Question 1

What are typical stop-loss specific deductible benchmarks by employer size?

Accepted Answer

For 2025, median specific deductibles by employer size: 50–99 employees — $75,000–$100,000; 100–249 employees — $100,000–$150,000; 250–499 employees — $150,000–$200,000; 500–999 employees — $200,000–$300,000; 1,000+ employees — $300,000–$500,000+. Larger employers can absorb more individual claim risk and benefit from lower stop-loss premiums with higher deductibles. The right deductible depends on financial reserves, risk tolerance, and the premium savings from a higher deductible.

Question 2

What is the typical stop-loss premium as a percentage of expected claims?

Accepted Answer

Stop-loss premium typically ranges from 8–15% of expected claims, depending on the specific deductible level, employer size, and claims history. Lower deductibles (more protection) cost more as a percentage of claims; higher deductibles cost less. For a 200-employee employer with $2 million in expected claims and a $100,000 specific deductible, stop-loss premium is typically $160,000–$300,000 per year. Competitive bidding among 3–5 carriers typically saves 10–20% on stop-loss premium.

Question 3

What is the aggregate attachment point benchmark for stop-loss?

Accepted Answer

The aggregate attachment point (the level at which aggregate stop-loss kicks in) is typically set at 120–125% of expected claims. For example, if expected claims are $2 million, the aggregate attachment point would be $2.4–$2.5 million. Below the attachment point, the employer pays all claims; above it, the stop-loss carrier pays the excess. Some carriers offer lower aggregate attachment points (110–115%) for an additional premium, providing more protection against a bad claims year.

Question 4

How often do employers get lasered at stop-loss renewal?

Accepted Answer

Laser frequency varies by employer size and claims history. Approximately 15–25% of self-funded employers receive at least one laser at renewal in any given year. Lasers are most common when a member has had claims exceeding 50% of the specific deductible in the prior year, or when a member has a known high-cost condition (cancer, organ failure, rare disease). Negotiating laser limits (maximum laser amount) and laser-free contracts is an important part of stop-loss procurement.

Question 5

What is the difference between a 12/12 and 15/12 stop-loss contract?

Accepted Answer

Stop-loss contracts are described by their incurred/paid periods. A 12/12 contract covers claims incurred and paid within the 12-month contract year. A 15/12 contract covers claims incurred in the 15 months ending at the contract year end (3-month run-in) and paid within the 12-month contract year. A 12/15 contract covers claims incurred in the 12-month contract year and paid within 15 months (3-month run-out). Run-in and run-out provisions provide more comprehensive coverage but cost more in premium.

Stop-Loss Insurance Benchmarks

Key benchmark figures

Data sources

Stop-Loss Research Report

Stop-Loss Market Survey

Self-Funded Market Report

Stop-Loss Benchmarking Study

Large Claim Analysis

Self-Insured Health Plan Report

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