Sun Life Financial Ranks Top Ten Most Costly Stop-Loss Catastrophic Claims
Report includes recommendations to help self-insured employers manage medical costs
WELLESLEY, MA (May 2, 2013) – The Employee Benefits Group of the U.S. business group of Sun Life Financial Inc. (NYSE: SLF, TSX: SLF) today announced the top ten Stop-Loss catastrophic claims categories from research it conducted. The research presents an analysis of Stop-Loss catastrophic claims spanning from 2008 to 2011. These claims come from Sun Life Stop-Loss policyholders located across the United States with up to 25,000 employees. The report underscores the significant opportunity to receive catastrophic claims reimbursement—an opportunity that is available only to self-insured employers with stop-loss insurance.
The ten medical conditions triggering the highest Stop-Loss claims reimbursements remained relatively stable from 2008 to 2011. Cancer continues to be the most costly Stop-Loss catastrophic illness by a significant margin. Claims payments for cancer comprised 25% of all Stop-Loss claims payments over the four-year study.
The top ten catastrophic conditions, ranked by highest total Stop-Loss claims reimbursements, were:
- Malignant neoplasm (cancer),
- Chronic/End state renal disease (kidneys),
- Leukemia/lymphoma, and/or multiple myeloma (cancer),
- Congenital anomalies (conditions present at birth),
- Disorders relating to short gestation and low birth weight (premature births),
- Cerebrovascular disease (brain blood vessels),
- Complications of surgical and medical care,
- Congestive heart failure,
- Pulmonary collapse/respiratory failure (lungs), and
- Dorsopathies (spine conditions).
The most costly three conditions, malignant neoplasm (cancer), chronic/end state renal disease (kidneys), and leukemia/lymphoma/multiple myeloma (cancer), represented 33% of all Stop-Loss claims payments that Sun Life Financial made from 2008 to 2011. The total of all Stop-Loss claims payments during the four-year study was $1.7 billion.
“We conducted this research to bring greater focus to the significance of catastrophic claims for self-insured employers,” said Scott Beliveau, Stop-Loss Vice President. “We are committed to continuing the dialogue about how carriers, self-insured employers, brokers, and TPAs can work together to manage the high cost of catastrophic claims.”
To help manage medical costs, the report recommends that self-insured employers analyze their self-insured strategy to make sure that it includes cost-containment best practices. The report provides important questions for the employer to consider, such as whether the following approaches are in use: wellness programs, early detection programs, language in the medical plan document that helps contain costs, relationships with leading transplant centers to help ensure expert care and cost control, a “no new lasers at renewal” option with a renewal rate cap included in the Stop-Loss policy, and more.
Sun Life Financial Stop-Loss Claims Director Laura Rollinson, R.N., who led the claims study, said, “When self-insured employers, brokers, and third party administrators ask me what can be done to more actively manage costs, I advise a real focus on cost containment—both before and after there’s a stop-loss claim. By applying the ‘before and after’ approach, the stop-loss carrier’s medical case managers can suggest approaches and provide access to services that can result in improved patient outcomes and cost-savings for the employer.”
To request the full research report, please visit:
Sun Life Financial - Leading Stop-Loss Catastrophic Claims Conditions.
About Sun Life Stop-Loss
As of year-end 2012, the Sun Life Stop-Loss business had 1,548 policyholders, $839.9 million in annual premium, and 4.5 million covered lives.
About Sun Life Financial
Sun 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. Chartered in 1865, 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, and Bermuda. In the United States and elsewhere, insurance products are offered by members of the Sun Life Financial group that are insurance companies. 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. 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, and Stop-Loss insurance products.
These products are issued by Sun Life Assurance Company of Canada in all states except New York. In New York, these products are issued by Sun Life Insurance and Annuity Company of New York. Product offerings may not be available in all states and may vary depending on state laws and regulations. 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.
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