Stop-loss COVID-19 claims jumped 354% in 2021, study finds

COVID-19 was the eighth-highest condition for stop-loss claims reimbursement, and there was a 354 percent increase in the total number of claims compared to 2020, according to a report published June 21 by Sun Life.

The 10th annual report on high-cost medical claims analyzed nearly 50,000 stop-loss claims at over 2,800 self-insured workplaces from 2018 to 2021.

Nine key takeaways:

  1. Among all reimbursed stop-loss claims, 70 percent are from the top 10 conditions.

  2. From 2017 to 2020, 21 percent of employers had a member with over $1 million in claims.

  3. From 2020 to 2021, total million-dollar claims increased 19 percent.

  4. In 2021, the conditions with the most frequent claims for $1 million or more were cancer, complications around newborn/infant care and COVID-19.

  5. In 2021, COVID-19 was the eighth-highest condition for claims reimbursement. There was a 276 percent increase in COVID-19 spending and a 354 percent increase in total number of claims compared to 2020.

  6. COVID-19 claims that topped stop-loss deductibles averaged $231,300, with the highest claim at $1.75 million.

  7. The number of members with a mental or behavioral health claim has increased 21 percent since 2020.

  8. Cancer conditions have remained the first and second highest-cost claims over the past decade.

  9. The highest-cost claim this year was for a hemophilia/bleeding disorder at $6.23 million.

Read the full report here.

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