In a recent episode of Insurance Business TV, Paul Lucas spoke with Tara Krauss, the President of Accident and Health at QBE North America, about the company’s newly released 2025 Accident and Health Market Report. This report provides valuable insights into the current trends affecting self-funded healthcare plans, focusing on medical stop-loss claims, the growth of specialty pharmacies, and the societal factors impacting public health.
Krauss highlighted the significance of medical stop-loss coverage for self-funded employers. With over 65% of health plans now self-insured, and more than 85% of mid to large employers opting for this model, stop-loss insurance has become a crucial part of their benefits strategy. This coverage protects employers from high claims costs, which have been rising in frequency and severity. Notably, claims exceeding one million dollars have doubled in the past four years, emphasizing the need for robust stop-loss protection.
The report points to several key findings that brokers and employers should consider. One major trend is the rise in claims related to chronic diseases, particularly cancer, circulatory diseases, and premature births. Cancer remains a significant concern, accounting for a large portion of stop-loss claims. The complexity and cost of cancer treatments have increased due to advancements in medical technology and therapies. Additionally, the COVID-19 pandemic has led to an increase in claims for circulatory issues, as many individuals delayed preventive care during lockdowns.
Another critical aspect discussed was the impact of poor societal health on these trends. Krauss noted that lifestyle factors, such as diet, exercise, and environmental influences, play a significant role in rising cancer diagnoses. Many cancers are linked to modifiable factors, with studies suggesting a potential 50% increase in early-onset cancer globally in the coming years. This highlights the importance of addressing lifestyle-related health issues to mitigate future claims.
QBE has also expanded its services to include Taft-Hartley and multi-employer health plans, recognizing the unique needs of labor unions. These plans often have better healthcare access and management strategies, leading to improved health outcomes for members.
As brokers prepare for the upcoming year, Krauss emphasized the need for education on lifestyle factors and the importance of transparent pharmacy benefit management. She encouraged brokers to inform clients about the significance of understanding their specific deductibles and working with reliable carriers that provide strong support during claims.
For those interested in exploring the findings of the 2025 Accident and Health Market Report, it is available on the QBE website. This report serves as an essential resource for employers and brokers looking to adapt their healthcare strategies in a rapidly changing market.