One in four employees enrolled in supplemental health benefits has a reimbursable claim sitting unfiled, according to a new analysis by Nayya, an AI-powered benefits platform, that reviewed 6.7 million medical claims across 611,000 members in the first half of 2026.
Nayya's analysis found the average reimbursement opportunity is $1,080 for a hospital admission, $1,796 for a forearm fracture, and as much as $20,000 for a full cancer benefit. Across the dataset, roughly 300,000 people had at least one payout opportunity they had not pursued.
The data is Nayya's own, drawn from its platform rather than an independent study. It is, however, consistent with what independent research has found: NFP's 2026 US Benefits Trend Report found fewer than one in three employees fully uses their supplemental benefits.
The pattern is not new, but Nayya's analysis is one of the more detailed attempts to size it. Employees who experience a qualifying event, such as a hospital stay, a broken bone, or a serious diagnosis, frequently do not connect that event to the supplemental coverage they enrolled in during open enrollment months earlier. Filing a claim means first remembering the policy exists, then decoding what it covers, gathering documentation, and submitting it, usually while managing 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."
The understanding gap compounds the problem. Hospital indemnity and critical illness coverage, the two product types where payout values are typically largest and claims processes most complex, are also among the least well understood by enrolled employees, according to Nayya.
When claims go unfiled, the utilization data at renewal reflects it. Low claims activity on supplemental benefits can make coverage look underused, weakening the case for maintaining or expanding it, even when employees are experiencing qualifying events that would trigger payouts if they knew how to claim them.
That dynamic is pushing carriers to act. Mutual of Omaha and Claritev recently announced an integration that uses medical claims data to automatically identify employees who may be eligible to file under accident, critical illness, or hospital indemnity coverage and notifies them to do so. Securian Financial, meanwhile, reported that 49% of certain supplemental health claims among participating clients were initiated through medical claims data integration. Nearly half started only after an automated system identified the eligible event.
The Nayya analysis surfaces the same problem from a different angle. Rather than a carrier-side integration, Nayya's platform connects medical claims data to a member's supplemental coverage and identifies filing opportunities when a qualifying event occurs. Nayya said the system can then move the process forward on the member's behalf.
When claims go unfiled at scale, the utilization data that advisors bring to renewal conversations understates how much the coverage is actually being used. A carrier or platform that can demonstrate active claims activity, with payouts actually reaching employees after qualifying events, gives advisors a concrete story to tell employer clients about the value of the coverage they recommended. Without that, supplemental benefits can look like a cost rather than a benefit, regardless of how they were designed.
