Stop loss
Large-claim impacts on self-funded plans
In the last five years, catastrophic medical claims have become more frequent, and their dollar amounts continue to rise. This leaves self-funded plans open to greater financial risk. Stop loss insurance can help protect your plan against large and catastrophic claims.
Five-year trend: Number of individual claims over $1M received by Symetra1
Number of $1M+ claims by calendar year
The graph above shows a bar chart ranging from 2019 to 2023 with the amount of $1M+ claims filed for each year; 2019 had 133, 2020 had 152, 2021 had 118, 2022 had 124 and 2023 had 220.
The largest individual claims show a continued increase during 2019-2023
Maximum “ground up” claim
(The total amount of loss that’s covered by an insurance policy)
The graph above shows a bar chart noting Symetra’s largest ground up claims for each year from 2019-2023. 2019 had $5.5M, 2020 had $7.4M, 2021 had $7.1M, 2022 had $8.8M, and 2023 had $5.8M.
Cancer is the leading cause of large claims
It represents 25% of large claims, with an average ground-up claim of $1.4M (including treatments).
The chart shows how cancer is the leading cause of claims at 25% and $1.4M, compared to 14 other treatments totaling 75% and $20M. See “other” treatments and their percentages below.
- Some of the costliest health care individual claims are related to the treatment of heart disease, stroke, pre-term newborns and cancer.
- Cancer is the leading cause of large individual stop loss claims because of the continuous medical and pharmaceutical research and innovation that is available to patients affected with cancer diagnosis.
- In 2023, cancer claims represented 25% of all large claims.
- The large cancer claims average $1.4M ground-up charges. Some of the key cost drivers are effective treatments, such as CAR-T-cell therapy, and targeted specialty pharmaceuticals, which have made a significantly positive impact in patients' treatment success outcomes.
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Others include: 15%: Perinatal and premature infant, $1.6M |
6%: Nervous system / Sense organs, $1.5M |
Symetra 2023 claims performance results
29,698
Claims processed
$839 million
Claims paid by Symetra
7 days
Average turnaround service for stop loss claims
99%
Financial accuracy score
Preferred ASO Claims Advance
Our Preferred ASO Claims Advance option significantly reduces the wait time for many clients’ large and catastrophic claims, with reimbursements paid within two business days.
59
Preferred ASO Claim Advance requests processed
$27.1 million
Preferred ASO Claim Advance funds paid by Symetra
2 days
Average turnaround service for Preferred ASO Claim Advance requests
$3.7 million
Largest Preferred ASO Claim Advance
What does this mean for you?
You’ve worked hard to establish your self-funded medical plan and you want it to run well. Symetra delivers outstanding claims support, a high level of customer service, and the expertise to manage your plan expenses effectively—even before a reimbursement request is made.
Efficient processes
Our fast, efficient claims process and low documentation requirements mean less paperwork and ensures timely reimbursements.
Cost-containment support
Our dedicated cost-containment specialists work with vendors and centers of excellence to negotiate the best possible price for any high-dollar treatment charges that could affect your plan.
Claims reimbursement guidance program
Find out in advance how Symetra will reimburse a stop loss claim. You can request a review at any time, for any reason.
Regional focus
Aligning claims examiners, medical risk consultants and sales representatives by region allows us to consistently work with the same individuals and resources to build long-term relationships.
Alternative treatment plans
Your Symetra case manager may conduct an analysis to determine if potential treatments are the most cost-effective options. This may include alternative treatments not covered under your plan but still eligible for stop loss reimbursements.
Accelerated reimbursements
Advance funding is standardly included on all policies at no additional cost, which can significantly reduce the wait time for Specific stop loss claim reimbursements. It’s available through the duration of your policy—even the last 30 days.
How can Symetra support your self-funded medical plan?
Managing the risks of self-funding can be challenging. An experienced stop loss partner can help safeguard your plan against large or catastrophic medical claims.
Symetra Life Insurance Company is a direct subsidiary of Symetra Financial Corporation. First Symetra National Life Insurance Company of New York is a direct subsidiary of Symetra Life Insurance Company and is an indirect subsidiary of Symetra Financial Corporation (collectively, “Symetra”). Neither Symetra Financial Corporation nor Symetra Life Insurance Company solicits business in the state of New York, and they are not authorized to do so. Each company is responsible for its own financial obligations.
Stop loss policies are insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004. Base policy is ELC-24000 7/19. In New York, stop loss policies are insured by First Symetra National Life Insurance Company of New York, New York, NY. Mailing address: P.O. Box 34690, Seattle, WA 98124. Policy form number is ELC-24000/NY 7/19.
Coverage may be subject to exclusions, limitations, reductions, and termination of benefit provisions.
1 Combined claims data from Symetra Life Insurance Company and First Symetra National Life Insurance Company of New York, 2018-2023.