Reports and Surveys | August 19, 2022
The average stop-loss coverage premium increase is 9.8 percent for the nearly 250 health plans in Segal’s national medical stop-loss database’s 2022 dataset. That’s up from 8 percent in the 2021 dataset.
We’ve highlighted additional results of our analysis of the 2022 dataset below.
The most common specific deductible, which 10 percent of plans have, is $250,000. That’s up from $200,000 in the 2021 dataset.
However, specific stop-loss deductibles continue to vary widely, as illustrated below.
Average per-participant premiums are higher at lower specific stop-loss deductibles.
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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 Rx paid claims for a single individual 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.
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.
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