Medical Stop Loss Large Claim Frequency Increased During the COVID-19 Pandemic

QBE today announced the release of its inaugural Accident & Health Market Report. This report highlights key industry trends and product details to present insights employers can consider when evaluating their self-funded healthcare plans.

As a leading provider of medical stop loss insurance, QBE leveraged its claims database to analyze and share indications to help employers identify and mitigate risk. QBE’s team of technical experts detailed medical stop loss claim trends by primary diagnosis, specific deductible, frequency, and severity.

Among the key findings based on QBE data, the report notes an increase in the frequency of claims that exceed $200,000, when comparing annual policies that started in the first quarter of 2019 against those that started in the first quarter of 2020. These two time periods serve as a proxy for claims coming in before and after the onset of the COVID-19 pandemic. The increase was driven by more claims for mental and respiratory illnesses, which were only partially offset by fewer claims for neoplasms and circulatory system diseases.

“The claims frequency nearly doubled for respiratory illnesses, and it more than doubled for mental illnesses,” said Tara Krauss, Head of Accident & Health at QBE North America. “It demonstrates the broad impact of the pandemic and explains why we have seen employers seek more holistic solutions that connect mental and physical health.”

Although the frequency of $200,000+ claims for neoplasms declined during the pandemic, neoplasms remain a top concern. They were by far the most common of such claims both before and during the pandemic. Meanwhile, the decline in claims frequency throughout the pandemic may be the result  of missed and delayed cancer screenings, which could lead to an increase  in treatment costs and complications in the future.

“The potential impact of delayed screenings and treatment is a key concern, and we are closely monitoring the information for employers,” added Krauss.

In addition to claim frequency, the QBE report examines the total cost of stop loss claims reimbursement by primary diagnosis and deductible over a 3.5-year period. Claims for neoplasms  accounted for the largest share of reimbursements at every deductible level, but the share fell as the deductible level increased. By contrast, the share for conditions originating in the perinatal period tripled from the lowest to highest deductible level, becoming the second highest at 18% with a $1 million deductible.

Finally, the QBE report examines the pipeline of high-cost gene, cell, and orphan drug therapies that employers need to consider in their long-term claim financing and risk transfer planning. The growth in the number of these highly specialized therapies will have a lasting impact on healthcare for years to come.

“Two-thirds of covered workers are currently enrolled in healthcare plans that are self-funded, and medical stop loss insurance and related products will continue to play a key role in helping employers manage evolving risks,” said Steve Gransbury, Head of QBE’s Specialty business, which includes Accident & Health. “Beyond providing insurance protection, our goal is to help our customers identify and plan for future risks and opportunities. In that regard, we’re pleased to offer the QBE Accident & Health Market Report.”

About QBE

QBE North America is global insurance leader focused on helping customers solve unique risks, so they can focus on what matters most. Part of QBE Insurance Group Limited, QBE North America reported Gross Written Premiums in 2020 of $4.775 billion. QBE Insurance Group’s 2020 results can be found at

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 through its property and casualty insurance subsidiaries. The actual terms and coverage for all lines of business 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 or follow QBE North America on LinkedIn and Twitter.

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. QBE and the links logo are registered service marks of QBE Insurance Group Limited. ¬© 2021 QBE Holdings, Inc.

SOURCE QBE North America

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