WELLESLEY, Mass., June 5, 2017 /PRNewswire/ -- 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-ten – Based on dollar amount and
percentage of total stop-loss claims, malignant neoplasms and
leukemia/lymphoma/multiple myeloma (cancers) took spots one
and two on the top 10 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.
Media contact:
Devon Portney Fernald
Sun Life Financial
781-416-7151
devon.portney.fernald@sunlife.com
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SOURCE Sun Life Financial