Stop-Loss Isn’t a Safety Net—It’s a Strategy
When employers think about stop-loss coverage, it’s often framed as a safety net. That isn’t an incorrect train of thought, either, since stop-loss could very well be viewed simply as the financial cushion that protects your plan when catastrophic claims strike.
The truth, though, is that it undersells the role stop-loss can (and should) play. In today’s ever-evolving healthcare environment, stop-loss isn’t just about catching employers when they fall. It’s a proactive strategy that helps organizations strengthen their plans, manage volatility, and position themselves for long-term sustainability.
The Rising Tide of High-Cost Claims
It’s no secret that high-cost claims are on the rise, but Tokio Marine HCC’s 2025 Stop-Loss Market Report paints a particularly bleak picture. Large-dollar claims are becoming both more frequent and more severe. Since 2013, the incidence of catastrophic claims has steadily risen, and the drivers aren’t exactly a secret either.
Breakthroughs in medicine are transforming lives, but they’re also reshaping the claims landscape. From gene therapies to advanced oncology treatments, we’re seeing the numbers on price tags rise higher and higher. Even just one claim with that high a price can dramatically impact a self-funded plan. For your benefits program, this means that the risk of one or two outlier claims has never been greater.
This growing exposure is also driving change in the market itself. Carriers are pricing more aggressively, underwriting is becoming tougher, and premiums are on the rise. In this environment, stop-loss is poised to be far more than just a fallback option.
Stop-Loss as a Strategic Lever
When stop-loss is viewed as more than just “break glass in case of emergency” protection, it can offer a wealth of strategic value to your benefits strategy.
- Managing volatility: Stop-loss lessens the unpredictability of catastrophic claims, protecting budgets from unexpected spikes.
- Enabling sustainability: By reducing risk exposure, stop-loss gives employers the confidence to invest in long-term initiatives like wellness, disease management, and preventive care, cutting down on future costs.
- Informing decision-making: With clear visibility into their risk profile, organizations can make more deliberate choices around plan design, funding, and employee contributions.
Choosing Stop-Loss for the Future
Of course, not all stop-loss coverage is created equal. Treating it strategically means looking beyond premium costs and evaluating how the structure aligns with organizational goals. From contract terms to carrier expertise, it’s vital to make sure that your stop-loss coverage aligns with your plan and goals. At RMTS, we understand that means you need more than just one-size-fits-all. We take the time to build plans unique to our clients, going the extra mile to ensure quality with strictly A+ rated carriers.
The rise of catastrophic claims is not a passing trend. Employers who look at stop-loss as a core part of their strategy will be better equipped to weather today’s challenges and prepare for tomorrow’s uncertainties—and fully equipped with the resilience, sustainability, and smarter decision-making that’s needed in an unpredictable healthcare landscape.