There are a range of illnesses that can prompt a self-fundedemployer to make a claim on their stop-loss insurance policy, but anew study by SunLife Financial Inc. finds that a majority (53 percent) of the$5.3 billion in such claims paid by insurers from 2012 to 2015 camefrom 10 ailments.
|Related: Checklist for employers consideringself-funding
|The study shows the incredible impact of cancer. All types ofcancer account for more than a quarter of all stop-loss claims,with breast cancer alone accounting for 13 percent of the totalreimbursements.
|Claims that exceeded $1 million continue to be rare — only 319during the four-year period — but they account for nearly a fifthof the total reimbursements.
|Related: Medical stop-loss insurance is trendingup
|They have also steadily increased every year, from 60 in 2012 to107 in 2015. The number of claims exceeding $2 million, however,has not risen steadily, jumping from two to 20 in 2013 but thendropping again in the subsequent two years.
|"By highlighting the conditions that create catastrophic claimsand providing insights into trends influencing high costs, we canhelp employers anticipate what they'll see when self-funding andraise awareness about the importance of cost-containment resourcesand stop-loss insurance,” says Brad Nieland, vice president of SunLife Financial’s stop-loss division, in a press release.
|Related: Employees' health worries may be soothed bydisability insurance
|Here are the top 10 ailments associated with self-fundedemployer claims:
||Sepsis can be life threatening, with 50 percent of all casesstarting as infection in the lungs. (Photo: iStock)
|10. Septicemia
A condition that arises when the body reacts violently to aninfection, damaging critical organs in the process and in the mostsevere cases leading to septic shock, septicemia resulted in $54.7million in reimbursements between 2012 and 2015, or 2.4 percent ofthe total.
||Top causes of respiratory failure include lung diseases suchas chronic obstructive pulmonary disease, pnuemonia, pulmonaryembolism, and cystic fibrosis. (Photo: iStock)
|9. Respiratory failure
Pulmonary collapse or respiratory failure was the ninth leadingclaim for self-funded employers, resulting in $55 million inreimbursements from stop-loss insurance policies. Risk factors forthe condition include binge-drinking, smoking, and working in anenvironment that leads to inhalation of chemicals that irritate thelungs, all issues that employers can have a hand inimproving.
||Stroke is the leading cause of long-term disability in theUnited States with approximately 795,000 people suffering from astroke each year. (Photo: iStock)
|8. Cerebrovascular disease
Most commonly manifested through a stroke, cerebrovasculardisease or blood brain vessels prompted $57.4 million inreimbursements between 2012 and 2015, for 2.4 percent of the total.Although strokes are the fifth leading cause of death forAmericans, but two-thirds of stroke patients are over the age of65, suggesting the burden of caring for stroke patients fallsmostly on Medicare, rather than employers.
||Affecting nearly 5 million Americans, heart failure is theonly major cardiovascular disorder on the rise. (Photo:iStock)
|7. Congestive heart failure
The condition that afflicts roughly 2 percent of the adultpopulation and 5 percent of those age 60-69 resulted in $57.8million in reimbursements from catastrophic insurance policies in2012-15, accounting for 2.5 percent of the total.
|||One organ donor can save up to eight lives. That sounds likea lot, but still, 120,000 people are in need of an organ transplantin America. (Photo: iStock)
|6. Transplants
Transplants are becoming more common than ever, but the goodnews is that the operations are not as likely to force catastrophiccoverage. While transplants increased 65 percent between 2012 and2015, the total amount of stop-loss reimbursements paid because oftransplants only ticked up 0.7 percent compared to 2011-14, to$62.2 million.
|||According to the World Health Organization, an estimated 15million babies are born too early each year. One million of thosechildren die because of complications. (Photo: iStock)
|5. Premature births/low birth weight
Babies that are born prematurely and have to undergo longhospital stays in incubators or other treatment can promptastronomical costs for patients and their employers. From 2012 to2015, employers received $75 million in reimbursements related tosuch costs incurred by employees, or 3.2 percent of thetotal.
||Congential disorders, such as Down syndrome and spinabifida, affect 3 percent to 4 percent of all babies born inAmerica. (Photo: iStock)
|4. Congenital anomalies
The top claim that specifically relates to a condition at birth,congenital anomalies prompted $96.3 million in reimbursements from2012 to 2015, holding relatively steady from the 2011 to 2014period. That accounts for 4.1 percent of totalreimbursements.
|||Kidney disease, sometimes treated with dialysis, affects 26million Americans. Currently, 1 in 3 American adults is at risk fordeveloping kidney disease. (Photo: iStock)
|3. Chronic renal disease
Employers received $156 million from claims related to severedisease of the kidneys, accounting for 6.7 percent of the total.That is a 1 percent decrease from the 2011 to 2014 period. Whilethe costs of treating the condition have decreased 21 percent inthe past four years, the disease remains common and costlynonetheless. According to some estimates, chronic renal failure asmuch as 10 percent of the population, but it is the later stages ofthe condition that are the most severe and the most costly, oftenresulting in kidney transplants.
|||New cases of leukemia, lymphoma, and myeloma are expected toaccount for 10.2 percent of the more than 1.6 million new cancerdiagnoses in 2016. (Photo: iStock)
|2. Leukemia/lymphoma/multiple myeloma
The second family of cancers is the No. 2 claim for catastrophicinsurance. Its financial impact is great, but much smaller.Employers received $188 million between 2012 to 2015 from stop-lossreimbursements related to these conditions, accounting for 8.1percent of total claims nationally. The value of such claims hasremained steady in recent years.
||Breast cancer is a form of maligant neoplasm that affect 1in 8 U.S. women. (Photo: iStock)
|1. Malignant neoplasm
The leading type of cancer is by far the leading reason thatemployers make claims on their stop-loss policies. These types ofcancer accounted for 18.5 percent of all stop-loss claimreimbursements from 2012 to 2015, the study found, totaling awhopping $429 million. That represents a 0.9 percent increase overthe 2011 to 2014 period.
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