Multi-million-dollar medical cases increased 68% over past four years: Sun Life Report
SLPC 28445 6/17 (Exp 6/22)
Cancer remains most costly and common catastrophic health condition
WELLESLEY, MA - (June 5, 2017) – Health care claims that breach the million-dollar mark continue to rise, according to Sun Life’s 5th annual catastrophic claims report. The report, which details the top 10 catastrophic medical conditions from 2013 to 2016, found that the number of multi-million-dollar claimants increased 68% from 114 to 192 during that period. While multi-million-dollar cases make up a small number of overall claimants, they are a greater proportion of reimbursement dollars. In 2016, multi-million-dollar cases made up 2.2% of claimants but generated 23% of total stop-loss reimbursements.
Over the four-year period, total costs for catastrophic claims reached $6.1 billion, with $2.7 billion paid in stop-loss reimbursements. Sun Life Financial U.S. is the leading independent provider of stop-loss insurance for self-funded employers who currently cover 4.6 million lives. Sun Life’s catastrophic claims research also found:
- Cancer dominates the top 10 – Based on dollar amount and percentage of total stop-loss claims, malignant neoplasms and leukemia/lymphoma/multiple myeloma (cancers) took spots 1 and 2 on the top-ten catastrophic claims list, representing more than a quarter (26.7%) of total stop-loss reimbursements from 2013-2016;
- Breast cancer prevalence – Breast cancer is the most common form of cancer in the U.S., with an estimated 247,000 new cases reported in 2016, and an average paid claim amount of $147,100;
- Transplants costs are high – Bone marrow/stem cell transplants are the costliest transplant procedures, with an average paid claim cost of about $400,000. Transplants were the most common high-dollar claim condition among 20 to 39 year-olds;
- Highest individual claim – Of the top-10 conditions, the highest claim was $3.2 million, for malignant neoplasm (cancer). The attached chart details the highest claims in each top-10 condition;
- The top three highest-cost conditions – Leukemia, lymphoma and/or multiple myeloma (cancers); congenital anomalies (conditions present at birth); and malignant neoplasm (cancers) are more likely to result in million-dollar claimants due to their frequency; and
- IV medications tracked in the study pushed up costs – When looking at data on intravenous drugs, the report showed they accounted for 48% of total paid charges on the top five highest-dollar claimants. Of the 562 claimants exceeding $1 million between 2013 and 2016, 45 generated more than $1 million in high-cost intravenous medications.
"Health insurance is for the unexpected. Providing full coverage for catastrophic medical events without lifetime limits as designed under the Affordable Care Act is the right thing to do,” said Dan Fishbein, M.D., president of Sun Life Financial U.S. “An unintended result of removing caps under employer plans has been a steady rise in the frequency of multi-million-dollar claims fueled by life-saving treatments and drugs. While this benefits all of us, the overall increase in health care costs underscores the need for self-insured employers to plan for and manage catastrophic, high-cost claims so they can continue offering affordable health benefits to their employees.”
The 2017 Sun Life Stop-Loss Research Report is composed of data from high-cost medical claims during the study period. The report is the first in a series of four that will become available through the remainder of the year. The next report, due later this summer, will cover high-cost medications.
Sun Life is the top independent stop-loss insurer in the U.S., and has been reporting on catastrophic claims annually since 2012 on claims data dating back to 2008.
About Sun Life Financial
Sun Life Financial is a leading international financial services organization providing a diverse range of insurance, wealth and asset management solutions to individuals and corporate Clients. 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. As of March 31, 2017, Sun Life Financial had total assets under management of C$927 billion. 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 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 the U.S. Employee Benefits business of Assurant, Inc., in Q1 2016. For more information, please visit www.sunlife.com/us.
Devon Portney Fernald
Sun Life Financial