November 2009


SunResources® Cost-Containment Program

Three New Vendors Added to Help Manage Healthcare Costs

We are pleased to announce the addition of three new preferred vendors to our SunResources program. These vendors are available to our Stop-Loss customers and their TPAs at discounted pricing.

SunResources is a voluntary program that connects our customers to money-saving vendors and services that can help lower their total cost of self-funding. Since the early 1990's, we have been helping our customers lower their first-dollar and catastrophic claim costs through SunResources.

New Transplant Centers of Excellence Network

We have added a second Centers of Excellence transplant network, expanding our customers' options and allowing us to access the best pricing for transplant facilities nationwide. The CIGNA LifeSOURCE Transplant Network is now part of our SunExcel Centers of Excellence program. SunExcel offers financial benefits to employers and employees when they voluntarily use the program, including a lower Specific Deductible and reimbursement for travel, housing, and patient out-of-pocket costs.  

CIGNA's LifeSOURCE network provides access to more than 100 renowned transplant facilities across the U.S. After a careful evaluation, we selected CIGNA for SunExcel based on the size of their network and the quality of their pricing contracts.

For more information about managing transplant claims, please contact Linda McCarthy, Sr. Nursing Manager, at 1-800-432-1102, extension 1135 or linda.mccarthy@sunlife.com.

New Cancer Management Service

In 2009, it is estimated that there will be nearly 1.5 million new cancer diagnoses in the U.S.[1] These new patients will face a complex disease, involving multiple physicians, specialists, concurrent treatments, numerous prescriptions, and intense side effects. Their employers will face a high-dollar healthcare expenses that can be difficult to manage.

To help patients and employers manage the medical and financial impact, we have added cancer risk management services to our SunResources program. Our preferred vendor for oncology services is ITA Partners, Inc. of Philadelphia, PA. ITA is an independent cancer risk management company. ITA's staff of clinical oncology experts supports patients as they navigate the maze of providers, ensuring the most appropriate plan of treatment is delivered and that patients receive the support they need to give them the best chance for a positive outcome.

Physicians and registered nurses spend time with patients, helping them understand diagnoses and treatment, reinforce doctor-provided education, and monitor symptoms to reduce complications. ITA's cancer management services can help:

  • Make sure treatment plans meet current standards
  • Ensure patients receive quality care in a timely manner
  • Provide information to help patients and their families make wise medical and financial decisions

ITA's goal is to ensure that patients receive the correct treatment, at the correct time, in the correct setting. When healthcare resources are used efficiently, it can produce significant cost savings. ITA reports a 5:1 average yearly return on investment to its cancer management clients.  

For more information about cancer management services, please contact Linda McCarthy, Sr. Nursing Manager, at 1-800-432-1102, extension 1135 or linda.mccarthy@sunlife.com.

International Medical Travel Network

We have added an international Medical Travel network to SunResources. Medical Travel, or "medical tourism," refers to U.S. patients traveling outside the U.S. to obtain lower-cost, yet high-quality medical care. This is a small, but growing trend among employers who are struggling to manage health care costs.

Our preferred network is Preferred Providers International (PPI). PPI offers an international network of accredited medical facilities for certain elective, specialized procedures, like orthopedic or cardiac surgeries. PPI is not a broad-based network, but rather a very selective network of international facilities that can yield significant savings on very specific procedures.

Our Stop-Loss customers can also receive protection for medical travel claims that are covered in their underlying plan. Ask your Sun Life Financial representative for more information about this coverage option, available at no additional cost.

 

Legislative Update

Mental Health Parity and Stop-Loss Insurance

This information is for general information only. Always consult your legal counsel to better understand the requirements of any new legislation.

Background
Starting October 3, 2009, the Mental Health Parity and Addiction Equity Act of 2008 requires that all employers with 51 or more employees must apply the same treatment and financial requirements for Mental/Nervous/Drug/Alcohol benefits (such as deductibles and copays) and cannot have more restrictive limitations for their Mental/Nervous/Drug/Alcohol benefits than for their other medical or surgical benefits. Mental/Nervous/Drug/Alcohol conditions must be treated the same as any other condition.

Employers must update their Summary Plan Documents (SPDs) to comply with this new requirement.

If an employer does not offer Mental/Nervous/Drug/Alcohol benefits at all, they are exempt from the Mental Health Parity Act, as are employers with less than 51 employees.

Stop-Loss to Cover Mental Health Parity
Starting October 3, Sun Life Financial expanded our Stop-Loss coverage to help customers comply with the Mental Health Parity Act. Although this regulation doesn't affect Stop-Loss insurers, we do not want to create additional gaps in coverage between the SPD and our Stop-Loss contract.

As a result, we have expanded our coverage to provide reimbursement for eligible Mental/Nervous/Drug/Alcohol claims. We removed our Mental/Nervous/Drug/Alcohol limitation across the board, for all customers, to eliminate any confusion and potential claim issues that may result. We believe this is the best approach, since it is clear and unambiguous.

Because Sun Life has one of the largest Stop-Loss blocks of business, we are able to spread the risk across nearly 3 million covered lives, making the potential impact to any one customer minimal. In addition, Mental/Nervous/Drug/Alcohol claims do not generally reach the Specific deductible, which minimizes the actuarial impact even further.

We expect that our customers will not see any change in Sun Life's underwriting process due to Mental Health Parity. If you have any questions about Sun Life's position on the Mental Health Parity Act, please feel free to contact your Sun Life representative.

 

Want to speak to us? Feel free to send any general questions or feedback to:  tpa.insight@sunlife.com.

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