Life and Health Insurance Operations: Global Industry Report

Summary

This report examines life and health insurance operations with a global scope and regional detail for Europe, the United States and China, using the latest available data. Premiums are still growing. Global life premiums rose 6.9 percent and global health premiums rose 12.3 percent in the latest reported period ¹. Forecasts point to slower growth. Swiss Re forecasts global life real premium growth of 2.3 percent, above its long-term trend ⁴. Key themes are aging populations and rising medical costs as drivers of health demand ¹, strong expansion in Asia and China ¹⁶, and growing exposure to alternative assets and private credit ⁴¹¹. The main risks are valuation uncertainty in alternative assets, cooling growth and gaps in verified data on profitability, fraud and workforce. The outlook is for moderating but positive growth, led by health and Asia, with the strongest implications for insurers' asset and product strategies and for supervisors monitoring structural shifts.

Key findings

1. 1

   Life and health premium growth remained strong in the latest period

   Global life premiums grew 6.9 percent year-on-year, and global health premiums grew 12.3 percent, the fastest rate in the source's comparison ¹. These are observed figures from one publisher's series.

   Confidence: High
2. 2

   Growth is forecast to moderate

   Swiss Re forecasts total global real premium growth to ease to 1.3 percent from 3.9 percent in the earlier period, while life real premium growth stays robust at 2.3 percent ⁴. These are forecasts, not outcomes.

   Confidence: Medium
3. 3

   AXA shows health and life growth, with a short-term health combined ratio below 100 percent

   AXA reported full-year life premium growth of 9 percent and health growth of 5 percent ⁷. Its first-half short-term Life & Health combined ratio was 97.1 percent ⁹. These are company-reported figures for one provider, so they cannot be generalized to the market.

   Confidence: Medium
4. 4

   Health insurance penetration in Asia is very low

   Health insurance penetration in Asia is below 1 percent in almost all markets, according to Allianz analysis reported in the trade press ². The source gives no exact figures, so the statement is qualitative.

   Confidence: Qualitative
5. 5

   Alternative assets and private credit are a supervisory focus

   The IAIS reviewed the effects of rising allocations to alternative assets and asset-intensive reinsurance on life insurers and proposed a principles-based definition focused on valuation uncertainty, illiquidity and complexity ¹¹. The proposal is not binding.

   Confidence: Qualitative

1Industry definition and scope

Life and health insurance covers policies that pay benefits linked to death, survival, disability, illness or medical costs. This report treats the life and health business as the underwriting, pricing, distribution, administration, claims handling and investment of those policies, together with the supervisory and reporting rules that govern them. Property and casualty insurance is excluded except where sources report totals.

Definitions vary by source and must be read with care. The IAIS standard expects legislation to categorize insurance business at least into life and non-life ¹⁰. Allianz reports health as a separate premium line ¹². The US NAIC reporting framework covers accident and health alongside life ³¹², and AXA reports a combined Life & Health segment ⁷⁸. Growth rates may be nominal, as for China ⁶, or real, as in the Swiss Re outlook ⁴⁵. Premium totals are also not on one basis: global life premiums are given in euros ², while China's forecast is in US dollars ⁶.

Geography is global, with regional detail for Europe, the United States and China where sources are regional. The reporting period is the latest available data, with forecasts as published. Terms used in this report include gross written premiums (AXA's measure), direct premiums and considerations (US usage), real premium growth (adjusted for inflation) and nominal growth (not adjusted).

Definitions are taken from the cited sources. No definition has been harmonized across sources.

2Market size, structure and value chain

Life insurance is the largest premium segment globally, ahead of property and casualty and health ². Global life premiums were reported at EUR 2,861 billion in the latest period ². The pack does not provide a verified global total for health premiums, so the share of health within the total cannot be stated.

Growth is strong but moderating. Global life premiums grew 6.9 percent year-on-year, slower than the prior period but above historical norms ¹. Health premiums grew 12.3 percent ¹. In the United States, direct life premiums and considerations reached a record USD 1.09 trillion ³. Accident and health direct premiums grew 7.8 percent, with private participation in government programs a key driver ³.

Regional structure is shifting. Allianz describes Asia as the principal growth engine for life premiums, with China expanding strongly ¹. Swiss Re reports China life premium nominal growth of 9.4 percent ⁶ and forecasts growth of about 7.0 percent, with life premiums of roughly USD 633 billion in the forecast period ⁶. These figures use different currencies and definitions and should not be added to the euro total ².

The value chain runs from product design and underwriting through distribution, policy administration and claims, asset management and reinsurance. The IAIS identifies asset-intensive reinsurance as a structural shift affecting life insurers ¹¹. Revenue depends on premiums and investment returns. The pack does not quantify the mix of these income sources. Key stakeholders include insurers, reinsurers, supervisors, government health and retirement programs ³⁵, and investors. Distribution channel mix (agency, bancassurance, direct, broker) is not verified in the pack.

• Global life premiums 2,861EUR billion Observed Global, Latest available data [2]
• Global life premiums, year-on-year growth 6.9percent Observed Global, Latest available data [1]

Chart values are as reported by Allianz. No figures have been adjusted for inflation or currency.

3Customers, demand and adoption

Demand is driven by aging populations and rising medical costs, which Allianz identifies as the reason health premiums grew at the fastest rate in its series ¹. The sources do not provide customer counts by segment, so the size of each customer group cannot be measured.

Asia shows the largest gap in health cover. Health insurance penetration in Asia is below 1 percent in almost all markets ². The source does not quantify affordability or demand. Low penetration suggests that growth will depend on product design, distribution reach and the cost of cover, but the pack does not measure these factors.

In Europe, country-specific pension reforms and retirement solutions are described as creating structural growth opportunities ⁵. Swiss Re expects Advanced Europe life real premium growth of 1.5 percent, moderating from about 2.4 percent ⁵. The sources do not show how demand splits between retirement income and protection.

Product preferences are shifting in the United States. Individual indexed life premiums rose and reached 13.2 percent of individual life premiums ³. This points to growing demand for products linked to market indices, although the source does not state the reasons.

The pack does not provide evidence on purchasing criteria, customer satisfaction, claims experience or digital adoption, so these points are not assessed here.

• Global health premiums, year-on-year growth 12.3percent Observed Global, Latest available data [1]

Demand observations rely on premium data and qualitative statements. No adoption rates are available in the pack.

4Competitive landscape and key players

The pack contains limited comparable provider data. Only AXA publishes segment-level Life & Health figures ⁷⁸⁹. Swiss Re and Allianz are research publishers rather than operators, and S&P Global reports aggregated US data ³. A fair comparison of competitors is therefore not possible. AXA is treated here as one illustrative provider, not a representative peer group.

AXA reported full-year life gross written premiums and other revenues growth of 9 percent and health growth of 5 percent ⁷. Total group top-line growth was 6 percent ⁷, and Life & Health gross written premiums were EUR 35 billion ⁷. In the first half, Life & Health gross written premiums and other revenues rose 8 percent to EUR 29.2 billion ⁸. These figures come from different company documents, and the full-year premium total differs across trade sources, so only the growth rates are relied on here.

Profitability indicators show a mixed picture. AXA's Life & Health underlying earnings rose 5 percent to EUR 1.8 billion, mainly from short-term health technical profitability ⁸. The short-term combined ratio was 97.1 percent in the first half ⁹. Interpretation: under the usual definition, a combined ratio below 100 percent indicates an underwriting profit on short-term business. The pack does not provide a life-specific cost-to-income ratio, return on equity or loss ratio, so margin comparison is limited.

Market share and concentration cannot be assessed from the pack. The present value of expected premiums rose 1 percent to EUR 25.9 billion, led by life volumes ⁹. Competitive pressure is rising as premium growth cools ²⁴. Interpretation: slower growth tends to intensify competition for the same customers and shifts the focus toward pricing discipline and asset returns.

• AXA full-year life gross written premiums and other revenues growth 9percent Observed Group (global), Full year, latest available data [7]
• AXA Life & Health short-term combined ratio 97.1percent Observed Group (global), First half, latest available data [9]

Only growth rates are relied on for AXA premium totals because the euro totals differ across sources.

5Technology, operations and workforce

The pack does not verify technology adoption, automation rates, productivity measures, staffing levels or talent supply for life and health operations. These gaps matter because the operating model depends heavily on administration, claims and investment systems. The analysis below therefore relies on reporting requirements and regulator material.

Operating practice is shaped by regulatory reporting. In the United States, life, accident and health companies file quarterly statements 45 days after quarter end, plus an annual statement, under NAIC instructions ¹². The NAIC annual statement blanks and instructions cover life, health and property and casualty companies ¹². Interpretation: operations teams must support structured, recurring data production on a fixed cycle.

Fraud reporting is also annual. Insurers report counts of claims received, special investigation unit referrals for application and claim fraud, and fraud bureau referrals ¹³. The pack reports no aggregate values, so fraud rates cannot be stated. This is a clear data gap.

Asset management is becoming more complex. The IAIS notes that rising allocations to alternative assets and asset-intensive reinsurance affect life insurers ¹¹. Life insurers are among the fastest-growing investors in private credit exposure ⁴. Interpretation: these shifts require valuation, liquidity and data capabilities, which may increase operational and skills demand. The pack does not measure this effect.

Workforce skills, talent supply and automation effects are not verified for this sector and are therefore not assessed.

Operational points come from US reporting instructions and IAIS material. They are not evidence of current practice across all markets.

6Regulation, standards, risk and sustainability

The main international reference is the IAIS Insurance Core Principles and Common Framework (ICPs), which provides a globally accepted framework for fair, safe and stable insurance markets ¹⁰. The ICPs are a standard. They bind a jurisdiction only once adopted in its law and supervisory practice, and the pack does not show which jurisdictions have done so. The IAIS also adopted the Insurance Capital Standard, a risk-based measure of capital adequacy for internationally active insurance groups ¹⁰. This is also a standard that applies through supervisory adoption.

United States: NAIC statement instructions set the content and timing of reports for life, accident and health companies ¹². Antifraud reporting is an annual requirement under the NAIC form ¹³. Whether these apply as binding rules depends on state adoption, which the pack does not verify. This report therefore describes them as reporting requirements in the United States, not as proven binding obligations in every state.

Proposed rules and guidance: the IAIS public issues paper proposes a principles-based definition of alternative assets, focused on valuation uncertainty, illiquidity and complexity ¹¹. This is a proposal, not a binding rule. It signals supervisory direction rather than a current requirement.

Risks: the principal asset risks identified are valuation uncertainty, illiquidity and complexity in alternative assets ¹¹. Private credit exposure is growing ⁴. Operational risks include reporting deadlines and fraud. The pack does not cover privacy, data protection, conduct, ethics, environmental or social rules, so these are not assessed. Sector solvency ratios are not verified.

This section is not legal advice. Jurisdictional status of each standard must be confirmed against local law.

7Challenges, opportunities and case examples

Constraints: growth is moderating. Swiss Re forecasts total real premium growth easing to 1.3 percent from 3.9 percent in the earlier period ⁴. Alternative assets raise valuation and liquidity risk ¹¹. The pack has no verified fraud, loss ratio or workforce data, which limits confidence in operational benchmarks.

Opportunities: health demand linked to aging and rising medical costs ¹; low health penetration in Asia ²; European pension reforms ⁵. Swiss Re describes life real premium growth as robust, supported by higher yields and above long-term trend ⁴.

Case: AXA. Short-term health profitability supported Life & Health underlying earnings, which rose 5 percent to EUR 1.8 billion ⁸. Full-year health growth was 5 percent ⁷. Health can contribute to earnings growth, but the pack does not separate health margins from life margins.

Case: China. Life premium nominal growth reached 9.4 percent ⁶, with forecast moderation to about 7.0 percent ⁶. Allianz reports 11.4 percent year-on-year growth in China life premiums ¹. The two figures come from different sources and periods, so the gap should be read as a difference in definition or timing rather than a trend.

Case: United States. Indexed life premiums rose and reached 13.2 percent of individual life premiums ³. This indicates product demand in a record premium market, but the pack does not show profitability for this product.

Case examples are drawn from company and market reports in the pack and are not a full competitor review.

8Outlook and strategic implications

The base case, using the pack's published forecasts, is moderating growth. Swiss Re expects total global real premium growth of 1.3 percent ⁴ and robust life real growth of 2.3 percent ⁴. Allianz projects global life premiums growing 4.9 percent a year and health premiums 6.7 percent a year over the next decade ². These forecasts use different definitions and horizons, so they are not directly comparable.

Likely shifts: health is expected to gain share as aging and medical cost pressures rise ¹². Asia and China remain the largest growth regions ¹⁶. Asset portfolios are moving further into alternatives and private credit ⁴¹¹. Interpretation: valuation governance and asset risk management become more important as growth slows.

Uncertainties: the pack does not verify profitability, loss, fraud or workforce trends, so the margin outlook is not quantified. Practical implications: insurers should test pricing against slower growth and monitor asset valuation risk. Supervisors should track alternative asset disclosure as the IAIS proposal develops ¹¹. Investors should compare company data on consistent definitions.

Forecasts are not outcomes. The table compares published figures without adjusting for definition.

9Conclusion

Life and health insurance premiums are growing strongly, but forecasts point to slower growth. Health demand and Asia are the clearest growth drivers in the pack. Asset risk and data gaps are the most important constraints to assess before drawing firm conclusions about profitability, fraud or workforce needs.

How this was built

Sources

1. 1

   Allianz Global Insurance Report: The Future of Insurance in a Fragmenting World

   Allianz Research Market research

2. 2

   Global insurance premiums climb 7.1% as growth cools

   Insurance Business (reporting Allianz Research) News report

   insurancebusinessmag.com
3. 3

   Life insurers post modest gains following record results, S&P Global finds

   S&P Global Market Intelligence (reported by Insurance News Net) News report

4. 4

   Insurance: a stabilising force as the cycle softens

   Swiss Re Institute Company report

5. 5

   Europe insurance

   Swiss Re Institute Company report

6. 6

   Insurance: China life premium growth outlook (Swiss Re sigma China outlook)

   Swiss Re Institute Company report

7. 7

   Full Year Earnings Presentation

   AXA Group Company report

   webcast.axa.com
8. 8

   AXA sees 9% growth in life premiums (first half results)

   AXA Group (reported by Cover Magazine) Company report

   covermagazine.co.uk
9. 9

   AXA half-year financial report (activity report)

   AXA Group Company report

10. 10

    Insurance Core Principles and Common Framework for the Supervision of Internationally Active Insurance Groups (December edition)

    International Association of Insurance Supervisors (IAIS) Standard

11. 11

    Public Issues Paper on structural shifts in the life insurance sector

    International Association of Insurance Supervisors (IAIS) Regulator

12. 12

    Statistical Compilation and Annual Statement Instructions for Life, Accident and Health and Fraternal Insurers

    National Association of Insurance Commissioners (NAIC) Standard

    content.naic.org
13. 13

    Annual Antifraud Statistical Report Form

    National Association of Insurance Commissioners (NAIC) Regulator

    content.naic.org