June 21, 2022
Research based on Sun Life's high-cost claims data also shows:
WELLESLEY, Mass., June 21, 2022 /PRNewswire/ -- Sun Life U.S. has released its 10th annual report on high-cost medical claims, analyzing its stop-loss claims data and medical trends from 2018 – 2021. COVID-19 rose to a top 10 costliest condition in 2021, with the highest-cost COVID-19 claim reaching $1.75 million. Other categories of medical claims, including cancer and mental health claims, showed increases as well. The report reviewed nearly 50,000 Sun Life member claims from more than 2,800 self-funded employer clients around the country, providing research and data indicative of U.S. healthcare trends. The rise in claims over the study period are the result of increases in underlying medical claims cost as well as changes to Sun Life's book of covered business.
According to the Kaiser Foundation's annual report on employee benefits, 64 percent of employees in the U.S. are enrolled in self-funded health plans. As the largest independent stop-loss provider in the U.S., currently covering 5.3 million lives, Sun Life covers high-dollar claims for employers who self-fund their employee health plans. Sun Life also provides members with health advisory and care navigation services through its Health Navigator solution, powered by PinnacleCare.
"From COVID-19 to mental health, new treatments and healthcare trends are continuously emerging and evolving, and self-funded employers need guidance as they consider health plan designs and how to best support their employees' health," said Jen Collier, senior vice president of Sun Life U.S. Health and Risk Solutions. "Compiling this research every year allows us to understand and provide analysis and insights on the evolution of clinical and drug treatments and trends for the highest-cost diagnoses. This helps employers understand how to anticipate the potential frequency and costs of claims, as well as assess risk factors and improve health outcomes. When we arm our clients with the best information and expertise, they can make the best decisions for the health of their employees."
Other key takeaways from the report:
Two years of COVID-19
Mental health claims on the rise
Multi-million-dollar claims continue to rise
Medical vs. Rx/pharmacy costs
Sun Life's high-dollar claims report also offers employers guidance on optimizing care and improving health outcomes which can result in cost savings as well. Care navigation, site of care changes, expert claims review, and employee wellness programs can all help reduce the cost of care while improving the member's medical journey.
Sun Life's recent webinar presenting additional insights from the report is available to view here.
About Sun Life
Sun Life is a leading international financial services organization providing asset management, wealth, insurance and health solutions to individual and institutional Clients. Sun Life 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. As of March 31, 2022, Sun Life had total assets under management of C$1.35 trillion. For more information, please visit www.sunlife.com.
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, Sun Life is one of the largest group benefits providers, serving more than 55,000 employers in small, medium and large workplaces across the country. Sun Life's broad portfolio of insurance products and services in the U.S. includes disability, absence management, life, dental, vision, voluntary and medical stop-loss. Sun Life and its affiliates in asset management businesses in the U.S. employ approximately 8,000 people. Group insurance policies are issued by Sun Life Assurance Company of Canada (Wellesley Hills, Mass.), except in New York, where policies are issued by Sun Life and Health Insurance Company (U.S.) (Lansing, Mich.). For more information, please visit www.sunlife.com/us.
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SOURCE Sun Life U.S.