If your most recent stop-loss renewal felt more challenging than usual, you’re not alone. 

Over the past year, I’ve had more conversations with employers about rising renewal costs, large claims, and market uncertainty than I can remember. And while it’s easy to focus on the sticker shock of a renewal increase, I think that misses the bigger story. 

My view is simple: The stop-loss market isn’t broken. It’s responding to a healthcare system where claim severity is increasing faster than historical models were built to anticipate. 

The diagnoses themselves haven’t changed dramatically. Cancer, cardiovascular conditions, complex neonatal care, and other high-cost conditions have always existed within employer-sponsored health plans. What’s changed is the cost once those claims escalate, the sophistication of available treatments, and the length of time members remain in active care.  

We’re living in a time when healthcare can accomplish things that would have seemed impossible just a decade ago. That’s good news for patients. But it also means employers need to rethink how they approach risk management, plan financing, and stop-loss strategy. 

For years, million-dollar claims felt like outliers. Today, they’re becoming a much more common part of plan experience. 

QBE’s 2026 Accident & Health Market Report found that claims exceeding $1 million have nearly tripled over the past five years. At the same time, claim frequency continues to increase across several high-cost categories, including cancer, circulatory diseases, and preterm births.  

What’s particularly interesting to me is that the underlying conditions driving these claims aren’t necessarily new. Neoplasms, circulatory diseases, and birth-related conditions continue to be the leading sources of stop-loss reimbursement, just as they have been for years.  

The difference is that when these claims occur today, they often involve more complex treatment plans, longer durations of care, and significantly higher costs than employers would have expected even a few years ago. In other words, we’re not just seeing more catastrophic claims. We’re seeing more expensive catastrophic claims. 

One of the biggest drivers of rising claim severity is also one of healthcare’s greatest success stories. 

Gene therapies, cellular therapies, and CAR-T treatments are transforming patient outcomes. Some therapies are offering treatment options—or even potential cures—for conditions that previously had few alternatives. Research identified more than 40 FDA-approved gene and cell therapies currently on the market, with hundreds more in development. Many carry treatment costs ranging from $400,000 to more than $4 million.  

As an actuary, what fascinates me isn’t just the price tag. It’s how quickly these therapies are moving from rare conditions into more common conditions. Many new therapies are being developed for oncology, meaning employers are increasingly seeing advanced treatments used earlier in the course of care and across broader patient populations.  

This is exactly why traditional models have struggled to keep pace. Historical data is an important predictor of future costs, but healthcare innovation is advancing more quickly than many forecasting models can fully absorb.

Another trend I don’t think gets enough attention is what’s happening within hospital systems. 

According to KFF, hospital care accounted for approximately 40% of national healthcare spending growth between 2022 and 2024, contributing $277 billion of additional spending during that period.  

Hospitals continue to face rising labor costs, operational expenses, and increasing patient complexity. At the same time, advances in medicine are allowing providers to care for patients who previously might not have survived—or who would have received far less intensive treatment.  

That’s undeniably positive from a clinical perspective. 

But it also helps explain why employers are seeing claims that would have been considered extraordinary several years ago become increasingly common today. A complex NICU stay, a lengthy cancer treatment journey, or a specialty drug regimen can now create costs that ripple across multiple plan years. Those costs ultimately show up in claims experience, underwriting results, and renewal discussions.

When employers ask what they should be doing right now, my answer is usually the same: Focus less on next year’s renewal and more on your overall strategy. 

The organizations navigating today’s environment most effectively are asking questions like: 

The common denominator is visibility. 

As healthcare becomes more complex, employers cannot effectively manage costs they don’t understand. Better data, stronger collaboration, and proactive planning have become competitive advantages. That’s true whether you’re evaluating specialty drug exposure, managing large claims, or preparing for your next renewal.  

I don’t expect stop-loss renewals to suddenly return to what employers experienced five or 10 years ago. But I also don’t think the takeaway should be doom and gloom. 

Healthcare is delivering remarkable advances in treatment and outcomes. The challenge for employers is adapting their strategy to a world where those innovations come with greater financial complexity. 

The employers that will be best positioned moving forward won’t necessarily be the ones that avoid large claims. They’ll be the ones that understand their risks, build strong partnerships, use their data effectively, and make informed decisions long before renewal season arrives. That’s where the real opportunity lies. 

Sources: Kaiser Family Foundation (KFF), MIT Center for Biomedical Innovation, QBE North America