Sun Life Financial has started to publish data that could shed light on one of the interesting questions about the Patient Protection and Affordable Care Act (PPACA): How much the PPACA ban on annual and lifetime medical insurance benefits would cost.
Thanks in part to emotional congressional hearings featuring witnesses who suffered from catastrophic conditions such as hemophilia, the idea of banning major medical benefits limits had bipartisan support.
When the Republicans introduced a PPACA alternative in November 2009, for example, their measure included a ban on annual and lifetime benefits limits. The ban on benefits limits is so strict that it’s one of the reasons the limited-benefit medical insurance market is gone. No insured or self-insured individual or group medical plan can cap lifetime benefits payments.
Health insurers, stop-loss carriers and others were vague about how much the ban on benefits limits might cost. Executives at the direct health insurance writers and the stop-loss carriers that protect the direct writers against giant claims seemed, understandably, to be reluctant to get anywhere near the topic of the value of a human life.
Sun Life doesn’t actually address that topic in a new report on catastrophic stop-loss claims paid since 2010. The company does report that it saw 22 stop-loss claims for more than $1 million over the period it covered in the report. Over that four-year period, it processed more than 100,000 claims and paid about $1.9 billion to self-insured employer plans.
The number of claims for more than $1 million increased to 22 in 2013, from two in 2010. Twelve of the jumbo claims were for premature babies and other babies facing serious complications. Five had to do with transplants, three with leukemia, and 21 for all other conditions.
Although Sun Life does not say how much cash it actually paid out in connection with the 22 jumbo claims, it seems possible that the total could amount to about 1 percent to 3 percent of the $1.9 billion in stop-loss reimbursement payments.