Sun Life issued their 2018 Stop Loss Research Report and it confirms what we have been seeing in the market. Large claims continue to grow in frequency and severity. Cancer remains the leading large claim condition, followed by disorders of the kidneys.
83.7% of self-insured employers with stop loss coverage experienced a claim and 50.7% of employers had a cancer claim that breached the stop loss threshold. Birth-related disorders are another significant driver of large claims with an average of 9.5% of babies born pre-term and 7.9% born with low birthweight.
The report reveals, the most prevalent stop loss deductibles in 2017 among employers are:
- 1000+ employees: $250,001 to $500,000
- 500 to 999 employees: $100,001 to $250,000
- 499 or fewer employees: $50,001 to $100,000
In 2017, large claims that included injectables totaled $186.3 million and there were six drugs with claims averaging over $300,000 each. From 2014 to 2017, 9% of total paid claims included injectable drugs, 44% of which were reimbursed to employers under their stop loss coverage.
The number of Sun Life claimants over $1 million increased from 104 in 2014 to 194 in 2017 with six claimants surpassing the $3 million mark in 2017.
Stop loss coverage is more important than ever. We recommend specific coverage even for large employees. And don’t even consider omitting pharmacy coverage.