Sun Life Financial recently released a report on the top ten claims conditions which give rise to stop loss claims under a self-insured healthcare plan. Sun Life analyzed four years of their catastrophic claims data and found that these ten claims represent 53% of all stop loss claims reimbursements.
26.6% of all stop loss claims reimbursements were attributable to cancer, the most costly of these catastrophic conditions. As we continue to see pharmaceutical costs rising and driving cost trend, it’s not surprising to see the report shedding light on the high – and escalating – cost of intravenous medications. Out of the top 20 intravenous medications, 45% were used to treat cancer in 2015.
And large claims are just getting larger. In 2015, million dollar claims comprised 1.9% of claims with 146.3 million in paid stop loss claims. This is up from 1.3% and 71.5 million in 2012. Member care including extended hospital stays, highly specialized treatments, and high-cost medications are all key contributors.
Employers with larger populations have a greater probability of million dollar claimants; however, self-insured employers of all sizes must mitigate the escalating risk and protect themselves with both medical and pharmacy coverage. This year we heard about an individual claimant who amassed $15 million in claims.
Employers large and small are considering self-insurance as a means to control or reduce costs. But self-insurance comes with significant risk to the employer, and the insured employee and their family. Selecting an advisor that is an expert at navigating stop-loss traps is an essential component of risk management.