For every dollar of group accident-insurance premium in 2024, insurers paid back 38 cents in claims. Group major medical paid back 88. Both numbers sit in the same NAIC exhibit, computed the same way: accident-only and AD&D group policies collected $6.12 billion in premium and returned $2.33 billion in benefits, a loss ratio of 37.94 percent.
Picture a $100 gift card that covers $38 of groceries while the store keeps the other $62. On major medical, the same card buys $88 of care. Across the whole group accident market, that remainder came to roughly $3.8 billion in one year, premium that never returned as a benefit on a product sold as cash for a broken arm or a hospital stay.
The mechanism is one sentence of law. The ACA makes major medical spend at least 80 to 85 cents of every premium dollar on care or refund the difference; accident coverage is an excepted benefit, so the floor never reaches it. What I keep coming back to is that nothing pulls the 38 toward the 88. The gap is the design, working.