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:
- Among all reimbursed stop-loss claims, 70 percent are from the top 10 conditions.
- From 2017 to 2020, 21 percent of employers had a member with over $1 million in claims.
- From 2020 to 2021, total million-dollar claims increased 19 percent.
- In 2021, the conditions with the most frequent claims for $1 million or more were cancer, complications around newborn/infant care and COVID-19.
- 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.
- COVID-19 claims that topped stop-loss deductibles averaged $231,300, with the highest claim at $1.75 million.
- The number of members with a mental or behavioral health claim has increased 21 percent since 2020.
- Cancer conditions have remained the first and second highest-cost claims over the past decade.
- The highest-cost claim this year was for a hemophilia/bleeding disorder at $6.23 million.
Read the full report here.