High-Cost Claims Increase in Frequency and Severity, according to QBE North America’s Accident & Health Market Report
NEW YORK, NY, June 25, 2026 — QBE North America today announced the release of its 2026 Accident & Health Market Report, highlighting the key trends and cost drivers impacting self-funded healthcare plans.
The annual report, which leverages claims data and industry research, highlights a continued rise in healthcare cost pressures and a shift in the frequency and severity of high-cost claims. Claims data in this year’s report shows that neoplasms account for 36% of all stop loss claim reimbursements, maintaining their position as the leading diagnosis across all deductible levels. At the $200,000 deductible level, the severity of neoplasm claims is up 12% from the average of prior years, while frequency is up nearly 30%.
The claim frequency across all conditions for members exceeding $200,000 in annual claims per 10,000 employees increased by nearly 20% from the prior year, driven primarily by neoplasms, birth-related claims and circulatory diseases. Notably, birth-related claim frequency more than doubled from 2024 to 2025.
“High-cost claims are no longer outliers. They are becoming a routine part of the healthcare landscape and must be proactively anticipated and managed,” said Tara Krauss, President of Accident & Health, QBE North America. “Longer inpatient hospital stays, prolonged care due to advanced treatment options and the widespread adoption of specialty pharmaceuticals are all driving up costs and fundamentally altering the risk profile of employer-sponsored health plans.”
Key themes explored in the 2026 report include:
- Leading and evolving drivers of high-cost claims, including neoplasms, circulatory and birth-related conditions.
- The sharp acceleration of healthcare cost trends, particularly at the highest claim levels.
- The evolving influence of specialty pharmaceuticals and advanced therapies.
- Increased clinical complexities and more intensive treatment plans for neoplasms.
- The impact of specialized populations, including pediatrics and transplant patients.
- Expanding variability and reduced predictability in claim outcomes.
“Employers are facing a multitude of pressures, from rising medical costs to increases in claim severity, which makes prevention, early intervention and proactive cost management more critical than ever,” Krauss added. “Our annual report reinforces our commitment to delivering strategic, flexible solutions that align with the changing needs of self-funded employers.”
About QBE North America
QBE North America is a global insurance leader that gets to the heart of what’s at risk for customers. Part of QBE Insurance Group Limited, QBE North America reported Gross Written Premiums in 2025 of $7.7 billion. QBE Insurance Group’s results can be found at qbe.com. Headquartered in Sydney, Australia, QBE operates out of 26 countries around the globe, with a presence in every key insurance market. The North America division, headquartered in New York, conducts business primarily through its insurance company subsidiaries. The actual terms and conditions of any insurance coverage are subject to the language of the policies as issued. Additional information can be found at qbe.com/us or follow QBE North America on LinkedIn, Facebook and Instagram.
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