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奥纬咨询&佳达：2025年秋季止损保险市场动态更新报告（中译版）（33页）.pdf

上传人： 1****1 编号：931311 2025-10-10 33页 1.02MB

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1、STOP LOSS MARKET UPDATEFall 2025 Oliver Wyman and Guy Carpenter2Guy Carpenter and Oliver Wyman present our third annual joint Stop Loss Market Update.This newsletter includes reported annual statutory financial experience,market and cost trends and drivers,and a discussion of advanced predictive and

2、 AI analytical techniques.Our aim is to keep you abreast of key stop loss market trends and dynamics that impact stop loss insurer financial results and profitability.2019-2024 statutory financials resultsStop loss carrier premium volume increased to$39.0 billion in 2024,reflecting a growth rate of

3、11.2%from 2019-2024 with 10.0%of the annual growth attributable to cost trends and business mix changes,and the remainder due to increased enrollment.Claims increased at a faster rate than premiums resulting in loss ratios deteriorating from 81.6%in 2019 to 86.0%in 2024 with quite a bit of loss rati

4、o volatility in the interim years.Stop loss market trendsAs healthcare costs continue to rise and inflationary pressures persist,employers are adopting self-funding strategies to better manage their costs and overall healthcare spend.Over the past five years,enrollment in the fully insured group med

5、ical market has declined by almost 17%.High dollar claims trendsThe growing frequency of large claims has become a significant concern for insurance and reinsurance companies with claims over 1 million dollars steeply increasing in the past 5 years.All signs indicate that the frequency of claims exc

6、ess of 1 million will continue to grow in the upcoming year.These large claims can be attributed mainly to cancer treatments,premature births,complex conditions,and new high-cost pharmacy therapies.Optimizing advanced analytical approaches to improve stop loss performanceRising claim costs has place

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根据《Guy Carpenter and Oliver Wyman 第三届联合停损市场更新》报告，以下为全文关键点： 1. 2019-2024年，停损保险市场保费增长11.2%，至390亿美元，但损失率从2019年的81.6%上升至2024年的86.0%。 2. 医疗成本上升和通货膨胀压力促使雇主采用自筹资金策略，导致完全保险团体医疗市场参保人数下降17%。 3. 高额索赔趋势明显，过去五年中，超过100万美元的索赔数量大幅增加。 4. 停损市场趋势：自筹资金策略增加，完全保险团体医疗市场参保人数下降，高额索赔趋势明显。 5. 高额索赔分析：基因和细胞疗法等创新治疗手段成本高昂，成为高额索赔的主要原因。 6. 优化高级分析方法：利用人工智能和高级分析技术，提高停损保险表现，有效管理风险。
**市场趋势揭秘** **高成本索赔分析** **AI助力止损优化
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