WELLESLEY, Mass., July 11, 2016 /PRNewswire/ -- In its fourth
annual Top Ten Catastrophic Claims Conditions report, Sun Life
Financial U.S. brings insights to self-funded employers about
critical factors impacting medical costs. The report compiles the
costliest medical conditions covered by Sun Life stop-loss
insurance from 2012 to 2015 and explores emerging trends to help
brokers and self-funded employers understand and mitigate their
risks.
During the four years of the study, billed charges from medical
care providers totaled $9 billion.
Self-insured employers paid just over half ($5.3 billion) of those billed charges after
discounts were applied and received $2.3
billion in reimbursements through stop-loss
protection.
The report shows that million-dollar-plus claims continue to
trend up with an increase of 25% compared to last year. Severity
continues to be a factor with less than 2% of million-dollar plus
claimants (448) accounting for a disproportionate 18.5% of overall
stop-loss claims reimbursements ($431.2
million).Over the four-year period, the average amount paid
by an employer on a claim above $1
million was $1.45 million,
which was reduced to $491,000 after
applying the average stop-loss claim reimbursement ($962,000).
Cancer continues to dominate the top of the list (number one and
number two) with $618 million in
stop-loss reimbursements, accounting for more than one-quarter
(26.6%) of total stop-loss claims. Of the various types of cancer
identified in the report, breast cancer accounted for 13.6% of the
total reimbursements for this condition. Cancer is also a leading
million-dollar condition—it's in the number-two spot after
premature infant and liveborn complications.
The report cites intravenous medications as a key driver of
rising cancer costs and provides an analysis on the top twenty
intravenous medications in 2015.
Chronic/end-stage renal disease (kidneys) held steady in the
number-three spot on the list, accounting for over $369 million in combined first-dollar claims and
stop-loss claims reimbursements. Although the average treatment
cost for claims associated with kidney disease has gone down 21%
over the last four years, the high incidence rate of the condition
contributes to its ranking. One in three Americans are at risk for
kidney disease, with diabetes and hypertension as leading
causes.1 The report highlights how improvements in cost
management and increased use of transplants might continue to
reduce the costs associated with this condition over time.
As an upward trend to watch, transplants made the report in the
number-six position, with a 65% increase in incidence from 2012 to
2015. In addition to the expanded use of transplants, the report
cites an increase in organ donations and improved procedures (which
can increase the pool of potential candidates) as contributing
factors. Transplants represented over $62.2
million in stop-loss claims. Notably, there was a 79%
increase in bone marrow/stem cell transplant costs and a 55%
increase in associated pre- and post-transplant costs.
"More employers are self-funding their medical plans than ever
before, and managing the rising cost of health care continues to be
one of their central concerns," explained Brad Nieland, Vice President, Stop-Loss, Sun
Life Financial U.S. "By highlighting the conditions that create
catastrophic claims and providing insights into trends influencing
high costs, we can help employers anticipate what they'll see when
self-funding and raise awareness about the importance of
cost-containment resources and stop-loss insurance."
This year, the report also takes into account how geographic
location impacts the costs for medical care. The East South
Central, Mid-Atlantic, and Pacific regions were the most expensive
areas to experience a catastrophic condition, with costs above the
national average (27%, 22%, and 19% respectively).
For more information, see the following:
- PDF of the full report:
http://bit.ly/2016slfcatastrophicclaimsreport
- Infographic of catastrophic claims costs and the top ten
conditions: http://bit.ly/2016slfcatastrophicclaimsinfographic
About Sun Life Stop-Loss
Sun Life is the number-one
independent provider of stop-loss insurance in the United States.2 Stop-Loss
insurance protects self-funded employers by limiting the risk
associated with catastrophic claims. As of year-end 2015, 1,979
self-funded employers had stop-loss insurance with Sun Life,
covering 5.2 million individuals.
About Sun Life Financial
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. Sun Life Financial has
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. 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.
In the United States, Sun Life
Financial is one of the largest group benefits providers, serving
more than 60,000 employers in small, medium, and large workplaces
across the country. Sun Life's broad portfolio of products and
services in the U.S. includes Disability and Absence Management,
Life, Dental and Vision, Voluntary, and Stop-Loss insurance. This
includes the acquisition of Assurant Employee Benefits in Q1 2016.
For more information, please visit www.sunlife.com/us.
- National Kidney Foundation, "Fast Facts," referencing United
States Renal Data System 2015 Annual Report and the Centers for
Disease Control and Prevention,
https://www.kidney.org/news/newsroom/factsheets/FastFacts. National
Institute of Diabetes and Digestive and Kidney Disease, High Blood
Pressure and Kidney Disease,
http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/high-blood-pressure-and-kidney-disease/Pages/facts.aspx.
- 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.
Media
Contacts:
Amanda Gallo
Sun Life Financial
amanda.gallo@sunlife.com
781-446-1264
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SOURCE Sun Life Financial U.S.