Stop Loss paid claims analysis 2023

Stop Loss Insurance can help protect self-funded employers by lessening the impact of devastating medical claims. Our goal is to help both intermediaries and employers stay on top of the latest Stop Loss trends — to better mitigate risk by offering a flexible contract with options that best serve each employer’s needs and proven cost containment programs.

In 2022, our top 10 claims average increased about 8% from 2021 and diseases of the blood comprised three of the largest claims. We’re also noting that individuals exceeding Stop Loss deductibles from $100,000 to $750,000 have increased at an annualized rate ranging from 5%-8% from 2019-2022.

Let’s take a closer look at the cost drivers and other trends we’ve identified based on our book of business — and what we’re predicting in the Stop Loss market.

Protect the unexpected costs of medical care

Medical and prescription costs can add up for just one person — this table illustrates what it can look like in a catastrophic claim. Each claim represents the total claim cost for one person with one specific condition for just one year:

Here are a few trends we’re seeing:

Frequency of diagnoses per 10,000 employees

Based on our claims experience, here’s how often the top 10 claims diagnoses can be found within a population:

Using the information in the table above, if a client has a population of 3,000 employees, they might see roughly $3.3 million in claims:

This is shown as an example only. Actual results may vary.

Changes in incidence

While claim frequency is up from last year (19.7 up to 23.3), average claim size is down. Cancer claims continue to make up the largest number of claims submitted and the largest percentage of total claims costs. The average claim cost, in line with medical trend, is expected to continue rising.

In addition, here are three other trends we noticed:

What we’re watching: Cell and gene therapy

We are keeping a close eye on cell and gene therapy, especially considering recently approved, high-dollar treatments. These have the potential to impact Stop Loss claims, along with others already on the market — and could emerge in the top 10 claims in the future.

We’re continuing to cover cell and gene therapies, as long as the underlying medical plan covers the treatment and it meets the terms and conditions of the policy. We also exclude these high-cost claims from the following year’s renewal package, helping lower the impact on self-funded employer costs.

To learn more about our flexible Stop Loss Insurance, contact your Voya sales representative. You may also view this brochure for our complete Stop Loss paid claims analysis:

View Brochure

 

Text representation of article graphics (for screen reader accessibility):

Graphic 1: Top 10 large Stop Loss claims (includes medical and prescription)

Top 10 large Stop Loss claims (includes medical and prescription)	2022 allowed charges
1. Injury and poisoning	$5,770,286
2. Diseases of the blood and blood-forming organs	$5,280,957
3. Congenital anomalies	$4,488,221
4. Diseases of the blood and blood-forming organs	$4,195,624
5. Injury and poisoning	$4,137,342
6. Diseases of the blood and blood-forming organs	$4,119,624
7. Diseases of the circulatory system	$4,116,541
8. Diseases of the musculoskeletal system & connective tissue	$4,099,288
9. Neoplasms	$3,908,400
10. Certain conditions originating in the perinatal period	$3,840,786

All statistics and trends are based on our book of business. The average Stop Loss claim allowed charge amount in 2022: $475,401.

Graphic 2: Notable trends

• In 2022, the average of the top 10 claims increased by approximately 8% from 2021.
• Diseases of the blood made up 3 out of 10 of the largest claims in 2022, while premature births made up 2 out of 10, down from 4 out of 10 in 2021.
• High-cost claims due to emerging specialty drugs and recently approved cell and gene therapies may emerge in the top 10 claims in the coming years.

Graphic 3: Top 10 claims diagnoses categories & examples in 2022

Top 10 claims diagnoses categories & examples in 2022	Average paid claims cost by diagnosis category	Frequency per 10,000 employees
Neoplasms	$466,215	7.1
Diseases of the circulatory system (heart attack, heart disease, atherosclerosis)	$417,088	2.5
Injury and poisoning	$558,490	1.9
Disease of the digestive system	$422,885	1.5
Endocrine, nutritional and metabolic diseases, and immunity disorders	$502,415	1.5
Diseases of the musculoskeletal system and connective tissue	$312,995	1.2
Diseases of nervous system and sense organs	$428,227	1.2
Infectious and parasitic disease	$571,249	1.0
Diseases of the genitourinary system	$371,083	0.9
Other	$551,711	4.5

• Average cost: $475,401
• Total frequency: 23.3

Graphic 4: Roughly $3.3 million in claims

• 23.3 claims per 10,000 employees = 7 claims per 3,000 employees
• 7 x $475,401 average cost = $3,327,807 estimated claims

Graphic 5: Deductible and Average annual trend growth rate in incidence

Deductible	Average annual growth rate in incidence
$100,000	6.1%
$150,000	7.3%
$250,000	7.0%
$500,000	7.7%
$750,000	5.5%

Graphic 6: Notable trends

• Individuals exceeding Stop Loss deductibles from $100,000 to $750,000 have increased at an annualized rate ranging from 5%-8% from 2019-2022.
• Annual growth in incidence at these deductibles from 2019-2022 has changed from 2018-2021, which was shown last year. The biggest change is a narrower range of growth rates.
• We continue to expect claim incidence to increase annually, on average. Stop Loss coverage can help protect self-funded employers by limited the impact of devastating medical claims.