Medical Stop‑Loss Coverage: Premiums Up 8% for 2021

Key findings on medical stop-loss coverage

Our latest analysis found that: 

• There was an 8 percent average premium increase for all stop-loss insurance policies in Segal’s 2021 dataset as a result of aggressive negotiations.
• A large majority of plans — 94 percent — have purchased broad coverage that covers medical and prescription drug claims.
• Among plans that bid or renewed their stop-loss coverage, 86 percent stayed with the incumbent insurer.
• High-cost claimants with $100,000+ paid claims per year account for less than 1 percent of all claimants but 25 percent of total medical plan claim expenses in a typical year.

Why medical stop-loss coverage?

As the number and value of high-amount 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 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 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.