COVID-19 was one of the costliest medical conditions in 2021, with the highest claim reaching $1.75 million, Sun Life claims data shows
Research based on Sun Life's high-cost claims data also shows:
- Million-dollar+ claims increased 37% from 2018 to 2021
- Highest-dollar claims were due to combinations of in-patient hospitalization, injectable/specialty drugs, comorbid conditions and complicated surgeries
- Highest-cost claim in 2021 was
$6.23 million , for hemophilia - High-cost mental health claims increased 21% from 2020 to 2021
According to the
"From COVID-19 to mental health, new treatments and healthcare trends are continuously emerging and evolving, and self-funded employers need guidance as they consider health plan designs and how to best support their employees' health," said
Other key takeaways from the report:
Two years of COVID-19
- In 2021 COVID-19 was a top 10 condition with a total spend of
$114 million ; in the four-year ranking for 2018-2021, COVID-19 was still in the top 20 despite only having claims for two of the four years. - COVID-19 claims that were severe enough to breach stop-loss deductibles averaged
$231,300 , with the highest claim at$1.75 million . - COVID-19 also contributed to the cost of care for two members with primary conditions of sepsis with a total spend of over
$3 million each.
Mental health claims on the rise
- Total spend on mental and behavioral health claims rose by 22% in 2021; the average cost per claim remained relatively flat at
$68,300 , indicating that the increase was mostly due to more members having high-cost mental health claims, not higher costs of care. - Depressive disorders saw the most significant growth at 85%, while sleep/wake disorders rose by 68%, and alcohol- and opioid-related claims increased as well.
Multi-million-dollar claims continue to rise
- From 2020-2021 the number of million-dollar+ claims increased by 21% and increased 37% from 2018-2021 (adjusted for changes in number of covered lives)
- In 2021 the conditions with the most frequent million-dollar+ claims were cancer, complications around newborn/infant care and COVID-19.
- The
$6.23 million claim for hemophilia was driven almost entirely by injectable drug costs. - The highest-cost claim driven primarily by in-patient care was for
$5.43 million , for a congenital anomaly (condition present at birth), with a comorbidity of septicemia. - Ten members had claims over
$3 million in 2021, for conditions including hemophilia, sepsis, cancer, burns, and complications around newborn/infant care. - Cost drivers for these claims include extended in-patient hospitalization, complicated surgeries, injectable drugs/Rx treatment, and comorbidities such as COVID-19, kidney failure, or cardiac complications.
Medical vs. Rx/pharmacy costs
- Claims for three conditions – malnutrition, transplant and hemophilia – had at least 70% of total costs from drugs.
- The cost of conditions like COVID-19 or complications around newborn/infant care were driven almost entirely by medical spend (not pharmacy), largely due to in-patient hospitalization.
Cancer trends
- The highest-cost cancer claim in 2021 was
$5.41 million , driven by a combination of in-patient care, complicated surgeries, and injectable drugs. - Cancer has dominated the list of costliest conditions for ten straight years, due to both overall cost and frequency of claims.
- Eleven of the top 20 costliest injectable drugs are used to treat cancer.
Sun Life's high-dollar claims report also offers employers guidance on optimizing care and improving health outcomes which can result in cost savings as well. Care navigation, site of care changes, expert claims review, and employee wellness programs can all help reduce the cost of care while improving the member's medical journey.
Sun Life's recent webinar presenting additional insights from the report is available to view here.
About Sun Life
Sun Life is a leading international financial services organization providing asset management, wealth, insurance and health solutions to individual and institutional Clients. Sun Life has operations in a number of markets worldwide, including
In
Media contacts: |
|
|
|
Sun Life |
Sun Life |
781-800-3609 |
214-549-1553 |
Connect with Sun Life
https://www.facebook.com/SLFUnitedStates
https://www.linkedin.com/company/sun-life-financial
https://twitter.com/SunLifeUS
View original content to download multimedia:https://www.prnewswire.com/news-releases/covid-19-was-one-of-the-costliest-medical-conditions-in-2021--with-the-highest-claim-reaching-1-75-million-sun-life-claims-data-shows-301571409.html
SOURCE Sun Life
Jet Insurance Company First to Offer Pay-As-You-Go Surety Bonds
Financial Wellness Benefits Market to Witness Huge Growth by 2028 : Hello Wallet, Learn Vest, Smart Dollara
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News