As health care costs continue to rise, more employers are turning to self-funded strategies to manage the benefit spending. A critical piece of that strategy? Stop loss insurance.
CBIZ recently hosted an in-person client seminar in Kansas City, in partnership with Stealth Stop Loss, to explore current trends, challenges, and best practices for building a sustainable stop-loss program.
Five Key Considerations for 2026
Whether you’re entering renewal season or reevaluating your plan midyear, these focus areas can help you strengthen protection, manage costs, and align your stop-loss strategy with long-term goals.
Your Data is Telling a Story: Are You Listening?
It’s not just about totals. You need to understand what’s driving costs, such as high-cost claimants, specialty drugs, or emerging chronic conditions.
“Data doesn’t make decisions—people do,” said Rory Kain, vice president at Stealth. “But clean, accurate claims data give you leverage and clarity at renewal.”
Don’t just collect data, analyze it. Employers who understand the story behind their numbers are better positioned to improve plan design and strengthen negotiations.
Specific vs. Aggregate: Understand Your Coverage Costs
The structure of your stop loss policy matters, especially in a shifting market. It’s critical to understand how specific (individual claims) and aggregate (overall plan spend) coverage align with your deductible levels, cash flow, and risk appetite.
“There’s no one-size-fits-all approach to stop loss,” said Jonathan Krass, senior account executive at CBIZ. “You need to evaluate each component—lasers, premiums, advance funding—against your unique financial situation before renewing.”
Avoid rushing through renewals or making assumptions. Misalignment between contract details and your risk profile can lead to costly outcomes. Ask yourself: Are your attachment points aligned with your risk tolerance? Are you reviewing terms like lasers or advanced funding? These details can significantly impact both cost and coverage
Partner with the Right Carrier: Not Just the Lowest Bidder
Stop loss insurance is more than a transaction; it’s a relationship. We’ve seen several cautionary tales of employers chasing low premiums only to face delays or denials when large claims hit.
“When something goes wrong, the carrier becomes your most important partner,” Kain explained. “And if they’re not responsive, you’ll feel it fast.”
Beyond price, evaluate a carrier’s reputation, financial strength, and alignment with your long-term strategy. When it comes to claims, trust and responsiveness matter most.
Expect and Plan for Volatility
The healthcare market is changing fast. New gene therapies, unpredictable large claims, and rising specialty pharmacy costs are reshaping stop loss risk.
“Drug manufacturers are developing drugs for rare disease states which carry prices at $500,000 to $1M+ per patient per year,” said Mike Zucarelli, director of CBIZ’s pharmacy consulting practice. “The utilization is sporadic, but can be devastating to a smaller self-funded plan.”
Prepare by reviewing reserves, modeling various claims scenarios, and maintaining a flexible funding strategy. Employers that treat stop loss as a static line item are often caught off guard.
Strengthen Communication Between Your TPA, Broker, and Carrier
One of the most actionable takeaways from our seminar? Collaboration matters. Even well-designed stop loss policies can fail if claims are delayed or information is lost between parties.
CBIZ recommends holding quarterly strategy meetings and establishing a clear communication protocol, especially around high-dollar claims. Real-time collaboration between employers, third-party administrators (TPAs), brokers, and carriers helps avoid claim issues and coverage gaps.
Make Your 2026 Stop Loss Insurance Strategy Stronger
As you prepare for renewal season, go beyond basic questions. Challenge your assumptions, refine your approach, and ensure your stop loss program supports long-term goals. A strong stop loss program isn’t just coverage; it’s a strategic tool for stewardship, sustainability, and long-term financial protection.
“In today’s market, staying comfortable isn’t an option,” said Maggie Knudson, senior account executive at CBIZ. “The landscape is shifting fast—embrace the discomfort and adapt.”
At CBIZ, we’re committed to helping you navigate renewal season with clarity, confidence, and strategic foresight. Ready to refine your stop loss strategy? Contact a member of our team to take the next step.
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