High Dollar Claims Rise by 87 percent in Employer-Sponsored Stop-Loss Insurance

The number of employer-sponsored stop-loss insurance claims of $1 million or more grew by 87 percent from 2014 to 2017, according to a new analysis from Sun Life Financial.

Over the four-year period, 634 employees with $1 million claims cost stop-loss insurers $935.3 million.

Most claims ranged between $1 and $1.5 million per individual, but 21 claims exceeded $2 million and a handful topped $3 million each.

The top five conditions that result in million-dollar claims include leukemia, lymphoma, multiple myeloma, congenital anomalies, and malignant tumors.

High-cost injectable treatments and blood infusions for cancers and rare blood diseases also drove claims costs over the million-dollar mark.

“Of the total $935.3 million in claims attributed to members with more than a million dollars in claims between 2014 and 2017, 6.6 percent (or $61.5 million) were for high-cost injectables,” the team said.

How Payer Philanthropy Can Address Social Determinants of Health The top five most expensive treatments were mainly for blood diseases.

The most expensive drug on the list was Yervoy, a cancer treatment.

Large employers are more likely to have a higher number of high claims costs than smaller employers.

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