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Cancer tops costliest stop-loss claims

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Cancer remains the costliest contributor to stop-loss catastrophic claims, according to a report released Thursday by Sun Life Financial Inc.

According to Wellesley Hills, Massachusetts-based Sun Life Financial's analysis of the firm's stop-loss catastrophic claims data from 2011-2014, various cancers accounted for the top two costliest conditions at 25.7% of the $2.1 billion total claims paid by Sun Life to stop-loss claimants over the four-year period.

The report, “Top Ten Catastrophic Claims Conditions: Spring 2015,” said end-stage renal disease followed with 7.8% of total stop-loss claims paid, Sun Life Financial said.

Stop-loss insurance offers protection against the risk exposure of a self-funded medical plan, and a stop-loss claim is one that exceeds the stop-loss insurance deductible.

The top 10 costliest conditions, which remained generally consistent with last year's report, accounted for more than half of the total claims paid at 52.8%, Sun Life Financial said. In addition to cancer and renal disease, conditions included congenital anomalies, or conditions present at birth, premature births, congestive heart failure, cerebrovascular disease, pulmonary collapse or respiratory failure, medical and surgical complications, and septicemia.

Sun Life Financial also said intravenous medications, which represented 13% of the total paid stop-loss claims in 2014, contributed significantly to the high cost of cancer claims, as half of the top 20 intravenous drugs are used to treat cancer.

Transplants, which were the eleventh-costliest catastrophic claims condition during the four-year period, representing more than $41 million in stop-loss claims, have breached the top 10 list in the past two years, moving from the 10th-costliest condition in 2013 to the fifth-costliest last year, Sun Life said.

Though the number of lung, heart, kidney and liver transplants remained consistent over the four-year period, the number of bone marrow and stem cell transplants rose from 13 total in 2011 and 2012 to 36 for 2013 and 2014.The increase could be attributed to new uses of the transplant in ovarian, testicular and brain cancer, Sun Life Financial said.

Finally, the report showed that individuals with claims of more than $1 million remain a major driver of stop-loss payments, representing $348 million of the total paid stop-loss claims. Cancer, conditions present at birth, and premature births accounted for 28% of all claims exceeding $1 million, according to the report.