Andy NearyI help insurance professionals turn brand awareness into business growth.

Why do health insurance brokers sh!t on voluntary benefits?

20 Apr 2026 · 1 min

Watch on YouTube

1:05

In this segment, the speaker explains that many voluntary employee benefit products—such as stop‑loss, critical illness, and hospital indemnity—are largely unknown to plan members, resulting in very few claims being filed. Consequently, loss ratios for these products sit at only 30‑40%, which benefits carriers and, by extension, brokers who profit from the low utilization. The speaker argues that integrating these benefits with third‑party administrators (TPAs) to obtain claims data enables automatic adjudication of voluntary benefit claims. When auto‑adjudication is implemented, loss ratios rise dramatically to around 70%, indicating higher claim utilization, which the speaker views as a desirable outcome for the market.

Chapters

A lot of stop-loss claims are also critical illness claims, hospital indemnity claims. And I would tell you the big knock on the voluntary benefits industry is that these are products that are unknown by the members. And so they don't even know to file a claim. And because of that, the loss ratios are in the 30 to 40% range. And, you know, the carriers in that space are high-fiving because they're making a lot of money. We are very interested in integrating these products. We are very interested in the claims integration aspect, and you can get to that when you work directly with the TPA. So where we can get claims data, we can actually integrate an auto adjudication for voluntary benefits. And when we do that, we see the loss ratios go up much higher, more like 70%. And we're okay with that because we want these products to be utilized.