Introduction: The purpose of this study is to present a localized and practical framework for developing a risk profile for supplementary health insurance in Iran. The framework is designed to systematically identify, assess, and manage risks, with the aim of enhancing the resilience of insurance companies, improving insurers’ decision-making, and supporting the development of more efficient insurance products.

Methodology: The research was carried out in three stages: (1) extracting the components of the risk profile from specialized sources, (2) conducting a comparative study of international experiences, and (3) analyzing the current state of Iran’s insurance industry in terms of human, technological, legal, and institutional infrastructure to propose a localized and applicable version.

Findings: The risk profile can serve as a strategic tool for effective management of insurance risks. The proposed framework includes seven key stages, which contribute to identifying and forecasting high-cost medical risks, prioritizing threats, and allocating resources in a targeted manner. Moreover, the review of international experiences highlights the crucial role of emerging technologies and the existence of advanced regulatory frameworks in enhancing the efficiency of risk management systems.

Conclusion: The systematic implementation of a risk profile for supplementary health insurance can foster fair pricing, improve financial resilience, and enhance the quality of insurance services. However, challenges such as the lack of structured data, weak technological infrastructure, shortage of specialized human resources, and absence of comprehensive regulations call for the simultaneous development of infrastructure and stronger coordination between insurers and regulatory bodies.