SIIA Survey Finds Strong Captive Insurance Growth Outlook for 2026

The Self-Insurance Institute of America (SIIA) reports continued optimism about the captive insurance market, with medical stop-loss leading growth expectations and brokers emphasizing pricing stability and risk management. The findings are detailed in SIIA's sixth annual 2026 Captive Industry Survey & Trend Report: What Is Changing and Where the Market Is Going, which examines industry trends, broker adoption, underwriting practices, and emerging risks.

The survey included 160 participants representing captive managers, service providers, captive owners, prospective owners, and insurance brokers. According to SIIA, respondents rated the future of the captive insurance industry an average of 7.6 on a 10-point scale, with nearly half expressing greater optimism than in 2025.

Medical Stop-Loss Leads Captive Growth

Medical stop-loss continues to generate significant interest in captive insurance arrangements. According to the report, 67.6 percent of respondents to the relevant survey question identified gap or medical stop-loss as an area of increased captive interest, with cyber risk and professional liability also attracting attention.

Among medical stop-loss service providers, employee benefits and medical stop-loss were identified as the strongest areas of growth. SIIA also identified underwriting challenges, collateral requirements, competitive commercial insurance capacity, and employer readiness for self-funding as barriers to broader adoption.

The report identified rising pharmacy costs and high-cost specialty claims as emerging concerns. According to SIIA, respondents cited GLP-1 medications, gene and cell therapies, oncology treatments, and transplants among the developments affecting the captive insurance market.

Captives Report Favorable Renewal Experiences

Medical stop-loss captives reported relatively favorable results during the January 1, 2026, renewal cycle. According to SIIA, more than half of the medical stop-loss service providers responding to the question indicated that their renewal blocks performed better than the standard insurance market, while most others reported similar conditions.

Pricing predictability was another significant finding. The report indicated that 21 of 23 medical stop-loss respondents rated captive renewal pricing as moderately, very, or extremely predictable compared with the standard market. Several respondents also reported average renewal advantages in the high single digits, although the responses were not sufficiently standardized to establish a market-wide average.

Brokers Emphasize Pricing Stability and Risk Management

Insurance brokers increasingly identify pricing stability and risk management as important benefits of captive participation. According to SIIA, brokers ranked pricing stability as the leading benefit, followed by improved risk management, ownership of underwriting profits, and access to data and benchmarking.

Broker expectations for captive insurance remained favorable. The report found that 90.6 percent of brokers responded to the 5-year demand question anticipating growth, while most rated captive value above the traditional insurance market and indicated they would recommend captive arrangements to new clients.

Despite these favorable perceptions, limited understanding of captive structures continues to restrict broader adoption. According to SIIA, 57.1 percent of brokers without captive clients identified insufficient knowledge as a reason for not introducing captive arrangements. Most expressed interest in additional education and support, and all respondents to a follow-up question indicated they would be highly likely to recommend captive insurance with a better understanding of its benefits.

Claims Management and AI Influence Captive Operations

Operational capabilities are becoming an increasingly important consideration in captive insurance arrangements. According to the report, medical stop-loss service providers identified claims management as the most valuable captive resource, followed by loss control and data analytics.

Artificial intelligence (AI) is also gaining a role in captive underwriting. SIIA reported that 88.2 percent of broader service providers had implemented AI in underwriting, compared with 57.1 percent of medical stop-loss service providers. The report identified data quality, clinical interpretation, and explainability as considerations affecting AI adoption in medical stop-loss underwriting.

Emerging Risks and Regulatory Trends

Interest in captive insurance continues to extend beyond established coverage applications. According to SIIA, respondents identified cyber risk, professional liability, climate-related exposures, voluntary benefits, and coverage gaps as areas of interest, although adoption remains uneven, and many discussions on emerging risks are still exploratory.

Regulatory developments were not widely identified as influencing captive insurance interest. According to the report, 91 percent of respondents to the regulatory trends question reported no evolving regulatory developments increasing or decreasing captive interest, a notable increase from the previous 2 years.

Overall, SIIA's findings indicate that continued captive insurance growth will depend on more than market demand. The report identifies underwriting discipline, effective claims management, pricing predictability, broker education, and appropriate use of technology as important factors shaping the industry's next phase.