Stop-loss premiums are at levels not seen in decades — and the reasons are more layered than simple medical inflation. Coming out of COVID, a surge in deferred elective procedures collided with a rapidly shifting pharmacy landscape, and the stop-loss market hardened in response. Million-dollar claims have increased 50% in the last four years. The cost split between medical and pharmacy has shifted from 80/20 to 65/35. And GLP-1 medications alone now account for 1% of total medical trend.
In this episode, Steve Sopko of Ryan Specialty Benefits helps benefits leaders make sense of what's driving today's cost environment and what to do about it. Steve walks through the three highest-cost claim categories putting the most pressure on self-funded plans right now — cancer, premature births, and catastrophic accidents — and explains why the employers who fare best are the ones using their data proactively rather than waiting for a shock renewal.
Steve also tackles the question of ecosystem integration — how stop-loss has to work alongside your TPA, network, PBM, and point solutions — and shares the specific contract features, questions, and levers that benefits leaders should be using but often aren't. If your stop-loss strategy hasn't kept pace with today's market, this conversation is a strong place to start.
