Stop Loss Insurance paid claims analysis 2025
What’s driving costs and trends based on our claims data
Oct 13, 2025
As health care costs continue to rise, we review our Stop Loss Insurance claims every year to better inform intermediaries and employers as they evaluate stop loss coverage — and point to solutions and cost containment programs that can help protect self-funded employers from high-dollar medical claims.
Based on our 2024 claim incidence rates, we’ve identified some key cost drivers and trends intended to help employers mitigate risk and set the proper medical plan funding. Plus, find out what we’re keeping a close eye on in the Stop Loss market.
Safeguard against unexpected health care costs
Medical and prescription costs can add up quickly for just one employee. Based on our book of business, this table illustrates what catastrophic claims can look like — each one represents the total claim cost for one person with one specific condition for just one year:
| Top 10 largest Stop Loss claims (includes medical and prescription) | 2024 TPA allowed charges |
|---|---|
| 1. Congenital anomalies (i.e., premature birth, birth defects) | $8,873,908 |
| 2. Injury and poisoning | $8,852,010 |
| 3. Congenital anomalies (i.e., premature birth, birth defects) | $7,448,326 |
| 4. Diseases of the digestive system | $7,150,047 |
| 5. Symptoms, signs, and ill-defined conditions (i.e., not otherwise specified) | $6,171,902 |
| 6. Neoplasms (i.e., cancer) | $5,805,862 |
| 7. Neoplasms (i.e., cancer) | $5,785,916 |
| 8. Diseases of the respiratory system | $5,633,125 |
| 9. Congenital anomalies (i.e., premature birth, birth defects) | $5,537,541 |
| 10. Congenital anomalies (i.e., premature birth, birth defects) | $4,839,347 |
All statistics and trends are based on our book of business. The average Stop Loss claim allowed charge for our top 10 in 2024: $6,609,798. Actual results may vary.
Our Stop Loss insurance covers employers with a total of 2.2 million employees. The data presented throughout this article reflects policies effective Jan. 2, 2023 with coverage through Jan. 1, 2024, and claims completed through April 30, 2025. Actual results may vary.
Frequency of diagnosis per 10,000 employees
According to our claims experience, this is how often the top 10 claims diagnosis can be found within a population:
| Top 10 claims diagnosis categories and examples in 2024 | Average paid claims cost by diagnosis category | Frequency per 10,000 employees |
|---|---|---|
| Neoplasms (i.e., cancer) | $485,320 | 10.2 |
| Diseases of the circulatory system (i.e., heart and blood vessels) | $407,396 | 3.6 |
| Diseases of the digestive system | $382,995 | 2.5 |
| Endocrine, nutritional and metabolic diseases, and immunity disorders (i.e., hormone, nutrition) | $532,319 | 2.0 |
| Diseases of the musculoskeletal system and connective tissue (i.e., bones, muscles, joints) | $291,842 | 1.9 |
| Injury and poisoning | $479,072 | 1.8 |
| Diseases of the nervous system and sense organs (i.e., brain, nerves, and senses) | $439,308 | 1.8 |
| Infectious and parasitic disease | $546,074 | 1.3 |
| Diseases of the genitourinary system (i.e., urinary and reproductive systems) | $346,311 | 1.2 |
| Other | $586,067 | 6.2 |
| Average cost: $473,973 | Total frequency: 32.5 |
All statistics and trends are based on our book of business.
Using the information in the table above, if a client has a population of 3,000 employees, they might see roughly $4.6 million in high-cost claims:
Changes in incidence
Claim frequency is up significantly (32.5 up from 23.8). Cancer claims continue to make up the largest number of claims submitted and the largest percentage of total claims costs. We expect cancer claims will continue to make up the largest portion of total claim spend. Also, we anticipate the average claim cost to increase in line with medical trend.
| Deductible | Average annual growth rate in incidence |
|---|---|
| $100,000 | 8.1% |
| $150,000 | 10.9% |
| $250,000 | 10.9% |
| $500,000 | 13.2% |
| $750,000 | 15.4% |
Want to learn more about our flexible Stop Loss Insurance? Contact your Voya representative today — and view this brochure for our full Stop Loss paid claims paid analysis.
1 Ranking of top Stop Loss providers in the United States based on 2024 annual premium as of 5/24/2025 by MyHealthGuide Newsletter: News for the Self-Funded Community.
The information provided on this document does not, and is not intended to, provide legal advice. Neither Voya® nor its affiliated companies or representatives provide tax or legal advice. Please consult a tax or legal professional regarding your specific circumstances.
Excess Risk (Stop Loss) Insurance is issued and underwritten by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya® family of companies. Voya Employee Benefits is a division of both companies. Stop Loss Policy #RL-SL-POL-2013; in New York Policy #RL-SL-POL-2013-NY. Form numbers, product availability and specific provisions may vary by state.
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