What Changes When You Appoint a Private Medical Insurance Broker?

For many businesses, the decision to appoint a private medical insurance (PMI) broker can be overlooked or underexplained. While some companies choose to work directly with insurers, they may not fully understand the potential benefits a broker can bring. A broker can help save you time, reduce your administrative workload, and provide ongoing expert advice. However, the real changes that come with appointing a broker are often not clearly communicated.

This article aims to provide clarity on what typically changes—and what remains the same—when working with a private medical insurance broker. Its purpose is to support businesses in understanding the role of a broker and the considerations involved in appointing one.

What Typically Doesn’t Change

1. Your Benefits (Including Your Chosen Cover Limits)

When you appoint a broker, the benefits of your policy stay the same. Your coverage, including any benefit limits and terms you selected, remains unchanged. Whether your policy includes inpatient, outpatient, mental health, or other services, those benefits continue as they were when you worked directly with the insurer.

2. Your Underwriting Terms

The underwriting terms, including any specific exclusions applied by the insurer, will not change. These terms determine the treatments and coverage your policy provides. This means you will continue to be covered for the same conditions with the same exclusions as before appointing a broker.

Understanding your underwriting terms is essential to avoid surprises when making claims. If anything is unclear, it’s best to refer to your policy documents or contact your insurer or a regulated adviser—such as a broker—for clarification.

3. The Claims Process

The claims process will remain the same. You will still contact the insurer directly for pre-authorisation and follow the same steps you did previously. While your broker can offer support and guidance, the insurer will handle your claims.

4. Your Premiums

   
   

Your premiums will generally continue to be calculated in the same way as they were when you dealt directly with the insurer. Appointing a broker does not usually change the method for determining premiums. However, it's important to note that in some cases, broker remuneration may form part of the overall premium. Premiums and processes remain subject to change at the insurer’s discretion and should be clearly outlined at the outset of any arrangement with a broker.

What Typically Does Change

1. Annual Market Review

When you appoint a broker, they should review the market on your behalf each year. Your broker should receive your renewal documentation from the insurer and compare your current cover with available alternatives. They should provide you with guidance and recommendations based on the most suitable options for your needs.

In addition, the broker may conduct a needs analysis to identify areas where your policy could be updated. For example, if your outpatient cover has a low limit, your broker might suggest ways to enhance it, helping you make informed decisions. The availability of options will depend on your specific circumstances.

2. Potentially Negotiating Better Terms

A broker may work to negotiate better rates or discounts with your insurer. By leveraging competitor quotes (where applicable) and using their relationships with insurers, brokers often try to secure better deals during the renewal process. While discounts aren’t guaranteed, brokers aim to ensure you’re paying competitive rates.

3. Simplifying Administration

Managing a private medical insurance policy can involve a significant amount of administration, such as adding or removing employees, updating member details, and ensuring continuous cover. A broker should handle much of this administrative work on your behalf, saving you time and effort. You shouldn’t need to deal with the paperwork or manage updates directly with the insurer.

Though you can still manage these tasks yourself, many businesses prefer to let the broker handle them for convenience.

4. Policy Information

Alongside the insurer, your broker should typically act as a point of contact for any policy-related questions. Whether you need clarification on your cover or assistance understanding the insurer’s terms, your broker may be able to provide the necessary information and help you better understand your policy.

5. Claims Support

While the insurer will continue to manage claims directly, your broker may be able to offer support if issues arise. If you encounter difficulties with a claim or need help navigating the process, a broker can usually support you in dealing with the insurer and provide guidance to help you try to resolve any problems.

Cost and Contracts

One of the key benefits of appointing a broker is that their services typically come at no direct cost to your business. Brokers tend to operate on a commission-based model, receiving a commission from the insurer for their services. However, this commission does not usually affect your premiums now or in the future. For specific details about how broker commissions work, it's best to speak directly to a broker.

Additionally, there is usually no contractual obligation to stay with your broker. You are free to switch brokers or return to dealing directly with the insurer at any time, simply by informing either the broker or the insurer.

How to Appoint a Broker

Appointing a broker is typically a straightforward process. You’ll need to complete a short form known as a Letter of Appointment (LOA). Once signed, the broker submits it to the insurer, who typically confirms the appointment within a few working days. After confirmation, the broker can start supporting you with your private medical insurance.

By appointing a broker, you may benefit from access to expert guidance and ongoing support, which can include policy assessments, market reviews, and help with administrative tasks—depending on the services they provide.

Disclaimers:

Disclaimer 1: The information provided in this article is accurate as of April 13, 2025. However, all details are subject to change in the future based on updates to insurer terms, market conditions, or regulatory changes. For the most up-to-date information, please contact a broker or your insurer directly.

Disclaimer 2: The information provided in this article is intended for educational purposes only and should not be used as specific advice for any individual insurer, broker, or policy. For details regarding your specific policy or broker, always refer to your insurer’s policy documents or contact a broker or your insurer directly for personalised assistance.