You studied Management and Business Administration at the Portuguese Catholic University. What brought you into the insurance sector?

I entered insurance as soon as I had finished my degree, following an invitation from university professor, Eduardo Madeira Correia. At the time he served as a director at Companhia de Seguros Império (Império Insurance Company) and had asked a few students to join the business Some of us took up the challenge. I found Império fascinating as a company. Not only was it a market leader but it was also known for innovative practices and for having a human resources policy focused on developing talent. As I was working on my degree, the Personnel Management class provided an opportunity to visit Império’s state-of-the-art training department. I was impressed by the diverse lines of business and variety of skills within an insurance company, and insurance’s extremely meaningful role in social and economic intervention. That focus also ensures it has to evolve constantly — in order to keep pace with social changes.

That is why I didn't hesitate when, back in 1982, I was invited to start my professional life in the sector. I stayed, and it's been 40 years now. I've never lost my taste for learning and evolving, and it's brought me a sense of personal and professional accomplishment.

Your career has been rich and varied. Could you tell us about the companies you’ve worked at, and the roles you have had?

Well, I never left the company where I started my career, but I did get the opportunity to work in different lines of insurance and across multiple enterprise groups, due to the mergers and acquisitions that Império went through.

I started in the marketing department. We all did, before being assigned to other business areas, as that provided a perspective and basic (yet indispensable) knowledge of all the insurance lines and the insurer's main functions, especially the commercial function. Having been there for a year, they asked me whether I would like to transition to life and join a department that was still in development to tackle a new class of life insurance, capitalization insurance. That role led me to get to know other markets, namely the French market which, at the time, was very influential and a major inspiration behind the development of capitalization insurance and pension funds. Talk of unsustainable Social Security and the state not being able to guarantee comparable rates of income for people’s retirement was exactly the same as it is now, 30-40 years later. At the time, there was an expectation that the insurance sector would drive development of the second and third pillars of retirement. That didn't happen, despite the intense dynamic at the time and the launch of numerous products. It was a truly enriching experience to be part of a team that pioneered not only pension funds but also launched capitalization products - with Império bringing the first Retirement Savings Plan to market in Portugal.

After 14 years in the life business, half of which as head of branch, I was asked to join motor claims, which threw a serious challenge my way. I came from a financial background, had studied actuarial science, and I didn't think I had the skills to lead a department structured around legal considerations. I even thought about leaving the company. But a friend took me aside and said, “Just get to know the department. They're a good team, you’ll grow together. Motor is probably one of the most interesting lines in the sector. You’ll be managing people and resources and you know how to do that. Your people will have the legal skills.” So, I did. I faced it head on and for 11 years I lead motor claims.

Now I’m confident that it was one of the most gratifying periods of my career and the one that led to the most personal and professional growth. I moved into motor claims at Império after three years following its sale to the BCP Group. I, and part of my team went to Autogere and, five years later, were acquired by the CGD Group, where Império Bonança and Fidelidade Mundial joined. We then had the opportunity, as an extremely experienced team, with a large number of cases under our belt, to work with the Portuguese Association of Insurers and the Motor Warranty Fund (Fundo de Garantia Automóvel) to design a sensible proposal for the settlement of motor claims with bodily injury, which was then the subject of a ministerial dispatch.

For two years, I took on additional responsibilities, juggling motor and workers’ compensation, the aim being to transfer to   motor claims management all the principles and assistance practices that existed in casualty.

In 2008, after a decade with motor, I was once again called upon to change. This time, it would be the health department, specifically the management team at Multicare. I’ve now been here for 14 years. I consider this the most interesting area of the insurance sector. We have an extraordinary team that works every day to manage the health of over one million customers and it constantly motivates me to learn and improve myself.

You’ve been with Multicare for a number of years. What do you think is your most valuable contribution to the company?

Maybe my team should answer that — they’d be more impartial. I would say the most relevant aspects of my contribution to the company are our vision of service: service to the insured, colleagues, distributors. And also, the sense of urgency that goes into everything we do, along with the restlessness we feel when we look at everything that still needs doing. Closeness, the human touch, in a company that is becoming ever more digital, are other qualities that set us apart.

As CEO of Multicare, what is your mandate?

My role is to ensure the whole team is on the same page, that everyone helps define the path we’re on and that everyone knows where we want to go. Above all, to make sure people enjoy what they do, that their work makes sense, and that people can find a purpose for their professional life in their day-to-day. It was my privilege to have mentors (some of them in leadership) who showed me the purpose behind what I do. That often helped me power through adversity and lack of motivation, finding true opportunities for growth and development.

Over the years, Multicare has embarked on numerous innovative initiatives, such as the launch of oncology insurance, or the recent push for online medicine, for prevention, and mental health. Would you like to elaborate?

We lead on premiums, but what really sets us ahead of the competition is innovation. Not just in terms of products and services, but in forming true partnerships with providers for technological and therapeutic innovation. More often than not we're the first insurer to create protocols for innovative tests and exams and new clinical procedures.

We’ve long upheld the importance of prevention and that health insurance is not merely something you use when you're ill but, fundamentally, something you employ to prevent illness. In 2009 we pioneered the inclusion of annual check-ups at no additional cost for our customers. Promoting tracking and early detection of illness has been a top priority. Especially tracking oncological illness. Once again in 2015 we pioneered oncology insurance, with unique, comprehensive coverage of treatment and a very extensive annual tracking and early detection programme. In 2016, partnering with Teladoc, world leader in remote medical technologies, we launched the first online, exclusively medical platform in the insurance sector. It's been growing steadily, and it offers medical appointment services across a number of medical specialties, psychology sessions, and nutrition and exercise programmes. Above all we want to encourage prevention and self-care by providing quick, 24/7/365 access to primary health care. This platform played an instrumental role in our support to customers during the pandemic, helping to track the illness through consultation and prescriptions for tests. But we went beyond that. We were concerned about the aftermath, so for all customers whose policies included check-ups and who'd been infected, we offered post-Covid check-ups designed around the severity of the illness. In 2020 we again took a major step when we launched the world-renowned Vitality programme, which incentivizes and rewards healthy behaviours. And once again we blazed a trail when we launched a coverage last year that focuses on mental health. As a rule, mental health is excluded from insurance contracts.

We innovate so that we can strengthen protection. That is our lead priority.

During the pandemic, among the insurers that exclude this particular risk, Multicare was the only one to waive pandemic-related exclusions, ensuring that customers who caught Covid-19 would have access to the guarantees in their policies. What led the company to this position?

Three major goals led us to an agreement with the National Association of Private Hospitals to assist our insured who were sick with Covid-19 and hadn't got a referral from the National Health Service. Firstly, we wanted to assure protection for our customers’ health. Secondly, to take some of the strain off of the clinical units in the NHS, avoiding the transfer of Covid-19 patients who hadn't been referred by the Portuguese NHS and all the associated medical procedures, thus contributing to the high rate of efficiency the NHS demonstrated. Finally, we wanted to ensure continued support of the private health system. It has inarguably contributed to the improvement of health care among the Portuguese and, as a consequence, to the development of health insurance in Portugal. Its hospital network has proved absolutely instrumental in the recovery stage with regard to treatments that were postponed due to the pandemic.

Because this was a unilateral decision, not only did we stop invoking exclusions, but we also decided to bear all costs, not reflecting them in policies, either for companies or individuals.

How do you see health insurance in a scenario where inflation and recession will cut down on the economic capacity of families and companies?

Health insurance has proven very resilient as a business. It was the only line that maintained constant growth during the 2008-2013 economic crisis and has grown steadily at 9% in recent years. This year it has exceeded 10%. However, in this new macroeconomic scenario we're living through, I see a loss of momentum, especially for the individual segment. As to companies, health insurance is one of the benefits employees value the most — it helps keep teams healthy and productive. During the two years of the pandemic many new companies turned to the market, SMEs, and large corporations alike, to acquire health insurance for their employees. What might happen, considering that insurers are asking for higher premiums and companies are tightening their purse strings, is that coverage plans will get revised. Our position has been to advise placement of available amounts on risk coverage as opposed to regular consumption coverage, to hospital stay and outpatient care coverage which will effectively protect people from costs they will find hard to bear.

My role is to ensure the whole team is on the same page, that everyone helps define the path we’re on and that everyone knows where we want to go. Above all, to make sure people enjoy what they do, that their work makes sense, and that people can find a purpose for their professional life in their day-to-day.

In that light, how will the rising costs of health operators impact pricing of health insurance?

As I said earlier, they already are. All operators reviewed their price structure in 2022. They are already reflected in accident rates this year, and they're working on prices that will apply in early 2023. So, health insurance premiums are already being impacted with regard to contract renewals and are going up in line with inflation. The corporate segment, which usually renews contracts at the start of the year, is in a frenzy of activity right now. Once again, I'd point out that prioritizing actual risk is the most important thing.

What are your main concerns regarding the future of health insurance?

My main concerns about health insurance fall into two categories: one its long-term financial viability. Our society is aging and there's a generational imbalance in the population. In Portugal, as we know, the problem is of a worrying magnitude. Two, the adequacy of insurance models and their capability to guard against constantly evolving risk.

Generational imbalance may be the greatest challenge to the principles of mutual benefit that health insurance rests on if you consider the huge, increasing cost pressure that aging brings.

With medicine evolving, mortality has fortunately dwindled. But morbidity has not, on the contrary. Many illnesses hitherto deemed lethal have fortunately become life-long conditions, but treatment is quite costly. Ever faster technological and therapeutic innovation, as we know, is another factor driving costs and health insurance must provide access to innovation — which doesn't always happen.

On the other hand, the technical structuring of health insurance, temporary, annual, and renewable, covering a kind of risk that isn't discrete but continual, with many exclusions and limitations, does not work with the way this risk evolves or the function that an insurer must perform: helping customers remain healthy and, in times of illness, give them access to the finest health care.

A very current example is coverage of mental illness, an issue very much of our time, which is excluded from insurance policies. That said, a year ago of course we decided to launch a specific coverage that we included in our standard portfolio. But we're the only ones to have done it so far.

Helping customers stay healthy includes motivating them towards healthy lifestyles, towards tracking, performing self-care. But that's not enough. We have to be available for prophylactic and preventative treatment. Decoding the genome brought us the possibility of learning our risk profile and being able to act preventatively. That's a major challenge coming for health systems and particularly for health insurance, whose object, anachronistically, is illness manifesting during contract duration.

You have five daughters. What was it like, reconciling such a demanding career with a large family?

Having a big family was something my husband and I had always wanted. We organized ourselves so we could share duties and we’ve both been very present at each stage of our five daughters’ lives. They’ve all grown up now, found their own careers and independence. Obviously, we had indispensable help from grandparents and two domestic helpers who’ve been with me for over 30 years, and I owe them eternal gratitude.

I’ve always tried to follow a rule — leave things organized at home before you walk out the door so you can put in 100% at the office. And I've always tried to do the same when I wrapped up the workday and went home.

I confess it never struck me as a great challenge, balancing work, and family life. On the contrary, family helped me put problems in perspective, overcome difficult stretches without major upset and try to find a new way forward. Now it's my grandchildren, the wonder of being a grandmother, who remind me how important that balance really was.