The Numbers are in: 2019 Stop Loss Claims Go High

Voya Employee Benefits helps self-funded employers respond with several strategies to contain costs.

While the nature of Stop Loss Insurance—which helps to protect self-funded employers from catastrophic claims—makes trends hard to predict, one thing clear when you look back: High-dollar claims appear to be on the rise. In 2018, the largest stop loss claim that Voya received was more than $4.6 million. In 2019, the top five largest stop loss claims to Voya were all above that amount.¹

“We see continued increase in the incidence of high dollar claims,” says Voya Employee Benefits AVP and Sr. Actuary Manager Curtis Heaser. “Do we expect this increase to continue in the future? In my opinion, yes, driven by emerging specialty drugs and gene therapy treatments.”The largest claim of 2019, at $6.2 million, was related to a premature birth. Pregnancy complications and premature birth were the reason for two of the largest claims of the year, which is consistent with previous years. New to the top ten this year were claims stemming from severe burns.

“We expect the average claim cost to stay in line with medical trends, and continue to rise in coming years,” according to Heaser. As costs continue to rise each year, Stop Loss coverage only increases in importance to employers. “Without Stop Loss Insurance, the employer would be paying for these catastrophic claims out of pocket,” says Heaser.

How cost containment strategies help

When self-funded employers work with Voya Employee Benefits, they’re able to take advantage of services that can help limit high costs.

Voya’s cost containment team works with third party administrators and brokers on behalf of employers on high cost events like cancer, which continues to make up the largest number of claims submitted and the largest percentage of total claims costs each year.

When the team receives a cancer claim, they review it and refer it to Cancer Treatment Centers of America (CTCA), if appropriate, with whom Voya has a vendor contract. This allows Voya to secure savings that help clients realize significant discounts. In one actual case, Voya contained costs by 29%. 1

Another high cost area for which Voya’s cost containment team has established vendor relationships is kidney dialysis. These relationships allows Voya to obtain savings with national dialysis providers like DaVita Kidney Care and Fresenius Kidney Care.

If renal disease progresses to the need for a kidney transplant, Voya’s cost containment team works with multiple transplant networks and can provide options for extra contractual negotiations with facilities that are not in a transplant network. Voya’s team compares all contracts and determines the best contract for each claimant’s situation.

In terms of emerging specialty drugs and gene therapy, where a single infusion can cost more than $2 million², Voya’s clinical staff is consistently monitoring the FDA pipeline for new treatments while working with vendors to manage costs. Voya’s cost containment team helps employers navigate through these complex treatments, as well as reviewing plan document language to account for these drugs and therapies in an appropriate way. 

When employers understand the cost drivers for the previous year and trends for the next year, they can more appropriately mitigate risk and set the proper medical plan funding. Voya Employee Benefits works with employers to provide a customized Stop Loss plan that will work the best for their organization, and their medical cost needs.

Excess Risk (Stop Loss) Insurance products are issued by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya® family of companies. Product availability and specific provisions may vary by state.

¹ Voya Stop Loss insurance covers employers with a total of 2.1 million employees. The data included reflects policies effective January 2, 2018 with coverage through January 1, 2019 and claims completed through March 31, 2020.