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June 23, 2015 at 12:48 PM
Politicians and consumers tend to talk about heart transplants, liver transplants and other transplants when thinking about costly medical catastrophes, but health insurance advisors know the big cost drivers are other, less-publicized conditions.
Employers that use stop-loss insurance to limit exposure to self-insured health plans have a keen interest in understanding and guarding against the medical bills resulting from those catastrophes.
Drafters of the Patient Protection and Affordable Care Act of 2010 (PPACA) intensified that concern, but prohibited any PPACA-compliant major medical plans, including employer-sponsored self-insured plans, by imposing annual or lifetime benefits limits.
Analysts at Sun Life (TSX:SFC) have tried to help employers, benefits advisors and policymakers understand the conditions that lead to catastrophic claims in the 2015 Sun Life Catastrophic Claims Report.
To create a list of the conditions leading to the highest total percentage of paid stop-loss claims, for example, the analysts used Sun Life U.S. stop-loss claims data from claims filed from 2011 through 2014.
