Medical Stop Loss Claims for Neoplasms Spiked to Historic Levels in 2022, According to QBE North America’s Accident & Health Market Report

01 Aug 2023

NEW YORK, August 1, 2023 – QBE North America today announced the release of its 2023 Accident & Health Market Report. This annual report covers healthcare industry trends and insurance product features to help employers consider how to best manage their self-funded healthcare plans.

Findings are based on industry research as well as QBE’s extensive claims database. As a leading provider of medical stop loss insurance, QBE has claims information that reflects the experience of health plans covering 1.5 million member lives.

The report notes that the frequency of medical stop loss claims exceeding $200,000 per 10,000 covered individuals continued to rise at a faster rate than before and during the height of the pandemic in 2020. This overall increase was primarily driven by a 21% rise in the frequency of claims for neoplasms, which accounted for 45% of all stop loss claims in 2022. Furthermore, the average cost of a neoplasm claim rose 14% to $390,000 in 2022.

“Claim frequency for neoplasms dipped slightly in 2020 as people delayed or couldn’t access care,” said Tara Krauss, Head of Accident & Health at QBE North America. “Now we are seeing the consequences as people come back with more serious conditions in a higher cost environment. Since neoplasms have historically been by far the leading cause of high cost claims, this trend bears top consideration as employers plan on how to mitigate health plan costs.”

The claims data also showed higher claims frequency from 2021 to 2022 for mental illnesses and diseases of the circulatory system, partially offset by a decline in frequency for respiratory claims.

“The dynamic between physical and mental health continues to merit attention in the overall benefits plan offered by employers,” added Krauss. “Poor mental health raises the risk of poor physical health, and vice versa. On the mental health side, stop loss claims frequency for substance abuse tripled from 2021 to 2022, matching the spike we saw in 2020.”

In addition to medical stop loss claim trends, the report features a mix of QBE data and secondary research to examine a range of topics for employers to consider in their long-term claim financing and risk transfer planning, including:

Market highlights for Medical Stop Loss (including captives), Organ Transplants and Special Risk Accident insurance
The proliferation of high-cost cell and gene therapies and trends in specialty pharmacy
The spread of sepsis and increased resistance to antibiotics
Regulatory developments to watch
Medical risk management strategies and cost containment opportunities
Underwriting and claims processing advancements

“Providing comprehensive and affordable healthcare coverage for employees and their dependents has become one of the toughest challenges for organizations of all types in today’s economy,” said Steve Gransbury, Head of QBE’s Specialty and Residential business portfolio, which includes Accident & Health. “Even as general inflation seems to be cooling, pent-up pricing pressure in the healthcare sector and the expansion of expensive new treatments will likely accelerate health plan expenditures. Employers would be wise to work with their providers to plan and leverage effective volatility and cost containment strategies. To help in that regard, we are pleased to release our third annual QBE Accident & Health Market Report.”

About QBE

QBE North America is a global insurance leader helping customers solve unique risks, so they can stay focused on their future. Part of QBE Insurance Group Limited, QBE North America reported Gross Written Premiums in 2022 of $7.27 billion. QBE Insurance Group’s results can be found at qbe.com. Headquartered in Sydney, Australia, QBE operates out of 27 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. QBE insurance companies are rated “A” (Excellent) by A.M. Best and “A+” by Standard & Poor’s. Additional information can be found at qbe.com/us or follow QBE North America on LinkedIn and Facebook.

This release and the QBE Accident & Health Market Report are for general information purposes only and should not be construed as legal, commercial or other professional advice. QBE makes no warranty, representation, or guarantee regarding the information herein or the suitability of these suggestions or information for any particular purpose. Any references to prior QBE claims or claim frequency is illustrative only and should not be perceived as a representation that such frequency will continue. QBE hereby disclaims any and all liability concerning the information contained herein and the suggestions herein made. The use of any of the information or suggestions described herein does not amend, modify, or supplement any insurance policy. Consult the actual policy or your agent for details about your coverage.