Top 10 Costliest Medical Conditions


In its fourth annual Top Ten Catastrophic Claims Conditions report, Sun Life Financial U.S. brings insights to self-funded employers about critical factors impacting medical costs. The report compiles the costliest medical conditions covered by Sun Life stop-loss insurance from 2012 to 2015 and explores emerging trends to help brokers and self-funded employers understand and mitigate their risks, according to a press release from Sun Life Financial.

During the four years of the study, billed charges from medical care providers totaled $9 billion. Self-insured employers paid just over half ($5.3 billion) of those billed charges after discounts were applied and received $2.3 billion in reimbursements through stop-loss protection, the release notes.

The report shows that million-dollar-plus claims continue to trend up with an increase of 25% compared to last year. Severity continues to be a factor with less than 2% of million-dollar plus claimants (448) accounting for a disproportionate 18.5% of overall stop-loss claims reimbursements ($431.2 million).Over the four-year period, the average amount paid by an employer on a claim above $1 million was $1.45 million, which was reduced to $491,000 after applying the average stop-loss claim reimbursement ($962,000).

Cancer continues to dominate the top of the list (number one and number two) with $618 million in stop-loss reimbursements, accounting for more than one-quarter (26.6%) of total stop-loss claims. Of the various types of cancer identified in the report, breast cancer accounted for 13.6% of the total reimbursements for this condition. Cancer is also a leading million-dollar condition—it’s in the number-

Ranked by value of stop-loss claims reimbursements, the top 10 costliest medical conditions for 2016, according to Sun Life, include:

  1. Malignant neoplasm (cancer) —$429.5 million
  2. Leukemia/lymphoma/multiple myeloma — $188.6 million
  3. Chronic/end-stage renal disease — $156.6 million
  4. Congenital Anomalies — $96.3 million
  5. Disorders relating to short gestation and low birth weight — $75.2 million
  6. Transplant — $62.2 million
  7. Congestive heart failure — $57.8 million
  8. Cerebrovascular disease (brain blood vessels) — $57.4 million
  9. Pulmonary collapse/respiratory failure — $55.0 million
  10. Septicemia (infection) — $54.7 million

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