Every carrier and MGA leader wants to grow Accident & Health. It's profitable, capital-efficient, and one of the few specialty corners of the market still expanding at a healthy clip. But behind the growth narratives like embedded insurance, AI-powered underwriting, and the gig economy sits a more complicated reality: regulatory drag, broker friction, healthcare inflation, and the operational debt that quietly determines whether new products ever scale.
In Tinubu's recent A&H Growth Panel, four operators with a combined 90+ years of industry experience pulled apart that reality. Jim Villa, Global Head of A&H at Zurich, Steve Durany, Head of US A&H at Convex, Tom Patitucci, Head of A&H Strategy at Tinubu, and moderator Alex Pinchevsky, former Head of A&H Operations at Everest and AIG, covered where the real growth is hiding, where speed is and isn't paying off, and what most carriers are still getting wrong.
Here are the seven takeaways every A&H decision-maker should walk away with.
1. The Real Growth Is in the "H," But It Has to Be Designed for ROI
The "A" side of A&H, accident, remains the predictable, foundational business that anchors most specialty portfolios. But it's a saturated, price-competitive segment. The growth is on the "H" side, particularly in supplemental health, gap medical, and specialty disability.
Why? Deductibles keep climbing, co-insurance keeps shifting to employees, and the gap between major medical and what employees actually pay out-of-pocket keeps widening. Supplemental products that fill those gaps are increasingly relevant, but only if they pencil out for the buyer.
As Steve Durany put it, "the benefits space is so crowded and the products are so standardized that it's hard to muscle your way in with a new product unless you can clearly show a measurable ROI to the customer." Carriers and MGAs that can quantify that ROI and communicate it cleanly to employers will own this segment.
2. ICHRA, Affinity, and the Quiet Restructuring of Group Distribution
A structural shift is underway in the small-group market: employers are stepping back from administering health benefits and pushing employees toward Individual Coverage HRAs (ICHRAs). That's reshaping where supplemental products attach.
Jim Villa flagged that Zurich is filing both group and individual versions of its products specifically to navigate this shift: group for traditional employer relationships, individual for the affinity space and for employees not getting coverage through their employer. Affinity itself, he noted, has grown double-digits for ten years running, much of it powered by point-of-sale digital placements like the participant accident offer that pops up at sports registration checkout.
The lesson for carriers: file for flexibility, not just for today's distribution channel.
3. Speed-to-Quote Is Now Measured in Hours, Not Days
The industry's quote-turnaround expectations have collapsed. What was a two-day SLA five years ago became two hours, then minutes, especially for high-frequency products like participant accident, sports, and BTA.
The biggest sources of friction? Handoffs and re-keyed data, and as Steve pointed out, MGUs are just as guilty of this as carriers. Multiple systems, manual data entry, and serial reviews are the structural drag on speed. AI is part of the answer, but the panelists were careful to position it correctly: not a silver bullet, but a tool best deployed at specific points along the underwriting assembly line, including data ingestion, OFAC, licensing checks, and decision support on complex risks.
The harder question for carriers: how do you invest in a tech platform that won't be obsolete in six months? The answer the panel kept circling back to was modularity: systems that can plug into partner platforms via API rather than monoliths that try to do everything in-house.
4. Don't Forget the Back End: That's Where Promises Get Broken
Tom Patitucci made the point that's easy to miss in the speed-to-quote conversation: a fast quote means nothing if the policy delivery, endorsements, version control, and accounting feedback loops are broken.
Drawing on his earlier time on the broker side, Jim described the classic carrier failure mode: a quote arrives in two days, then the binder sits on someone's desk for the next two or three months, and when the policy finally lands it isn't correct. He hopes technology has improved this, but suspects it still happens too often.
Modern A&H technology has to close that loop end-to-end: quote, bind, issue, endorse, reconcile, report. Otherwise, the front-end speed advantage evaporates the moment the policy enters production.
5. Digital MGAs Are Partners, Not Disruptors
Both Jim and Steve pushed back on the framing that digital MGAs are coming for traditional carriers. Jim's exact words: he doesn't view digital MGAs as disruptors or competition, but as opportunities. Their natural ground is saturated segments like participant accident, where their technology and consumer-facing experience can genuinely move the needle.
The real strategic question isn't "do we compete with them?" It's "how do we plug into them quickly?" Carriers that can offer their rates, filings, and forms via clean APIs become the back-end of choice for digital MGAs. The carriers that can't are walled out of an entire growth channel.
A note of caution from Steve, an MGU operator himself: even greenfield MGAs eventually accumulate legacy systems. Build for evolution, not just for launch.
6. The Speed-vs-Discipline Tension Is Real, and Has to Be Engineered Away
Speed without underwriting discipline is how carriers blow up books. The panel was unanimous: underwriting discipline is non-negotiable, regulatory compliance is a close second, and speed is third, even though it often feels like the loudest demand from the market.
The way to reconcile the three is to build the discipline into the system. Configurable guardrails by state, product, and partner. Form version control that propagates from a single source of truth. AI that learns the carrier's risk appetite from how underwriters actually adjudicate, then surfaces recommendations consistent with that appetite. Aligned incentives between carriers and MGAs (profit-sharing, retention targets) so the partner has skin in the discipline.
Speed and discipline aren't opposites. They're both outputs of a well-designed operating model.
7. The Variables Problem, and Who Will Solve It First
Brokers say they want simpler submissions and less data entry. But every "canned" product offering eventually runs into the same broker response: "Great, but I need you to change X, Y, and Z." Steve put it bluntly: "We did it to ourselves. The market did it. Look at how many benefits, riders, and variables there are now versus 30 years ago."
Whoever can rationalize that variability through smarter product configuration, AI-assisted endorsement workflows, or templated plans with surgical customization will own a real competitive advantage. As Tom suggested, the answer probably isn't fewer variables; it's better tooling that makes complexity feel simple to the broker, even if real work is still happening in the back office.
What Should A&H Leaders Actually Do Next?
When asked what one thing A&H leaders need to fix in the next year, Jim went to talent: long-tenured, growable team chemistry as the foundation under all the technology. Steve went to execution risk: can you actually deliver what you promised your partners, on time, on profitability targets?
Both answers point to the same conclusion. Technology is the enabler. Product design is the differentiator. But talent and execution are the multipliers. Carriers and MGAs that pair a modern, modular technology stack with deep operational discipline (plus the people who know how to run it) will pull ahead in the next three to five years.
The growth is there. The question is whether your operating model can capture it.
Want to see the full panel discussion? [Request a recording]
