Top 10 high-cost claim conditions by industry and size
Sun Life is committed to sharing data on high-cost claims trends to help you plan and design coverage that works for you.
See what conditions are most likely to be a high-cost claim for your group based on total cost (inclusive of first-dollar and stop-loss reimbursements) by clicking on your industry and size.
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Education
Health & Hospital
Manufacturing
Mining & Construction
Public & Government
Finance, Insurance & Real Estate
Services
Transportation, Communication & Utilities
Condition/Disease/Disorder
Average Cost
Click here to select an Industry
Management Services
Wholesale & Retail Trade
Click here to access the full high-cost claims and injectable drug trends analysis
Overall
Malignant Neoplasm
$328,635
Cardiovascular
$331,642
Leukemia, Lymphoma, Multiple Myeloma
$400,316
Newborn/Infant Care
$581,863
Orthopedics/Musculoskeletal
$208,379
Respiratory
$189,595
Sepsis
$330,962
Gastrointestinal
$133,887
Congenital Anomaly
$480,628
Neurological
$141,484
Education - 1000+ Lives
Malignant Neoplasm
$234,788
Orthopedics/Musculoskeletal
$188,921
Leukemia, Lymphoma, Multiple Myeloma
$281,254
Cardiovascular
$142,861
Gastrointestinal
$142,896
Newborn/Infant Care
$351,023
Urinary/Renal
$148,170
Malnutrition
$392,497
Respiratory
$124,820
Neurological
$121,679
Education - 500 to 999 Lives
Malignant Neoplasm
$341,040
Newborn/Infant Care
$702,394
Leukemia, Lymphoma, Multiple Myeloma
$353,401
Congenital Anomaly
$546,957
Cardiovascular
$237,833
Orthopedics/Musculoskeletal
$237,158
Neurological
$260,763
Respiratory
$232,654
Gastrointestinal/Abdominal
$169,337
Sepsis
$314,001
Health & Hospital - 1000+ Lives
Malignant Neoplasm
$213,529
Cardiovascular
$171,565
Gastrointestinal/Abdominal
$130,629
Orthopedics/Musculoskeletal
$120,835
Leukemia, Lymphoma, Multiple Myeloma
$234,491
Newborn/Infant Care
$392,925
Urinary/Renal
$171,954
Neurological
$134,523
Respiratory
$88,857
Sepsis
$205,078
Health & Hospital - 500 to 999 Lives
Malignant Neoplasm
$304,226
Leukemia, Lymphoma, Multiple Myeloma
$298,435
Newborn/Infant Care
$505,317
Cardiovascular
$260,151
Sepsis
$322,587
Orthopedics/Musculoskeletal
$180,102
Neurological
$187,822
Respiratory
$129,126
Transplant
$260,472
Gastrointestinal/Abdominal
$149,450
Manufacturing - 1000+ Lives
Malignant Neoplasm
$208,756
Cardiovascular
$124,701
Leukemia, Lymphoma, Multiple Myeloma
$228,960
Orthopedics/Musculoskeletal
$100,022
Gastrointestinal/Abdominal
$91,077
Urinary/Renal
$156,697
Congenital Anomaly
$439,999
Respiratory
$108,877
Sepsis
$183,704
Hemophilia
$504,943
Manufacturing - 500 to 999 Lives
Malignant Neoplasm
$304,226
Leukemia, Lymphoma, Multiple Myeloma
$298,435
Cardiovascular
$260,151
Orthopedics/Musculoskeletal
$180,102
Neurological
$187,822
Newborn/Infant Care
$505,317
Urinary/Renal
$196,595
Sepsis
$322,587
Gastrointestinal/Abdominal
$149,450
Physician Treatment, not elsewhere categorized
$80,876
Management Services - 1000+ Lives
Malignant Neoplasm
$207,530
Gastrointestinal/Abdominal
$130,781
Cardiovascular
$120,556
Orthopedics/Musculoskeletal
$90,491
Leukemia, Lymphoma, Multiple Myeloma
$201,745
Congenital Anomaly
$306,853
Newborn/Infant Care
$342,045
Sepsis
$194,521
Urinary/Renal
$158,083
Mental and Behavioral Health
$139,299
Management Services - 500 to 999 Lives
Malignant Neoplasm
$287,931
Cardiovascular
$254,387
Leukemia, Lymphoma, Multiple Myeloma
$335,075
Newborn/Infant Care
$559,021
Orthopedics/Musculoskeletal
$179,581
Sepsis
$331,434
Hemophilia
$564,767
Gastrointestinal/Abdominal
$125,511
Physician Treatment, not elsewhere categorized
$83,613
Urinary/Renal
$207,994
Mining/Construction - 1000+ Lives
Malignant Neoplasm
$180,447
Cardiovascular
$139,378
Orthopedics/Musculoskeletal
$111,327
Gastrointestinal/Abdominal
$115,129
Cerebrovascular
$201,707
Sepsis
$175,524
Neurological
$72,514
Congenital Anomaly
$303,652
Respiratory
$63,425
Mental and Behavioral Health
$118,189
Mining/Construction - 500 to 999 Lives
Malignant Neoplasm
$309,130
Leukemia, Lymphoma, and/or multiple myeloma
$379,073
Sepsis
$498,048
Cardiovascular
$250,974
Newborn/Infant Care
$450,816
Orthopedics/Musculoskeletal
$150,446
Urinary/Renal
$200,449
Neurological
$165,859
Respiratory
$141,287
Gastrointestinal/Abdominal
$173,199
Public/Government - 1000+ Lives
Malignant Neoplasm
$211,527
Orthopedics/Musculoskeletal
$147,005
Cardiovascular
$156,988
Mental and Behavioral Health
$142,871
Gastrointestinal/Abdominal
$97,703
Respiratory
$110,775
Urinary/Renal
$141,851
Newborn/Infant Care
$280,040
Neurological
$108,161
Sepsis
$174,797
Public/Government - 500 to 999 Lives
Malignant Neoplasm
$333,992
Cardiovascular
$322,188
Newborn/Infant Care
$592,771
Leukemia, Lymphoma, Multiple Myeloma
$332,673
Respiratory
$215,684
Gastrointestinal/Abdominal
$174,713
Congenital Anomaly
$390,394
Neurological
$197,369
Hemophilia
$512,522
Orthopedics/Musculoskeletal
$152,681
Finance, Insurance & Real Estate - 1000+ Lives
Malignant Neoplasm
$196,078
Cardiovascular
$127,202
Orthopedics/Musculoskeletal
$332,588
Leukemia, Lymphoma, Multiple Myeloma
$213,130
Gastrointestinal
$108,451
Newborn/Infant Care
$119,642
Neurological
$120,652
Urinary/Renal
$101,034
Respiratory
$270,352
Cystic Fibrosis
$118,905
Finance, Insurance & Real Estate - 500 to 999 Lives
Malignant Neoplasm
$320,514
Newborn/Infant Care
$743,060
Leukemia, Lymphoma, Multiple Myeloma
$311,999
Cardiovascular
$397,212
Sepsis
$348,554
Orthopedics/Musculoskeletal
$146,542
Respiratory
$145,350
Urinary
$223,695
Hemophilia
$626,299
Neurological
$172,688
Services - 1000+ Lives
Malignant Neoplasm
$198,180
Leukemia, Lymphoma, Multiple Myeloma
$667,600
Orthopedics/Musculoskeletal
$135,216
Newborn/Infant Care
$226,949
Cardiovascular
$99,686
Sepsis
$185,040
Neurological
$99,159
Gastrointestinal/Abdominal
$118,830
Respiratory
$132,202
Urinary/Renal
$150,001
Services - 500 to 999 Lives
Malignant Neoplasm
$305,178
Cardiovascular
$359,729
Orthopedics/Musculoskeletal
$311,171
Leukemia, Lymphoma,Multiple Myeloma
$391,521
Neurological
$220,368
Newborn/Infant Care
$471,452
Urinary/Renal
$229,145
Respiratory
$209,566
Gastrointestinal/Abdominal
$173,405
Hepatic/Liver
$532,010
Transportation, Communication & Utilities - 1000+ Lives
Malignant Neoplasm
$194,724
Cardiovascular
$165,128
Leukemia, Lymphoma, Multiple Myeloma
$267,587
Orthopedics/Musculoskeletal/Disease/Disorder
$129,614
Congenital Anomaly
$362,897
Gastrointestinal/Abdominal
$154,282
Newborn/Infant Care
$256,371
Malnutrition
$527,143
Urinary/Renal
$182,018
Sepsis
$246,291
Transportation, Communication & Utilities - 500 to 999 Lives
Malignant Neoplasm
$269,827
Cardiovascular
$260,051
Leukemia, Lymphoma, Multiple Myeloma
$343,769
Newborn/Infant Care
$682,408
Orthopedics/Musculoskeletal
$198,384
Congenital Anomaly
$705,848
Sepsis
$340,592
Neurological
$194,637
Respiratory
$160,359
Gastrointestinal/Abdominal
$134,340
Wholesale & Retail Trade - 1000+ Lives
Malignant Neoplasm
$215,917
Cardiovascular
$137,283
Orthopedics/Musculoskeletal
$102,177
Sepsis
$268,689
Leukemia, Lymphoma, Multiple Myeloma
$169,628
Neurological
$129,827
Gastrointestinal/Abdominal
$87,442
Urinary/Renal
$124,549
COVID
$252,711
Respiratory
$68,078
Wholesale & Retail Trade - 500 to 999 Lives
Malignant Neoplasm
$187,770
Cardiovascular
$106,299
Orthopedics/Musculoskeletal
$95,489
Gastrointestinal/Abdominal
$84,235
Leukemia, Lymphoma, Multiple Myeloma
$210,677
Sepsis
$190,072
Urinary/Renal
$104,488
Respiratory
$70,398
Neurological
$69,728
Mental and Behavioral Health
$72,726
Manufacturing - 200 to 499 Lives
Malignant Neoplasm
$132,050
Cardiovascular
$76,629
Orthopedics/Musculoskeletal
$58,878
Gastrointestinal/Abdominal
$56,082
Urinary/Renal
$70,366
Sepsis
$110,512
Physician Treatment, not elsewhere categorized
$23,476
Respiratory
$46,019
Neurological Disease/Disorder
$51,784
Mental and Behavioral Health
$46,172
Manufacturing - Under 200 Lives
Malignant Neoplasm
$170,985
Cardiovascular
$108,700
Orthopedics/Musculoskeletal
$87,743
Gastrointestinal/Abdominal
$90,994
Urinary/Renal
$111,325
Sepsis
$168,010
Leukemia, Lymphoma, Multiple Myeloma
$186,063
Respiratory
$89,728
Newborn/Infant Care
$267,530
Neurological
$74,309
Wholesale & Retail Trade - 200 to 499 Lives
Malignant Neoplasm
$112,074
Cardiovascular
$73,556
Orthopedics/Musculoskeletal
$57,016
Gastrointestinal/Abdominal
$59,218
Sepsis
$138,299
Neurological
$60,577
Leukemia, Lymphoma, Multiple Myeloma
$177,953
Urinary/Renal
$73,493
Mental and Behavioral Health
$49,605
Respiratory
$40,430
Wholesale & Retail Trade - Under 200 lives
Malignant Neoplasm
$164,895
Orthopedics/Musculoskeletal
$76,796
Cardiovascular
$92,053
Gastrointestinal/Abdominal
$86,749
Leukemia, Lymphoma, Multiple Myeloma
$224,870
Newborn/Infant Care
$250,217
Sepsis
$133,719
Neurological
$71,996
Urinary/Renal
$83,532
Respiratory
$65,079
Health & Hospital - 200 to 499 Lives
Malignant Neoplasm
$102,846
Orthopedics/Musculoskeletal
$60,451
Cardiovascular
$65,604
Gastrointestinal/Abdominal
$54,683
Newborn/Infant Care
$295,217
Leukemia, Lymphoma, Multiple Myeloma
$151,744
Urinary/Renal
$81,147
Neurological
$45,386
Physician Treatment, not elsewhere categorized
$16,542
Immune System
$70,126
Health & Hospital - Under 200 Lives
Malignant Neoplasm
$184,624
Cardiovascular
$121,396
Orthopedics/Musculoskeletal
$90,884
Gastrointestinal
$101,718
Leukemia, Lymphoma, Multiple Myeloma
$213,818
Neurological
$90,451
Urinary/Renal
$124,359
Respiratory
$64,073
Sepsis
$140,740
Physician Treatment
$35,138
Education - 200 to 499 Lives
Malignant Neoplasm
$98,203
Orthopedics/Musculoskeletal
$47,620
Cardiovascular
$77,463
Gastrointestinal/Abdominal
$53,892
Mental and Behavioral Health
$50,351
Physician Treatment
$24,623
Leukemia, Lymphoma, Multiple Myeloma
$147,099
Neurological
$48,948
Sepsis
$129,390
Urinary/Renal
$62,576
Education - Under 200 Lives
Malignant Neoplasm
$162,429
Orthopedics/Musculoskeletal
$84,333
Gastrointestinal
$89,436
Cardiovascular
$106,761
Leukemia, Lymphoma,Multiple Myeloma
$216,859
Newborn/Infant Care
$366,453
Urinary/Renal
$104,660
Sepsis
$151,406
Respiratory
$74,872
Mental and Behavioral Health
$84,384
Finance, Insurance & Real Estate - 200 to 499 Lives
Malignant Neoplasm
$128,825
Orthopedics/Musculoskeletal
$58,817
Cardiovascular
$62,100
Gastrointestinal/Abdominal
$51,373
Leukemia, Lymphoma, Multiple Myeloma
$205,749
Newborn/Infant Care
$221,256
Mental and Behavioral Health
$42,981
Physician Treatment, not elsewhere categorized
$21,319
Neurological
$47,043
Respiratory
$43,762
Finance, Insurance & Real Estate - Under 200 Lives
1000+ Lives
500-999 Lives
200-499 Lives
U200 Lives
Malignant Neoplasm
$179,776
Cardiovascular
$104,315
Orthopedics/Musculoskeletal
$73,532
Gastrointestinal/Abdominal
$79,137
Leukemia, Lymphoma, Multiple Myeloma
$202,855
Neurological
$110,617
Urinary/Renal
$110,284
Sepsis
$150,609
Mental and Behavioral Health
$82,861
Respiratory
$75,090
Services - 200 to 499 Lives
Malignant Neoplasm
$125,644
Cardiovascular
$66,501
Orthopedics/Musculoskeletal
$52,171
Gastrointestinal/Abdominal
$63,813
Neurological
$61,407
Mental and Behavioral Health
$58,068
Physician Treatment, not elsewhere categorized
$25,942
Immune System
$91,718
Leukemia, Lymphoma, Multiple Myeloma
$161,101
Respiratory
$43,124
Services - Under 200 Lives
Malignant Neoplasm
$158,875
Cardiovascular
$95,196
Newborn/Infant Care
$286,714
Orthopedics/Musculoskeletal
$65,677
Gastrointestinal/Abdominal
$70,550
Neurological
$100,731
Mental and Behavioral Health
$77,476
Physician Treatment, not elsewhere categorized
$32,359
Urinary/Renal
$88,542
Leukemia, Lymphoma, Multiple Myeloma
$123,407
Management Services - 200 to 499 Lives
Malignant Neoplasm
$116,499
Orthopedics/Musculoskeletal
$52,339
Cardiovascular
$71,891
Gastrointestinal/Abdominal
$60,919
Leukemia, Lymphoma, Multiple Myeloma
$197,564
Respiratory
$46,933
Neurological
$42,999
Mental and Behavioral Health
$41,851
Urinary/Renal
$51,330
Physician Treatment, not elsewhere categorized
$14,451
Management Services - Under 200 Lives
Malignant Neoplasm
$174,378
Orthopedics/Musculoskeletal
$110,588
Leukemia, Lymphoma, Multiple Myeloma
$293,482
Cardiovascular
$97,127
Neurological
$97,596
Gastrointestinal/Abdominal
$80,792
Sepsis
$153,653
Newborn/Infant Care
l
$354,914
Respiratory
$82,495
Congenital Anomaly
$195,928
Public/Government - 200 to 499 Lives
Malignant Neoplasm
$127,981
Orthopedics/Musculoskeletal
$60,835
Cardiovascular
$69,243
Gastrointestinal/Abdominal
$57,924
Neurological
$51,982
Sepsis
$134,649
Congenital Anomaly
$125,450
COVID
$172,133
Physician Treatment, not elsewhere categorized
$19,783
Urinary/Renal
$51,669
Public/Government - Under 200 Lives
Malignant Neoplasm
$201,373
Cardiovascular
$113,823
Orthopedics/Musculoskeletal
$77,263
Urinary/Renal
$114,156
Mental and Behavioral Health
$90,624
Gastrointestinal/Abdominal
$71,881
Sepsis
$136,693
Respiratory
$66,377
Leukemia, Lymphoma, Multiple Myeloma
$160,673
Neurological
$52,923
Transportation, Communication & Utilities - 200 to 499 Lives
Malignant Neoplasm
$106,726
Cardiovascular
$73,150
Newborn/Infant Care
$1,234,054
Orthopedics/Musculoskeletal
$60,412
Gastrointestinal/Abdominal
$70,218
Mental and Behavioral Health
$59,693
Sepsis
$120,136
Neurological
$57,332
Urinary/Renal
$84,015
Cerebrovascular
$127,460
Transportation, Communication & Utilities - Under 200 Lives
Malignant Neoplasm
$152,919
Orthopedics/Musculoskeletal
$100,124
Cardiovascular
$99,146
Gastrointestinal/Abdominal
$79,413
Sepsis
$174,683
Neurological
$107,642
Newborn/Infant Care
$204,535
Respiratory
$66,321
Physician Treatment, not elsewhere categorized
$27,569
Mental and Behavioral Health
$64,324
Mining/Construction - 200 to 499 Lives
Malignant Neoplasm
$124,535
Orthopedics/Musculoskeletal
$58,348
Cardiovascular
$87,861
Gastrointestinal/Abdominal
$63,782
Sepsis
$146,586
Respiratory
$60,733
Newborn/Infant Care
$199,520
Leukemia, Lymphoma, Multiple Myeloma
$151,754
Urinary/Renal
$74,285
Congenital Anomaly
$137,595
Mining/Construction - Under 200 Lives
Due to industry and size segment breakdown, some of the conditions have a very small number of claims impacting average cost. Therefore, some of the averages may be higher or lower than expected.
Source: Ranking and average cost is from 2021-2024 Sun Life Book of Business, first-dollar data and stop-loss reimbursements.
Group stop-loss insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 07-SL REV 7-12 and 22-SL. In New York, Group stop-loss insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12 and 22-NYSL. Policy offerings may not be available in all states and may vary due to state laws and regulations. Not approved for use in New Mexico.
© 2025 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. The Sun Life name and logo are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.
SLDX-1573-2-a #1362359261 05/24 (exp. 05/26)
Malignant Neoplasm
$314,721
Cardiovascular
$273,368
Orthopedics/Musculoskeletal
$193,484
Leukemia, Lymphoma, Multiple Myeloma
$361,417
Gastrointestinal/Abdominal
$150,420
Sepsis
$337,616
Newborn/Infant Care
$616,258
Neurological
$196,215
Urinary/Renal
$196,804
Respiratory
$183,431
Overall - 1000+ Lives
Malignant Neoplasm
$209,318
Cardiovascular
$140,900
Orthopedics/Musculoskeletal
$121,794
Leukemia, Lymphoma, Multiple Myeloma
$221,613
Gastrointestinal/Abdominal
$108,562
Sepsis
$202,533
Newborn/Infant Care
$338,029
Neurological
$113,929
Urinary/Renal
$141,676
Respiratory
$95,776
Overall - 500 to 999 Lives
Malignant Neoplasm
$174,354
Cardiovascular
$104,308
Orthopedics/Musculoskeletal
$88,061
Gastrointestinal/Abdominal
$85,662
Leukemia, Lymphoma, Multiple Myeloma
$202,128
Sepsis
$162,269
Urinary/Renal
$100,537
Neurological
$80,588
Newborn/Infant Care
$257,822
Respiratory
$71,286
Overall - 200 to 499 Lives
Malignant Neoplasm
$116,974
Orthopedics/Musculoskeletal
$57,179
Cardiovascular
$72,554
Gastrointestinal/Abdominal
$58,035
Neurological
$51,263
Leukemia, Lymphoma, Multiple Myeloma
$153,858
Urinary/Renal
$68,423
Sepsis
$117,447
Mental and Behavioral Health
$46,257
Physician Treatment, not elsewhere classified
$20,569
Overall - Under 200 Lives
1000+ Lives
500-999 Lives
200-499 Lives
U200 Lives
1000+ Lives
500-999 Lives
200-499 Lives
U200 Lives
1000+ Lives
500-999 Lives
200-499 Lives
U200 Lives
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500-999 Lives
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U200 Lives
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U200 Lives
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200-499 Lives
U200 Lives
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