July 25, 2025 - Segal
By Michael S. Tesoriero

Medical Stop-Loss Premiums Increase Nearly 10%

The average stop-loss coverage premium increase is 9.7 percent for the 221 health plans in Segal’s 2025 national medical stop-loss dataset.

The average is for groups that maintained similar specific stop-loss benefit levels as the prior year.

Among all groups, including those 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 is 7.3 percent.

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Get additional current data on medical stop-loss insurance

You’ll learn:

• How the latest average stop-loss coverage premium increases compare to last year’s increases
• The percentage of plans that purchased broad coverage for medical and prescription drug claims and how that has changed since 2024
• The wide range of specific stop-loss deductibles
• Which deductible is most common
• The median deductible
• Median monthly per-participant premiums, which typically are higher at lower specific stop-loss deductibles, for three deductibles
• Prevalence of policy coverage for gene therapy
• Six factors that affect a plan’s premium and premium increases

Why group health plans need stop-loss coverage

High-cost claimants with $250,000+ paid annual claims account for less than 1 percent of all covered individuals but 15 percent of total medical and prescription drug 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 $3.5 million, underscores the value of stop-loss policies that cover prescription drug claims.

If you have stop-loss coverage, are you sure it’s adequate?

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.