When Sun Life, a stop-loss provider that covers high-dollar claims for employers who self-fund their employee health plans, released its annual high-cost claims and injectable drug trends analysis last year, the report illuminated yet another indelible mark left by the COVID-19 pandemic: Although COVID ranked “somewhat ironically” at #19 on its list of high-cost claim conditions over four years, that ranking was only after two years’ worth of cases, underlining the severity of the pandemic. For the year 2021, COVID ranked #8 for high-cost claims. The report also rang a number of alarm bells over the pandemic’s effect on mental health, noting the precipitous rise of depressive disorders and sleep/wake disorders since 2019.
So where are we now?
Sun Life’s 2023 edition of its report shows COVID-19 dropping from #8 in high-cost claims to #11, although it did rise from #19 to #13 on the report’s list of top claim reimbursements over the past four years. Sun Life also noted yet another rise in mental health conditions over the past year, this time with alcohol-related disorders leading the charge.
The report also highlights the effects COVID-19 has had on newborn and infant care. Quoting research from the March of Dimes 2022 Report Card, Sun Life says pregnant women in the United States who have or have had COVID have a 40% higher chance of pre-term birth. Moreover, women who had contracted COVID and also had other conditions like obesity or diabetes saw their risk of “very preterm” delivery increase by 160%, and a risk of preterm delivery by 100%, according to two California studies.
Overall, however, Sun Life says they are seeing more consistency in both their top 10 and top 20 high-cost conditions. Here are some other key insights from the high-cost claims report:
- 71% of all stop-loss claims came from the top 10 conditions.
- 20% of employers had at least one member with over $1M in claims during the four-year benefit period from 2018 through 2021.
- Million-dollar claims on a per million covered employees basis rose 15% in the past year and 45% over the past four years.
Click here for the full reporton 2022′s top 10 high-cost claim conditions.