Stop Loss Trend Watch: Fall 2021

Turn insights into action with these trends and tips from our Stop Loss leaders.

Trend 1: A competitive market

The stop loss market continues to be competitive in 2021. Employers are still focused on running their business amid a pandemic while also keeping up with legislation changes.

Insights from our leaders:

  • As a result of this competitive market, stop loss carriers will be creative in maintaining their renewals on cases that are performing well and are desirable to keep on the books. This may lead to increased persistency for some carriers, while testing disciplined growth strategies. 
  • In addition, employers have a lot on their minds. At the top of the list are the pandemic, the competitive job market and medical costs.1 We expect employers to focus on those items instead of replacing benefit plans that are currently working in the short term. Employers will continue evaluating ways to upskill and retain their top talent. Supporting the mental and financial wellness of employees will continue to be an increasing priority.2
  • We also believe employers are rightly focused on other market changes which will prevent them taking on the additional distraction of implementing a new carrier. Legislation changes that employers are trying to keep up with include the Consolidated Appropriations Act, which covers many topics (notably the surprise billing and transparency requirements), and the American Rescue Plan Act, which includes COBRA continuation and premium assistance.

Action steps you can take:

  • Support your clients in understanding the impact of legislation changes that may impact them, and confirm any changes to how your stop loss carrier manages employer groups as a result.
  • Partner with your clients to help them address their changing employment and benefit needs.
  • Remember that we are here to support the total financial wellness needs of your clients’ workplaces.

Trend 2: Cell and gene therapy

Cell and gene therapy will continue to be a conversation topic in the industry as we head into 2022. Employers need to be aware of these emerging therapies, and the potential implications for their medical plans.

Insights from our leaders:

  • We believe most carriers are going to be adapting as the pipeline progresses and more information is available. The industry is trying to figure out what these new treatments mean and whether there is capacity to manage it within the Stop Loss market. 
  • The unknowns around cell and gene therapy will produce different reactions and approaches within the industry. As carriers make different decisions on their strategy relating to cell and gene therapy, we expect a bit of uncertainty around inconsistency in approaches and what that could mean for your clients. 
  • One varying approach we expect to see is around pricing. There are many considerations that will affect pricing; for example, the capacity medical providers have to provide these treatments, as well as patient interest. Cost projections are difficult at this time, but we will continue to collaborate with our industry resources to monitor how the market is performing. We believe some carriers will price high, and that others will not price for it at all, which will continue to contribute to pricing volatility.
  • We currently believe we have the capacity to accommodate reimbursement claims on cell and gene therapies and will be closely monitoring the pipeline and our book of business.

Action steps you can take:

  • Ensure your clients’ medical plan documents have clear language regarding whether cell and gene therapy treatments will be covered.
  • Make sure the plan administrator is completing eligibility audits and confirm eligibility requirements with your stop loss carrier to avoid surprises at time of claim.
  • Ask your stop loss carrier if they are covering cell and gene therapies.
  • Reach out to us for help guiding and advising employers through these new advancements as our medical team stays on top of the latest FDA news and approvals.

Trend 3: Changing legislation

As a new administration makes strides in determining the path forward for our health care system, questions continue to rise related to how this may impact the self-funded market and particularly stop loss insurance.  

Insights from our leaders:

  • Employers and employees are facing rising medical costs. For example, according to data from the Kaiser Family Foundation, in 2020 the average annual premiums for employer sponsored health insurance were $7,470 for single coverage and $21,342 for family coverage. The average single premium increased 4% and the average family premium increased 4% from 2019-2020. Workers’ wages increased 3.4% and inflation increased 2.1%.”3 The self-insured environment remains one of the best opportunities to help manage rising medical costs more effectively.
  • We previously discussed the potential cost in care due to the loss of revenue and closure of rural hospitals as a longer term impact of COVID-19. Hospital systems, facilities, and physicians lost significant revenue over the past year and a half without an equal reduction in their expenses. This may result in higher prices, and therefore claims, as they attempt to close that gap. We will keep a continued eye on the market as the health care system responds to lower revenue and the cost of delayed care.
  • We are watching the details of provisions of the No Surprises Act, which was enacted as part of the Consolidated Appropriations Act, 2021, regarding the qualifying payment amount (QPA), consent on non-emergency care and what this may mean for the industry.

Action steps you can take:

  • Keep up to date on legislation changes and make sure you can keep your clients informed.
  • Look at new ways to help clients manage risk through proactive plan management.
  • Understand the cost implications for your clients' businesses and changes that may impact their medical spend.
  • Check in with us; we’ll be keeping up on legislation in order to assist employers as they navigate the changing landscape. 

Stay in touch with your Voya team for further discussion on these topics in the future. Reach out to your Stop Loss representative to learn more.

Excess Risk (Stop Loss) Insurance products are issued and underwritten by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya® family of companies. Product availability and specific provisions may vary by state.

1 “Top Challenges for HR Professionals Coming Out of COVID-19.” May 17, 2021.
2 “The 6 Biggest Challenges HR Faces in a Post COVID World.” HR Exchange Network. May 19, 2021.
3 Employer Health Benefits 2020 Annual Survey. Kaiser Family Foundation.