The latest analysis from QBE confirms what many plan sponsors already suspect, catastrophic claims are becoming more frequent, more severe and more expensive to insure. In less than five years, the frequency of million-dollar stop loss claims has doubled. Cancer remains the top cost driver, and specialty drug therapies are pushing claims even higher.
For plan sponsors, the impact is both immediate and long-term. Stop loss carriers are recalibrating their pricing models and the 2026 premium cycle will reflect that shift. The question is not whether costs will rise but whether your plan is prepared to contain them.
The Risk Landscape Is Shifting Fast
QBE’s 2025 Accident & Health Market Report highlights a series of trends that fundamentally alter claim behavior and risk profiles.
Cancer continues to dominate stop loss claims, particularly blood cancers like lymphoid leukemia. These diagnoses are increasingly treated with CAR-T therapy and other aggressive regimens, often exceeding $1 million per patient. Costs rise further with complications and extended hospital stays.
Circulatory disease is now the second most frequent category of catastrophic claims, with heart failure leading the list. Preterm births with congenital anomalies are growing in severity – some individual claims exceed $5 million!
Exposure to high-cost claims is also common in the specialty pharmacy market. Cell and gene therapies, now approved for cancers, autoimmune conditions and rare diseases, are crossing into seven-figure territory. Even when claims are rare, the financial impact is transformative.
QBE’s data shows that early-onset cancers are rising among individuals under age 50. These patients often require more intensive and longer-duration treatment, increasing the total cost of care and the likelihood of reaching the stop loss attachment point.
These are not isolated events. They are signals of the new normal.
Stop Loss Will Not Absorb This Quietly
The growth in claim severity is already showing up in underwriting. Carriers are raising premiums, increasing lasers, tightening exclusions and reevaluating how risk is spread across contracts. Plans with outdated language or loose definitions around allowable charges are especially vulnerable. So are plans with little insight into where their high-dollar claims are coming from—or how to stop them.
Carriers will adjust to protect themselves. The burden will fall on plan sponsors.
aequum Helps Plan Sponsors Reduce Exposure Before Costs Escalate
aequum supports plan sponsors with targeted legal, financial and administrative strategies to limit catastrophic loss and strengthen plan defensibility. This includes:
- Claims analysis to identify recurring patterns, high-cost triggers and preventable exposures.
- Plan design review to evaluate deductible levels, exclusions, reimbursement logic and coverage terms.
- Audit and recovery of overpayments and inflated provider charges.
- Guidance on implementing pricing models such as reference-based pricing (RBP) with participant representation and protections.
- NSA compliance and support for IDR enforcement, to ensure that disputes are handled correctly and costs stay controlled.
aequum’s team understands the legal, regulatory and claims-side pressure points that drive stop loss usage and how to keep those pressures in check.
What Plan Sponsors Should Do Now
Plan sponsors cannot control stop loss pricing. However, they can take meaningful action to influence it.
aequum is offering a claims exposure review to help employers understand where their plans are vulnerable, what strategies are available to reduce high-cost claims and how to reduce risk and exposure while preparing for the next stop loss renewal.
This is not about cutting benefits. It is about creating clarity, accountability and protection where the plan needs it most.
Stop loss should be a backstop, not a crutch. The best protection begins with the plan itself.
Contact aequum today to schedule your claims review and reduce exposure before stop loss carriers set the next price.