Medical Stop-Loss Premiums Increase Nearly 10%

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.