By CJ Jordan
Your high stop loss renewal is a function of a bad math problem. The math doesn’t math. Let me explain.
Take one dollar of premium. Let’s say the broker gets 5 cents. Admin and premium tax take about 10. The carrier wants 10 cents of profit. That leaves 75 cents to pay claims.
In 2025, stop loss carriers paid 91 cents in claims.
The carrier is losing money on your plan. It will raise premium until the math works again. Getting back to 75 cents means about a 21% increase before medical trend is added.
Chasing a lower stop loss number doesn’t ultimately solve your problem.
Only one number in that equation is in your control. Claims.
Know who your high-cost members are before renewal. Get them to good care at a fair price. Audit your pharmacy contract. Invest in primary care.