In November 2026, Aon published a survey of US hospital employers that showed how much of their medical spending was concentrated among members with very high claims. The release covers 170 health systems representing more than 1,800 hospitals and over 4.2 million covered employees. Aon did not give fieldwork dates in the release. The results describe participating health systems and should be read in that context.
Among the surveyed systems, a median 1.2% of plan members recorded more than USD 100,000 in annual medical claims; Aon attributed 39.2% of plan costs to this high cost group. Among systems participating in consecutive years, spending per employee increased 8.8%. The concentration figure shows how costs were distributed within the surveyed plans. The change in spending shows how costs moved in the repeat sample. Neither tells an individual employer how much its own renewal will cost.
Ask what makes the renewal move
A benefits committee reviewing a renewal can begin by separating changes in the broad cost base from the impact of a few large claims. Ask for a view of spending per covered member, the number of claims above a consistent threshold and the share of spending attributable to those claims. Compare like periods and confirm whether the figures reflect claims paid during the period or services incurred during it. A payment timing change can produce a misleading comparison.
Then ask whether the high claims reflect completed episodes, treatment likely to continue or uncertainty about future care. A plan sponsor needs this in aggregate. Clinical details belong with the people responsible for care and claims administration.
Compare protection with the exposure retained
Where employers buy stop loss, the attachment point determines how much eligible expense they retain before the contract pays. A large claim may be financially material even if an employer has coverage. The committee should understand what is excluded, when reimbursement is payable and how late claims are handled. It should also check whether the renewal changes the terms for particular high exposures, using a suitably protected process to discuss sensitive information.
Comparing quotes on price alone can hide material differences. Ask bidders to show the cost under a normal year, a year with several high claims and a year with one exceptional claim. Include cash timing as well as the expected annual cost. An employer may be able to bear the ultimate cost but still need liquidity if reimbursements arrive later than payments to providers.
Measure case management separately
Aon also reported that health systems use a mix of carrier programmes, navigation services and predictive tools. Their use does not establish that any one intervention lowered costs. A sponsor paying for a service should agree in advance how to assess it. Measures can include the time it takes a member to reach the appropriate team, how often cases are handed off successfully and whether the vendor can demonstrate an outcome against a reasonable comparator.
Multinational sponsors can use the same questions in other markets while respecting local plan design, privacy rules and the division of responsibilities between public systems and employer cover. The approach is to ask how each market identifies severe claims, who can act on that information and where the financial exposure ultimately sits.
For the next renewal, request a short reconciliation of cost growth, high claim concentration, amounts retained and expected reimbursements. Pair that view with evidence of service quality for members who need complex care. It gives the committee a basis for deciding whether to change the protection it buys, improve case management or keep the existing arrangement.
Sources
Aon: Benefits Survey of Hospitals release
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