Frequency of Medical Stop Loss Claims for COVID-19 More than Doubled from 2020 to 2021, According to QBE North America's Accident & Health Market Report

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Aug 04, 2022, 10:23 ET

NEW YORK, Aug. 4, 2022 /PRNewswire/ -- QBE North America today announced the release of its 2022 Accident & Health Market Report. This annual report highlights industry trends and product details that can help employers consider how to best manage their self-funded healthcare plans.

As a leading provider of medical stop loss insurance, QBE leveraged its extensive claims database to analyze and share findings to help employers identify and mitigate risk.

Among the key findings, the report notes that the frequency of medical stop loss claims for COVID-19 more than doubled (+108%) from 2020 to 2021. Moreover, this increase was widespread across age groups, with the youngest age group (0-29) up fivefold. Through April 2022, claims within the younger age groups, 0-29 and 30-39, have already reached levels similar to all of 2021.

"The highly infectious COVID variants together with the prevalence of comorbidities has lowered the average age for a stop loss claim from 54 in 2020 to 49 in 2021, and the average cost of a COVID claim climbed 87% year over year," said Tara Krauss, Head of Accident & Health at QBE North America. "We saw a few multimillion-dollar claims, which we didn't expect at the start of the pandemic. One case that involved a patient in intensive care for more than five months settled at $4.6 million. Furthermore, as the pandemic evolved, we saw increased claims severity in younger populations covered by employer-sponsored plans, particularly for patients with comorbidities."

When analyzing all claims exceeding $200,000, QBE found that frequency increased 17% from 2020 to 2021. Respiratory claims nearly doubled; neoplasms increased 21%; mental illnesses claims fell 15%, yet remained well above pre-COVID levels; and circulatory claims fell 16%.

"The overall increase is likely due not only to claims directly related to COVID but also indirectly related through the impact of delayed care," added Krauss. "For instance, in 2020 screenings and non-critical treatment for neoplasms were delayed, which presented an opportunity for the disease to worsen and require more expensive treatment. We are seeing early signs of increased severity and anticipate a significant impact through 2023 since neoplasms have for many years represented the largest share of claims above $200,000. In 2021, they accounted for 41%."

In addition to presenting medical stop loss claims trends, the report features a mix of QBE data and secondary research to examine a range of topics for employers to consider in their long-term claim financing and risk transfer planning, including:

Market highlights for Medical Stop Loss (along with captives), Organ Transplants and Special Risk Accident insurance
The rise of high-cost cell and gene therapies
Medical risk management strategies
Cost containment opportunities

"Currently, 160 million Americans are covered by employer-sponsored health insurance plans, and nearly two-thirds of those plans are self-funded by the employer," said Steve Gransbury, Head of QBE's Specialty and Residential business portfolio, which includes Accident & Health.* "As costs continue to rise and the quality of care grows increasingly important, medical stop loss insurance and related products will continue to serve as key tools for managing volatility. In addition to this insurance protection, we strive to provide insights and advice for our customers to help them plan for future challenges and opportunities. In that spirit, we're pleased to offer our second annual QBE Accident & Health Market Report."

About QBE

QBE North America is a global insurance leader focused on helping customers solve unique risks, so they can focus on their future. Part of QBE Insurance Group Limited, QBE North America reported Gross Written Premiums in 2021 of $6.29 billion. Information on QBE Insurance Group's results can be found at qbe.com. 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 primarily through its insurance company subsidiaries. The actual terms and conditions of any insurance coverage 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 qbe.com/us.

*2021 Employer Health Benefits Survey, KFF, https://www.kff.org/report-section/ehbs-2021-section-10-plan-funding/#:~:text=Sixty%2Dfour%20percent%20of%20covered%20workers%20are%20in%20a%20plan,60%25)%20%5BFigure%2010.2%5D, 11/10/21, accessed 8/3/22

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.

SOURCE QBE North America