Tokio Marine HCC’s 2026 Annual Market Report shows children under age 10 now account for 39% of stop-loss claims exceeding $1 million — more than triple the share of any other 10-year age group. This concentrated risk creates new considerations for self-funded plans, but targeted strategies can help manage costs.
Key findings:
- Cancer is the top diagnostic category overall, yet most claims over $1 million stem from perinatal/neonatal conditions and congenital or chromosomal abnormalities.
- Claim severity for members under age 1 is significantly higher than for all other ages — and rising.
- Drivers include advances in neonatal care that save more premature and medically complex infants, plus rising high-risk pregnancies tied to advanced maternal age, obesity, and diabetes.
MedBen can help employers manage this exposure by matching groups with provider networks suited to their demographics, conducting forensic claims reviews for appropriate payment, and supporting risk-reduction measures such as no-laser contracts and transplant carve-out policies. We can also work with you to explore additional plan design options.
For more on managing high-cost claims, contact your broker or MedBen Marketing.