July 18, 2024 - Segal
The average stop-loss coverage premium increase is 9.4 percent for the nearly 240 health plans in Segal’s 2024 national medical stop-loss dataset.
The average includes groups that increased specific stop-loss deductible levels and/or aggregating specific stop-loss deductibles resulting in an overall reduced rate action. The average premium increase for groups that maintained similar specific stop-loss benefit levels as the prior year is 11.5 percent.
High-cost claimants with $250,000+ paid annual claims accounted for less than 0.2 percent of all claimants, but 14 percent of total medical plan claim expenses, according to SHAPE, our medical claims data warehouse.
As the number and value of high-amount healthcare claims continues to grow, stop-loss coverage provides important asset protection and cost predictability, particularly for self-funded plans, smaller groups and those with modest cash reserves.
The fact that a growing number of drug therapies can exceed $1 million annually in prescription drug paid claims for a single individual, with some therapies costing over $3 million, underscores the value of stop-loss policies that cover prescription drug claims.
The rapid rate of change in newly approved medical technology and procedures requires a close inspection of the coverage language offered by each stop-loss insurer.
Segal subject matter experts carefully review stop-loss contract provisions to make sure policy language aligns with a plan’s coverage needs, so sponsors can secure coverage that meets their expectations.