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Many supplemental health benefit enrollees leave reimbursements unclaimed
Nayya said its review of 6.7 million medical claims covering 611,000 members found about 300,000 people had at least one payout opportunity they had not pursued.
Insurance Business reports that an analysis by Nayya, an AI-powered benefits platform, found that about one in four employees enrolled in supplemental health benefits had a reimbursable claim that remained unfiled. The company’s review covered 6.7 million medical claims across 611,000 members in the first half of 2026.
In Nayya’s dataset, the average reimbursement opportunity ranged from $1,080 for a hospital admission to $1,796 for a forearm fracture, with some benefits such as full cancer coverage reaching as much as $20,000. Across the dataset, Nayya said roughly 300,000 people had at least one payout opportunity they had not pursued.
The outlet said the analysis is based on Nayya’s platform data rather than an independent study. Insurance Business noted it aligns with independent research cited in the report, including NFP’s 2026 US Benefits Trend Report, which found fewer than one in three employees fully use their supplemental benefits.
Insurance Business also pointed to a core utilization gap, saying employees often do not connect qualifying events, such as hospital stays, broken bones, or serious diagnoses, to supplemental coverage they enrolled in during open enrollment months earlier. The story adds that filing a claim depends on remembering the policy exists.