Nayya's review of 6.7 million medical claims finds employees missing payouts worth up to $20,000, which can make coverage look unused at renewal
Employees typically pay for supplemental health coverage so they have cash when something goes wrong. A new analysis suggests many of them never collect it.
One in four employees enrolled in supplemental health benefits has a reimbursable claim they haven't filed, according to Nayya, a New York-based AI benefits platform. The company reviewed 6.7 million medical claims across 611,000 members in the first half of 2026 and found roughly 300,000 people with at least one payout they hadn't pursued.
The amounts aren't small. The average unclaimed reimbursement was $1,080 for a hospital admission and $1,796 for a forearm fracture, and a full cancer benefit could reach $20,000.
The data comes from Nayya's own platform rather than an independent study, and Nayya sells technology that files these claims. Still, the findings track with outside research. NFP's 2026 U.S. Benefits Trend Report found fewer than one in three employees fully use their supplemental benefits, and 13 percent forget they have them at all.
Why employees don't file
Supplemental health products, such as accident insurance, hospital indemnity and critical illness coverage, pay cash when a qualifying event happens. In most cases, though, the employee has to file. That means connecting a hospital stay or diagnosis to a policy chosen during open enrollment months earlier, working out what it covers, gathering paperwork and submitting a claim, often in the middle of a medical crisis.
"People buy this coverage precisely so they're protected when the worst happens," said Sarah Liebel, CEO of Nayya. "What's heartbreaking is that the system asks people to remember a policy, decode what it covers, and chase down paperwork in the exact moment they have the least strength to do any of it."
Understanding is another barrier. Hospital indemnity and critical illness plans, where payouts tend to be largest and claims most complex, are also among the least understood by enrolled employees, Nayya said.
That lines up with Employee Benefit Research Institute findings that voluntary benefits enrollment lags even as most workers are unprepared for a $1,000 medical bill. That research found employees rated their understanding lowest for supplemental health products.
Low claims can look like low value
Unfiled claims also distort the numbers HR brings to the renewal table. When employees don't file, claims activity looks low and the coverage can look underused. That weakens the case for keeping or expanding a benefit, even when employees are regularly having the hospital stays and diagnoses it was built to cover.
Health costs are rising elsewhere in the benefits budget, too. Regulators in New Mexico recently approved a 19.8% average rise in small group health premiums for 2027, topping the national median for a second year.
More employees may also be leaning on workplace coverage, as HRD has reported on expiring Affordable Care Act subsidies pushing workers toward employer health plans.
Carriers are automating the claim
Some carriers are taking the filing step out of employees' hands. Mutual of Omaha and Claritev announced an integration in August 2026 that uses medical claims data to flag employees who may be eligible under accident, critical illness or hospital indemnity coverage and prompts them to file.
Securian Financial reported that among clients using medical claims integration, 49 percent of claims were initiated through that system, based on its 2025 and 2026 client data. In those cases, the claim was started by the integration rather than by the employee.
Nayya's platform takes a similar approach, linking a member's medical claims to their supplemental coverage and flagging a filing opportunity when a qualifying event happens.
The questions this poses are practical. Does the carrier or platform connect medical claims to supplemental coverage? Who tells employees they may have a claim, and when? And does the renewal data show what employees were owed, or only what they filed?
Enrollment communication helps, but the moment that matters comes later. It's after a hospital visit or a diagnosis, when most employees are least likely to remember a policy they picked months ago.
