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What Insurers Need to Know About Rising Health Care Costs for 2025

What Insurers Need to Know About Rising Health Care Costs for 2025

As employers brace for a projected 9% increase in health care benefit costs in 2025, insurers need to be aware of key trends influencing these changes. Industry reports indicate that while companies anticipate higher costs driven by factors such as advanced treatments and inflation in the health sector, many are not passing the full burden onto their employees.

Cost Increases and Employer Strategies

Employers, according to surveys by organizations such as KFF and Aon, have seen a significant rise in premiums over recent years. Despite this, they have largely insulated employees from these surges to maintain workforce satisfaction in a competitive job market. The total annual premium for family coverage has risen by 24% over the past five years, yet employees’ contributions have increased by only about 5%, amounting to an average of $6,300 out of the $25,572 total. Large employers expect an 8% increase in costs for 2025—the most substantial jump in over a decade, as highlighted by Jim Winkler, chief strategy officer at the Business Group on Health. Although a majority are prepared to absorb much of the increase to keep health benefits attractive, some will likely pass on a portion of these costs to workers through higher premiums or adjustments to plan structures.

Contributing Factors to Rising Costs

Several factors are contributing to these rising costs:
  • Prescription Drug Costs: The growing demand for high-cost medications, including weight-loss drugs like GLP-1 inhibitors, is a significant driver. While more large employers are covering these medications, many impose usage conditions to manage expenses.
  • Advanced Therapies: Treatments such as in vitro fertilization and gene therapies, while life-changing, contribute to the overall increase in health care expenditures.
  • Health Care Workforce: A tight labor market for health care workers, compounded by an aging population and the consolidation of health care providers, has further pushed up costs.

Plan Adjustments to Offset Costs

To manage costs, insurers and employers are considering several strategies:
  • Cost-Cutting Measures: According to Mercer, about half of surveyed employers plan to introduce measures such as higher deductibles or tighter approval processes for certain treatments.
  • Innovative Health Plan Designs: Some companies, like JPMorgan Chase, are offering plans with no deductibles and free primary care within limited networks. This can make care more affordable for employees while controlling employer expenses.
  • Pharmacy Benefit Changes: Adjustments to pharmacy benefit managers and negotiations with vendors are becoming more common as employers seek to reduce the rising cost of prescription drugs.

Shifts in Employee Coverage

Although employers are seeking ways to contain costs, workers may face changes in their health plans. Options like health savings accounts (HSAs) continue to be a focus for many companies, offering a way for employees to save pre-tax dollars for medical expenses. The maximum HSA contributions for 2025 will be $4,300 for single coverage and $8,550 for family coverage, with an additional $1,000 for those over 55.

Industry Implications for Insurers

Insurers must remain agile to meet the evolving needs of employers managing these cost pressures. This may involve:
  • Offering Tailored Plans: Insurers should consider plans that balance affordability and coverage, such as those with strategic use of co-payments or cost-sharing mechanisms.
  • Enhanced Pharmacy Management: As prescription costs continue to soar, insurers could enhance their pharmacy benefit management strategies to offer competitive rates and maintain plan value.
  • Education and Support for Employers: Providing tools for employers to better understand and navigate the complexities of plan options and employee contributions can strengthen relationships and client retention.
The anticipated rise in health care costs poses challenges for both insurers and employers. While large companies are currently absorbing much of the increase to attract and retain employees, adjustments in plan designs and cost-sharing measures are expected. Insurers need to adapt by offering innovative solutions that support cost management without compromising on coverage quality.
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USG Announces Hire of Kamisha Kerr in Westlake, FL

USG Announces Hire of Kamisha Kerr in Westlake, FL

USG Insurance Services, Inc., a prominent national wholesaler and MGA, is pleased to announce the addition of Kamisha Kerr to their esteemed Brokerage Division. Kerr will be working under the guidance of Mitchel Zelman, National Director of the Brokerage Division. Kerr joins USG with over 20 years of dedicated experience in insurance and brokering, with a proven track record of client-focused service and effective insurance solutions. Her extensive expertise encompasses complex and catastrophic risk placements, as well as proficient negotiation and contract skills. Kerr's approach to brokering emphasizes strong client relationships, built on a deep understanding of unique insurance needs and challenges. She is committed to delivering customized, productive solutions that empower clients with confidence and clarity in their insurance coverage. USG is confident Kamisha's addition will enhance their Brokerage division’s capabilities and look forward to the positive impact she will make on their clients and company. This move is the most recent change that USG has implemented in its plan to continue expanding its operations nationally as a leading wholesaler brokerage firm. ABOUT USG: USG is a national wholesale broker and managing general agent (MGA) with offices throughout the country. USG represents 400+ A rated carriers, both admitted and non-admitted and is an MGA for 14 carriers, writing business in all states. USG's mission is to become the #1 provider of innovative solutions for the risk management industry--exceeding expectations with its advanced technology, creative problem solving, and research capabilities. CONTACT INFORMATION: KAMISHA KERR Inside Producer/Broker: Brokerage Division d: 813.466.3560
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Sinclair Files Lawsuit Against Cyber Insurers Over Unpaid Ransomware Claims

Sinclair Files Lawsuit Against Cyber Insurers Over Unpaid Ransomware Claims

In a high-profile legal battle that underscores the complexities of modern cyber insurance, media giant Sinclair Broadcast Group has filed suit against two of its cyber insurers, Continental Casualty (CNA) and Starr Indemnity & Liability, over unpaid claims stemming from a ransomware attack in 2021. The lawsuit was originally filed on September 13 in the Circuit Court for Baltimore County, Maryland, and was moved to the U.S. District Court in Maryland on October 16, according to reporting from The Wall Street Journal.

The 2021 Ransomware Attack and Its Aftermath

Sinclair, which owns or operates 185 television stations and 21 regional sports networks, fell victim to a ransomware attack on October 17, 2021. The company managed to recover by mid-November, but the damage was significant, with Sinclair estimating the total cost of the attack at $70 million. To mitigate such risks, Sinclair had purchased up to $50 million in coverage through a series of layered insurance policies. The structure of these policies was designed to pay out sequentially, with CNA managing the fourth layer and Starr covering the fifth. While the first three insurers met their obligations and paid Sinclair's claims, CNA and Starr have yet to do so, according to the lawsuit.

Policy Details and Disputed Payments

The primary insurance policy, valued at $10 million, was issued by Axis Insurance and covered various aspects such as crisis management, fraud response, and forensic investigations. The remaining coverage came from excess policies issued by QBE Insurance, Philadelphia Indemnity Insurance, CNA, and Starr, each providing $10 million in follow-form policies linked to the terms set by Axis. Sinclair claims that CNA initially indicated it would pay out under the policy. However, in October 2023, CNA presented a revised forensic report that reduced the business interruption claim for one of Sinclair’s two affected units from $42 million to $10.8 million. This adjustment, Sinclair argues, effectively placed the claim outside the scope for payout under CNA’s policy. Since March 2024, when Sinclair submitted further requested information, CNA has not provided an update on its decision, according to the lawsuit. Sinclair believes that Starr will issue payment once CNA does, as Starr's policy is contingent on CNA’s payout.

The Changing Landscape of Cyber Insurance

Sinclair’s situation highlights the evolving nature of the cyber insurance market, which has grown significantly in response to an increase in cyberattacks on businesses of all sizes. According to data from the National Association of Insurance Commissioners (NAIC), insurers saw an average loss ratio of 66.4% in 2021, driven by the surge in cyber-related claims. This led to stricter underwriting practices and reduced coverage offerings in subsequent years, with the loss ratio falling to 43% in 2023. To protect against extensive financial losses, many companies, including Sinclair, are forced to assemble coverage through multiple, layered policies. These policies may include specialized cyber policies and excess insurance that covers specific incident response costs.

Broader Implications and Industry Trends

Disputes over cyber insurance payouts, particularly for claims tied to ransomware and business interruption, have become more common as insurers attempt to manage risk and protect profitability. However, nonpayment disputes like Sinclair’s are rarer than coverage denials for broader policy terms. Notable past cases include a prolonged battle between food conglomerate Mondelez and its insurer Zurich over the 2017 NotPetya attack, which centered on whether the incident qualified as an act of war. The case was ultimately settled in 2022. In another instance, a North Carolina radiology practice sued its insurer in 2023 after a cyber policy lapsed just before an attack due to procedural errors. Sinclair’s spokesperson expressed disappointment in CNA and Starr's refusal to pay, stating, “We aren’t going to comment on ongoing litigation; however, we are disappointed that these insurance companies are refusing to honor their coverage obligations unlike other insurers on the same program who covered their portion of our loss.” Neither CNA nor Starr provided comments to The Wall Street Journal. As the case progresses, it will be closely watched by businesses and insurers alike for its potential impact on how cyber policies are interpreted and honored. This ongoing legal matter highlights the necessity for clarity in policy language and the importance of due diligence when structuring layered insurance coverage to address emerging risks.
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Tornadoes and Severe Storms Batter Oklahoma: A Look at the Damage and Response

Tornadoes and Severe Storms Batter Oklahoma: A Look at the Damage and Response

Severe thunderstorms, accompanied by intense tornadoes and flash flooding, have swept through the central and southern United States, particularly hitting states like Oklahoma, Texas, and Missouri. The recent storms follow a destructive weekend in Oklahoma, where powerful tornadoes caused significant damage to homes and infrastructure. The National Weather Service (NWS) confirmed at least five tornadoes over the weekend, including two EF3-level twisters in Harrah and near Sooner Road in Cleveland and Oklahoma counties. The Enhanced Fujita (EF) Scale rates tornadoes from EF0 to EF5 based on wind speed and damage potential, with EF3 storms capable of winds between 136 and 165 mph. Tornadoes struck during the night, a time known to increase fatalities due to reduced visibility and the likelihood of residents being asleep. Many residents awoke to splintered homes, overturned vehicles, and scattered debris.

Communities Rally Amid Extensive Damage

Over 137 structures in the Oklahoma City area experienced varying degrees of damage, with nearly 40 completely destroyed. The Oklahoma City Fire Department reported that at least 11 individuals sustained non-life-threatening injuries, and many others reported minor injuries but did not seek medical attention. Residents shared harrowing stories of the storm's impact. Katie Anderson, a resident in southeast Oklahoma City, recalled the terrifying moment she realized her roof had collapsed. “Every single thing is replaceable, but people aren’t,” Anderson said, emphasizing her gratitude for her family's safety despite the property damage. Another resident, Thomas Shaver, described the overwhelming noise as he hurriedly gathered his family to safety. His house lost its bedrooms and part of the roof, yet he remained thankful that they survived. Amid the destruction, community members have come together to support affected families. In Moore Public Schools, donations have started pouring in to aid those impacted.

Continued Weather Threats and Government Response

The severe weather system is not limited to Oklahoma. Tornado and severe thunderstorm warnings have expanded to northern Texas, southeastern Kansas, and southwestern Missouri. The NWS has warned of EF2 or stronger tornadoes, large hail, and damaging winds. Meanwhile, torrential rainfall has triggered flash flood warnings, affecting over 7 million people across the region. Oklahoma Governor Kevin Stitt declared an emergency for six counties and assured residents that efforts were underway to ensure polling stations would remain functional for the upcoming presidential election. As of early Monday, over 12,000 residents were still without power, and utility restoration continued where conditions allowed. “Potential life-threatening conditions will move across the state,” Stitt cautioned, highlighting the collaboration between the state and local authorities to provide essential support and resources. The recent surge in tornadoes, particularly during the fall, aligns with climate observations that indicate a shift toward more tornadoes occurring in less traditional seasons as warm, moist air from the Gulf meets colder atmospheric fronts.

Conclusion

As Oklahoma and neighboring states brace for continued storms, residents and officials are focused on cleanup, recovery, and preparation for potential future threats. The swift mobilization of resources and community support will be crucial as these states navigate through this challenging period.
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