Reports and Surveys | August 16, 2023

Medical Stop-Loss Premiums Increase by More Than 8%

The average stop-loss coverage premium increase is 8.4 percent for the nearly 250 health plans in Segal’s national medical stop-loss database’s 2023 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 13.4 percent.

Get the Infographic

Medical Team On Rounds Meeting Around Bed Of Senior Male Patient Download Now

To learn more about stop-loss insurance, download our infographic.

You’ll learn:

  • The percentage of plans that purchased broad coverage for medical and prescription drug claims
  • The range of specific deductibles and which deductible is most common
  • The relationship between deductibles and premiums
  • Factors that affect a plan’s premium and premium increases
  • The percentage of plans that stayed with the incumbent insurer when they bid or renewed their stop-loss coverage

Why get stop-loss coverage?

High-cost claimants with $100,000+ paid annual claims over the last two years accounted for less than 1 percent of all claimants but 28 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 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.

Have questions about medical stop-loss coverage?

To discuss the adequacy and competitiveness of your plan’s stop-loss coverage compared to plans in Segal’s 2023 dataset, get in touch.

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This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.