Third annual study analyzes highest-cost claims and emerging trends in stop-loss
Wellesley, MA – (June 18, 2015) — The U.S. business group of Sun Life Financial has released its third annual Catastrophic Claims Report, which compiles the top ten costliest medical conditions covered by stop-loss from 2011 to 2014 and explores emerging trends. The data can help both brokers and employers better understand the risk associated with large claims and the potential impact to a self-funded medical plan.
Cancer remains the costliest disease, accounting for more than one quarter (25.7%) of the $2.1 billion Sun Life paid out to stop-loss claimants during the report’s four-year period. The top three conditions, which include cancer (malignant neoplasm and leukemia/lymphoma/multiple myeloma) and end-stage renal disease, made up 33.5% of total reimbursement costs.
One of the contributors to catastrophic claims costs is intravenous medications, which accounted for over $71.4 million, or 13%, of the total paid stop-loss claims during 2014. The top twenty intravenous medications are quite expensive and represent 65% of the total cost of intravenous medications administered for catastrophic claims conditions. Approximately half of the top twenty intravenous medications identified in the report are used to treat cancer, and represent nearly $25 million in treatment costs in 2014 alone.
The report also shows that individuals with claims in excess of $1 million remain a major driver of stop-loss payments, accounting for $348 million of the total paid stop-loss claims. Cancer, congenital anomalies (conditions present at birth), and premature births account for 28% of all claims breaching the $1 million mark. The findings confirm the need for self-funded employers to protect against common health events that could turn into catastrophic claims.
As the number-one independent carrier of medical stop-loss in the U.S. with $1.03 billion in annual premium,* Sun Life is uniquely qualified to conclusively report on stop-loss activity, such as top claims, conditions, and emerging trends.
“Through our research, we are able to provide insight to the market on the conditions that drive high-cost claims and how self-funded employers can manage that risk effectively,” said Sun Life’s Brad Nieland, Vice President, Stop-Loss. “We help employers implement stop-loss and other cost-containment measures to support their self-funding strategy.”
*The number-one ranking is based on the 2014 year-end Sun Life Stop-Loss premium of $1.03 billion and on a Sun Life analysis of publicly available financial information and third-party market share data.
About Sun Life Financial
Celebrating 150 years in 2015, Sun Life Financial is a leading international financial services organization providing a diverse range of protection and wealth products and services to individuals and corporate customers. The Sun Life Financial group of companies operates under the “Sun Life Financial” name strictly as a marketing name and no legal significance is expressed or implied. Sun Life Financial and its partners have operations in a number of markets worldwide, including Canada, the United States, the United Kingdom, Ireland, Hong Kong, the Philippines, Japan, Indonesia, India, China, Australia, Singapore, Vietnam, Malaysia and Bermuda. In the United States and elsewhere, insurance products are offered by members of the Sun Life Financial group that are insurance companies. In the United States, Sun Life Financial provides a range of products and services to employers and their employees, including Group and Voluntary Accident, Critical Illness, Dental, Disability, Life, and Stop-Loss insurance products. Product offerings may not be available in all states and may vary depending on state laws and regulations. Sun Life Financial Inc., the holding company for the Sun Life Financial group of companies, is a public company. It is not an insurance company and does not offer insurance products for sale in the United States or elsewhere, and does not guarantee the obligations of its insurance company subsidiaries. Sun Life Financial Inc. trades on the Toronto (TSX), New York (NYSE), and Philippine (PSE) stock exchanges under the ticker symbol SLF. For more information please visit www.sunlife.com/us.