医疗保健止损保险市场的主要驱动因素

Fall 2025 Guy Carpenter and Oliver Wyman present our third annual joint Stop Loss Market Update. This newsletter includesreported annual statutory financial experience, market and cost trends and drivers, and a discussion of advancedpredictive and AI analytical techniques. Our aim is to keep you abreast of key stop loss market trends and dynamicsthat impact stop loss insurer financial results and profitability. 2019-2024 statutory financials results Stop loss carrier premium volume increased to $39.0 billion in 2024, reflecting a growth rate of 11.2% from 2019-2024with 10.0% of the annual growth attributable to cost trends and business mix changes, and the remainder due toincreased enrollment. Claims increased at a faster rate than premiums resulting in loss ratios deteriorating from 81.6%in 2019 to 86.0% in 2024 with quite a bit of loss ratio volatility in the interim years. Stop loss market trends As healthcare costs continue to rise and inflationary pressures persist, employers are adopting self-fundingstrategies to better manage their costs and overall healthcare spend. Over the past five years, enrollment in the fullyinsured group medical market has declined by almost 17%. High dollar claims trends The growing frequency of large claims has become a significant concern for insurance and reinsurance companieswith claims over 1 million dollars steeply increasing in the past 5 years. All signs indicate that the frequency of claimsexcess of 1 million will continue to grow in the upcoming year. These large claims can be attributed mainly to cancertreatments, premature births, complex conditions, and new high-cost pharmacy therapies. Optimizing advanced analytical approaches to improve stop loss performanceRising claim costs has placed a strain on some insurers'risk management and financial stability, posing significantprofitability challenges for the medical stop loss market. Guy Carpenter andOliver Wymanoffer AI and advancedanalytical solutions to improve bottom line performance and effectively manage stop loss blocks at both the portfolioand claimant levels. IN THIS ISSUE 1 012019-2024 statutory financials results 12Stop loss market trends 13High dollar claims trends 14Optimizing advanced analytical approaches to improve stop loss performance 2019-2024 STATUTORY FINANCIAL RESULTS By Marc Lambright, FSA, MAAA and John Rienstra, FSA, MAAA MARKET-WIDE STOP LOSS PREMIUM AND ENROLLMENT TRENDS We summarize enrollment, premiums, claims, and loss ratio trends of carriers with 2019-2024 reported statutoryfinancial information for the various segments of the stop loss market. Overall, the market has seen considerablegrowth in total premium, which has increased at an average rate of over 11% annually driven primarily through higherpremiums per member per month (PMPM), which have increased at an average rate of about 10% per year, whileaverage covered lives have stayed generally flat over the period. Note that these amounts are as reported other thanthat we removed certain data that appeared questionable, though there may still be some reporting inconsistenciesamongst carriers in addition to mix differences in the type of business written by different types of carriers. CARRIER TYPES We assigned a carrier type to each company that had premiums and lives reported in the AHPEE based on eachcompany’s characteristics, including distribution approach. MGU Paper Blues Elevance / Anthem, Inc.Ascendiun, IncAware Integrated, Inc.BCS Financial CorporationBlue Cross & Blue Shield of Mississippi, a Mutual InsuranceCompanyBlue Cross & Blue Shield of Rhode Island Inc.Blue Cross and Blue Shield of AlabamaBlue Cross and Blue Shield of Kansas CityBlue Cross and Blue Shield of Kansas, Inc.Blue Cross and Blue Shield of North CarolinaBlue Cross and Blue Shield of South CarolinaBlue Cross and Blue Shield of VermontBlue Cross Blue Shield of Arizona, Inc.Blue Cross Blue Shield of Michigan Mutual Insurance CompanyBlue Cross Blue Shield of WyomingBlue Cross Complete of Michigan LLCBlue Cross of Idaho Health Service, Inc.BlueCross BlueShield of Tennessee, Inc.California Physicians'Service, Inc.Cambia Health Solutions, Inc.Capital Blue Cross, Inc.CareFirst, Inc.CuraCor Solutions Corp.Gemstone Holdings, IncGoodLife Partners, Inc.GuideWell Mutual Holding CorporationHawaii Medical Service AssociationHealth Care Service CorporationHealthyDakota Mutual HoldingsHighmark HealthHorizon Healthcare Services, Inc.Independence Health Group, Inc.Louisiana Health Service and Indemnity CompanyPremera Blue CrossProsano, Inc.Trigon Healthcare, Inc.USAble Mutual Insurance CompanyWellmark, Inc. American NationalFairfax Financial Holdings LimitedFidelity Security Life Insurance CompanyPan-American Life Mutual Holding CompanyWestern & Southern Mutual Holding Company Comprehensive Medical Aultman Health FoundationCentene CorporationHumana Inc.Lifetime Healthcare, Inc.Medica Holding CompanyMedical Mutual of OhioPreferred Insurance Group Spec