With nearly one fifth of spending in the United States devoted to healthcare, the increasing amount of catastrophic claims are causing consultants and employer groups to seek solutions for controlling the rising costs associated with employee benefit coverage. As these costs continue to rise, Tokio Marine HCC – Stop Loss Group (TMHCC) is closely monitoring and analyzing them to see how stop loss rates are impacted by the changing market.

The following graph shows the experience TMHCC has seen over the past eight years. This data demonstrates how the number of $1 million+ claimants are growing 2.86 times faster than our enrollment and the total amount reimbursed is 3.03 times our enrollment growth. It is apparent that the rate of claims in excess of $1 million, and the total dollars reimbursed, substantially outpaces the growth rate of employee lives.

In May 2019, a $2.1 million gene therapy treatment called Zolgensma was approved by the FDA for the treatment of Spinal Muscular Atrophy (SMA) in children less than two years old. As more high cost treatments enter the market, the rate of claims in excess of $1 million will continue to increase. Stop loss premiums will need to increase to accommodate this new trend.

TMHCC is a leading provider of medical stop loss insurance provided through brokers, consultants and third-party administrators. By listening to the demands of the market, we have developed exceptional products, unparalleled resources and value-added services that set us apart in the industry. Visit our website to learn more about our innovative stop loss, Taft-Hartley, captive and organ transplant solutions.