“We believe sharing insights on the scale and trend of catastrophic claims can help self-insured employers, brokers, and TPAs devise better strategies to manage the costs of catastrophic illness,” added James. “Without stop-loss insurance, the self-insured employers in our study would have paid an additional $2 billion in catastrophic medical costs from 2010 to 2013. The findings of this year’s study also reveal the need to protect against claims from routine health events that are not expected to be catastrophic.”The report’s top ten claims conditions remain mostly the same as last year’s rankings, with cancer remaining the costliest, followed by chronic renal disease. Below are the key findings on the costliest claims:
- The ten costliest claims conditions comprise over half (53%) of the $2 billion in claims that Sun Life reimbursed to its Stop-Loss policyholders between 2010 and 2013.
- The three most costly conditions -- malignant neoplasm (cancer), chronic/end state renal disease (kidneys), and leukemia/lymphoma/multiple myeloma (cancer) -- represent over a third (34%) of all stop-loss claims payments that Sun Life made to policyholders from 2010 to 2013.
- Cancer continues to be the most costly stop-loss catastrophic illness by a significant margin, comprising one quarter (25%) of all stop-loss payments during the four-year period.
- Malignant neoplasm (cancer) was the costliest single condition, representing just over 17% of all stop-loss claims reimbursements.
|Medical condition||Percentage of paid stop-loss claims||Value of paid top-loss claims|
|1||Malignant neoplasm (cancer)||17.5%||$347,983,877|
|2||Chronic/end stage renal disease (kidneys)||8.2%||$164,304,588|
|3||Leukemia, lymphoma, and/or multiple myeloma (cancer)||8.0%||$159,012,585|
|4||Congenital anomalies (conditions present at birth)||4.3%||$86,438,173|
|5||Disorders relating to short gestation and low birth weight (premature births)||3.5%||$70,259,714|
|6||Cerebrovascular disease (brain blood vessels)||2.5%||$50,462,023|
|7||Congestive heart failure||2.5%||$50,154,043|
|8||Complications of surgical and medical care||2.3%||$45,700,864|
|9||Pulmonary collapse/respiratory failure (lungs)||2.3%||$45,484,490|
- Workplace wellness and early detection programs;
- A benefit program that offers protection against cancer at both the employer and employee level;
- An administrator with a direct focus on active claim management, including early detection through the use of predictive modeling and data analysis;
- A partnership with an administrator and stop-loss carrier that provides access to nationwide cost-containment vendors;
- A “no new lasers at renewal” option with a renewal rate cap included in the stop-loss policy.
To request the full research report, please visit: Sun Life Financial - Leading Catastrophic Claims Conditions.About Sun Life Stop-LossSun Life Financial is the largest independent writer of stop-loss insurance in the United States. At year-end 2013, the Sun Life U.S. Stop-Loss business had more than 1,600 policyholders, $915 million in annual premium, and approximately 4.6 million covered lives. About Sun Life FinancialSun Life Financial is a leading international financial services organization providing a diverse range of protection and wealth accumulation products and services to individuals and corporate customers. Sun Life Financial and its partners today have operations in key markets worldwide, including Canada, the United States, the United Kingdom, Ireland, Hong Kong, the Philippines, Japan, Indonesia, India, China, Malaysia, Vietnam, and Bermuda. 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. 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 Life, Disability, Dental, Critical Illness, Accident, and Stop-Loss insurance products. Product offerings may not be available in all states and may vary depending on state laws and regulations. For more information, please visit www.sunlife.com/us. SLPC 25887 05/14 (exp: 05/19)