Report Provides Insights into Self-funded Plan Expenses
In the past year, million-dollar claims per million covered employees increased by 15% and 45% from 2019 to 2022, according to a recent report from life and disability insurance company Sun Life.
This report analyzed claims data from 2019 to 2022, representing more than 55,000 members and over $5.5 billion in total stop-loss reimbursements and $12.2 billion in total costs.
The report revealed that 20% of employers had at least one member with over $1 million in claims from 2018 through 2021.
The report found that 71% of all stop-loss claims came from the top 10 high-cost conditions, with cancer being the highest at $324.8 million in reimbursements. Additionally, 11 of the top 20 high-cost injectable drugs were related to treating cancer, with the new cancer drug Rylaze having the highest average cost in 2022 at $808,700. Further, cardiovascular disease jumped from the third-highest claim to the second in 2022, with $142.4 million in reimbursements.
The other top 10 ranking conditions include:
Leukemia, lymphoma and multiple myeloma
Orthopedics and musculoskeletal conditions
Newborn and infant care
Sepsis
Gastrointestinal conditions
Neurological conditions
Respiratory conditions
Urinary and renal conditions
Nearly 1 in 9 employers (11%) had a birth-related stop-loss claim from 2018 through 2021. Additionally, the preterm birth rate increased by 10.5% from 2020 to 2021. In 2022, newborn and infant care ranked fifth among the highest-cost claim conditions, with an average cost of $371,800. The report highlights that while fewer members in employer self-insured plans make preterm or infant care claims, the costs of pediatric care, such as required specialty care at children’s hospitals, cause its high ranking.
Employer Takeaways
These findings highlight the importance of employers with self-funded health plans to find and implement strategies to better manage rising health care costs, improve health care affordability and reduce the risk of high-cost and catastrophic claims. Understanding current stop-loss trends and the potential impacts of high-cost medical and drug claims can help self-funded employers take steps to better support the health of their employees and protect themselves against increasing health care costs.
We will keep you apprised of any notable updates. Contact Helix Insurance Agency for more health care resources.
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