Key Survey Findings – 2025
Stop loss premiums vary widely due to deductible size. However, when normalized by contract (e.g. Paid, 12/12), an average cost is determined across the range of deductibles.
According to the Survey, average premium (normalized to a Paid contract) ranges from $229.40 per employee per month (PEPM) for a $100,000 Individual deductible to $50.98 PEPM for a $500,000 Individual deductible (see below table).
Annual increase in stop loss premium, as measured from 2024 to 2025, confirm increases from 8.8% to nearly 10.5% or higher as the stop loss deductible increases – verifying leveraged trend impacts. However, longer term premium growth is more elevated, from 9.9% to 12.1% and may better reflect 2026 impacts.
Further Market Observations
Our ongoing observations on the stop loss market include:
- Occurrence of catastrophic claimants. When surveyed, 49% of respondents report a claimant in excess of $1,000,000 paid in the last two policy years, with 25% of those in excess of $1,500,000.
- With increased focus on health care costs and self-funding, various risk management strategies are being discussed. But 53% respond as “none of the above”, including reference-based pricing and direct provider contracting, both getting no more than 4% interest. However, interest in a specialty Rx/gene therapy carve out attracted 21%.
- Be knowledgeable. Identify the best carriers and use an experienced broker or consultant. Stop loss is highly specialized reinsurance, with very high claim exposure. An inexperienced advisor can cost your plan hundreds of thousands with a single claimant gap.
Aegis Risk helps its clients and partners gain competitive positioning against these dynamics through comprehensive, data-focused and knowledgeable approaches to the medical stop loss market. As we like to say:
It’s a risk. Not a benefit. Be advised.
SOURCE: Aegis Risk
The numbers in the Aegis survey are based on traditional PPO type plans. Here’s the average cost for a Reference-Based Pricing (RBP) health plan using a $50,000 specific stop-loss deductible:
Estimated Monthly Premium Ranges
| Group Size | Average Monthly Cost (Per Employee) | Annualized Equivalent | Notes |
|---|---|---|---|
| 25–49 employees | $180 – $280 PEPM | $2,160 – $3,360 | Small group; limited underwriting data, higher margins. |
| 50–99 employees | $120 – $200 PEPM | $1,440 – $2,400 | Typical RBP self-funded mid-size group pricing. |
| 100–249 employees | $90 – $150 PEPM | $1,080 – $1,800 | More stable claims experience; competitive stop-loss rates. |
| 250+ employees | $65 – $110 PEPM | $780 – $1,320 | Volume and stability discounts; credible experience. |
