

From static underwriting to dynamic risk assessment

Traditional underwriting assesses cardiovascular risk at a single point in time. Medical questionnaires, clinical measures and actuarial tables create a static snapshot that informs pricing, with claims experience only influencing adjustments after the fact.

However, cardiovascular risk is not static. Daily behaviour is one of the strongest leading indicators of future claims exposure. Small, sustained behavioural changes can materially reduce the probability and severity of cardiac events. From an insurance perspective, this represents a critical opportunity to shift from reactive pricing to proactive risk management.

Extensive research published in journals such as The Lancet and by the Harvard T.H. Chan School of Public Health, shows that consistent moderate physical activity can reduce cardiovascular risk by more than 30%, with corresponding improvements in long-term health outcomes. When viewed through an insurance lens, these improvements translate directly into reduced claims volatility over time.

Digital engagement platforms now allow insurers to incorporate behavioural insights into the core design of group insurance products. Aggregated data on activity levels, habit consistency and engagement trends provides early signals of risk direction, strengthening underwriting intelligence without compromising individual privacy.

“At YuLife, behavioural engagement is embedded into the insurance experience itself. Employees are incentivised to build healthier daily habits, while employers receive anonymised insights into workforce risk trends. Over time, sustained behavioural improvement contributes to a healthier, more stable risk pool,” says Tal Gilbert, CEO of YuLife.

As healthier behaviours scale across a group scheme, claims frequency begins to stabilise, and premium pathways become more predictable. For employers, this improves long-term cost planning and reduces the likelihood of sudden pricing shocks at renewal.

The benefits extend beyond claims metrics alone. Improved cardiovascular health supports energy, focus and resilience in the workplace, contributing to reduced absenteeism and improved productivity, outcomes that further reinforce the value of well-designed group insurance cover.

A strategic imperative for insurers and employers

Non-communicable diseases will remain the defining risk exposures within life and disability insurance portfolios. While cardiovascular conditions are a significant component, the broader burden now includes diabetes, cancer, chronic respiratory diseases, mental health disorders and musculoskeletal conditions. Urbanisation, sedentary work patterns, nutritional shifts, rising stress levels and sustained economic pressure continue to shape workforce health outcomes across multiple risk categories.

The strategic question is no longer whether these risks exist, but how proactively they are managed within group insurance design. Forward-thinking schemes recognise that preventable and manageable conditions account for a substantial portion of claims experience. Embedding holistic prevention strategies into product structures, spanning physical health and mental wellbeing, lifestyle management and early intervention, aligns employee wellbeing with long-term financial sustainability.

“From my perspective, this is the direction group insurance needs to take. Stabilising claims, protecting employer budgets and supporting longer, healthier working lives are aligned goals. NCD’s are no longer abstract medical statistics; they are measurable insurance variables. The more effectively we manage overall workforce health risk, the more resilient and sustainable our group schemes will become,” Gilbert concludes