Stop-loss insurer stats show growth in high-dollar claims
Claims around cancer diagnoses remain a top concern for stop-loss insurers.
Self-insured employers are seeing an increase in high-cost health claims in the area of respiratory illness and mental health, a new report has found. The 2021 Accident and Health Market Report, released by stop-loss insurer QBE compared high-dollar claims from the months preceding the COVID-19 pandemic to costs from the early months of 2021. It found that while the top area of high-dollar claims, cancer treatment, moderated somewhat, other high-cost claims in the areas of respiratory illness and mental health saw significant increases.
“The claims frequency nearly doubled for respiratory illnesses, and it more than doubled for mental illnesses,” said Tara Krauss, Head of Accident & Health at QBE North America. “It demonstrates the broad impact of the pandemic and explains why we have seen employers seek more holistic solutions that connect mental and physical health.”
Related: Infographic: Trends in self-funded group health plans
Stop-loss insurance acts as a backstop for self-funded health plans, which have become increasingly popular with insurers because of their relative transparency and lower costs. When claims come in higher than projected, a stop-loss insurance plan can cover the additional costs. The report looked at claims from plan members exceeding $200,000 in annual costs.
Cancer costs remain a big concern
Overall costs have risen in part due to growth of claims in areas other than cancer, but claims around cancer diagnoses remain a top concern for stop-loss insurers. Those claims for cancer treatment remained the most common type of big-dollar claim, the report found.
An additional concern: the COVID-19 pandemic resulted in many health care services being suspended for a number of months. As a result, many American missed screenings or doctor appointments that might have resulted in an early cancer diagnosis. This delayed care could result in a rise of higher-cost claims in the future, according to Krauss. “The potential impact of delayed screenings and treatment is a key concern, and we are closely monitoring the information for employers,” Krauss said.
High-tech claims are also seeing growth
In addition to frequency, cancer-related claims accounted for the most claims at every cost level the study looked at over a 3.5-year period. At the same time, a rise in perinatal-related claims was also noted by the researchers.
In addition, the report found that high-tech therapies such as gene, cell, and orphan drug therapies are becoming more popular, and that these therapies can be very costly. The researchers said that employers need to keep this area in mind when thinking about financial planning around stop-loss policies. “The growth in the number of these highly specialized therapies will have a lasting impact on health care in the years to come,” the report concluded.
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