Mid-Year Claims Review: What to Pull Before Stop-Loss Renewal Season Starts

Most Employers Show Up to Renewal Unprepared

Stop-loss carriers start building your renewal file in August. They have your claims data already. The question is whether you've looked at it too.

Sun Life reported a 29% increase in claims of $1 million or more per million covered employees in 2024, according to the March 2026 edition of The Self-Insurer. The Phia Group flags GLP-1 drugs, rising neonatal costs, and cancer volume as the reason carriers are tightening underwriting rules right now. Your carrier knows this. Your renewal will reflect it, whether your own claims justify it or not.

The employers who push back effectively are the ones who run a structured mid-year review in June or July. The rest accept the number they're handed.

If you're still fully insured, the data problem starts even earlier. Your carrier may not be required to share your own claims with you at all.

The Metrics That Actually Matter at Mid-Year

Pull your claims data through May or June and build a clear picture before anyone puts a rate on paper. Start with these numbers.

• Paid claims vs. expected. Compare your year-to-date paid claims against your TPA's monthly expected. If you're running 15% above expected through six months, project that forward.
• Specific claimants approaching attachment. Any member above 50% of your specific deductible needs a flag. One $40,000 specific deductible can become a $110,000 claim by December. Your stop-loss carrier reimburses everything above that threshold, but only if the claim is captured correctly.
• Aggregate corridor tracking. Know where your aggregate attachment is and how far your paid claims are from triggering it.
• Diagnostic categories. Break claims by diagnosis. Cancer was cited as a top catastrophic concern by 92% of plan sponsors in 2025, up from 83% the prior year, per the 2025 Medical Stop-Loss Premium Survey from Aegis and IFEBP. Cardiovascular hit 29%. Newborn and infant care reached 26%. If those categories are driving your dollars, you need to know now.
• Specialty pharmacy spend. Specialty drugs including GLP-1s are a direct driver of stop-loss underwriting changes in 2026. Forty-seven percent of plan sponsors flagged specialty pharmacy as a top catastrophic concern last year. Pull your specialty spend separately and tie it to specific members where possible.

The DOL's 2025 Self-Insured Health Benefit Plans report found that plans with claims visibility systems averaged 3.2% lower renewal trends than peers without them. That gap compounds over three years.

How to Project Year-End Exposure

Six months of data is enough to build a credible projection. It doesn't require a consultant with a spreadsheet the size of a tax return.

Take your paid claims through June. Divide by six. Multiply by twelve. That's your baseline projection. Then layer in any open large cases, pending surgeries, or members in active treatment.

Voya's 2025 Stop Loss Insurance Paid Claims Analysis showed the eight largest individual claims in their book ranged from $5.6 million to $8.9 million, with the top claim tied to congenital anomalies. One NICU stay or late-stage cancer diagnosis can move your aggregate materially in the back half of the year.

Flag any claimant currently in treatment for cancer, cardiovascular disease, premature birth, or a digestive or respiratory condition. Those are the five diagnostic categories represented in Voya's largest claims. If you have an open case in any of those categories, build a conservative estimate of where it lands by December 31.

Now compare that projection to your specific and aggregate attachment points. If you're on track to pierce aggregate, your carrier already suspects it. Better to know it now, than when your renewal arrives.

What to Bring to Renewal Negotiations in August

Carriers start quoting in August for January 1 effective dates. If you walk in with nothing but a request to hold rates, you lose. If you walk in with a documented claims story, you have something to work with.

Build a one-page claims summary. Include your actual loss ratio, your large claimant detail, your diagnostic trend by category, and your projected year-end position. If your experience doesn't match what your carrier is pricing for, you can say that with numbers, not just frustration.

Three things to push on specifically during renewal negotiations this year.

• Attachment point changes. Carriers are raising specific deductibles on groups with any specialty pharmacy exposure. Know your current attachment and model the premium delta before you agree to move it.
• Lasering. If a carrier wants to laser a high-cost claimant, you need their full claims history in hand. You can't negotiate a laser limit you don't understand.
• Rate increases tied to market trend, not your experience. A 29% rise in million-dollar claims across the industry doesn't mean your plan had that experience. Your mid-year review is the evidence that separates your risk from the market's risk.

The employers who do this work in July don't always get better rates. But they make better decisions. And they stop paying for someone else's bad claims year.

Knowing your numbers is only half of it. The other half is knowing what to do with them at the negotiating table. Here's what your broker should be building before renewal starts.