RGA’s 2023 Mental Health Survey found that 85% of insurers surveyed ranked mental health as a top or moderate priority, yet 55% also reported that underwriting is challenging. That's often because some applicants choose not to disclose mental health conditions. Understanding why is key to improving mental health disclosures – and the applicant experience.
While some applicants may intentionally withhold information to secure coverage or lower premiums, non-disclosure often stems from psychological factors. Applicants may avoid disclosing a mental health condition due to feelings of embarrassment, shame, or emotional discomfort. Recognizing these emotional barriers is essential to improving disclosure rates.
The simplicity of questions also plays a role. True simplicity is derived not from the length of a question, but from its lack of ambiguity. A requirement to think deeply, consider multiple conditions at one time, recall complex details, make calculations, interpret medical terminology, make subjective judgments, or navigate emotional reactions can create a cognitive burden. This cognitive burden can lead to inaccuracies if customers misunderstand a question or simply cannot answer, or customers may approximate to avoid the effort of fully thinking through the question.
From RGA’s past research, we have identified five principles to guide the development of the optimized questions tested in this study:
In this study, we tested whether simplifying and normalizing mental health questions would increase disclosures and enhance the customer experience.
The research involved 4,049 participants who were demographically representative of the US and Australian populations and of typical insurance-holding age. Using a randomized control trial, we asked participants to complete a survey on their experiences with, and attitudes toward, mental health. Each participant received one of several versions of a mental health question: either a standard control question – typical of questions seen in the market without behavioral enhancements – or a behaviorally enhanced question. We measured both their disclosures and their experience.
Stigma often makes people uncomfortable discussing mental health in various settings.
To further reduce feelings of embarrassment, we separated the mental health conditions into three distinct questions based on their associated levels of stigma, as identified in previous research. This approach attempted to help participants feel more comfortable self-categorizing their mental health.
We evaluated two versions of the questions: one where participants respond "Yes/No" to having "any of the above conditions" and another where they responded "Yes/No" to each individual mental health condition.
We asked participants to rank different channels based on how comfortable they felt disclosing a mental health condition.
To improve mental health disclosures and applicant experiences, insurers must consider the human aspects of answering sensitive questions – how customers process the questions, and the emotions they feel while doing so. By reducing the sense of embarrassment and judgment, insurers can help customers complete applications with greater ease and accuracy.
These findings can also inform other sensitive areas of the insurance journey. Claim forms, like applications, can benefit from simplified, empathetic question design that minimizes embarrassment. More broadly, recognizing how customers perceive different mental health conditions can further support personalized, sensitive claims conversations.
This research suggests that new technologies may play a valuable role in the application process. Non-human channels, such as chatbots, can increase psychological distance, reducing negative feelings associated with disclosing sensitive information. However, these channels also present risks, such as the potential for increased dishonesty. Understanding how people interact with technology will be a crucial area for insurers to explore as they consider integrating these tools into the customer journey.
