Transplants remain a leading source of high-cost claims and can quickly reshape a plan’s stop-loss renewal. According to Milliman’s U.S. organ and tissue transplant report, a heart transplant alone can cost nearly $1.9 million in billed charges — enough to exhaust a specific deductible and invite lasers or premium increases at renewal.
A transplant carve-out policy takes that risk out of the underlying medical plan. Members still have first-dollar coverage from evaluation through post-transplant care, and the existing stop-loss arrangement stays in place.
That structure helps employers:
- Minimize the chance of hitting the stop-loss deductible on a transplant claim
- Reduce the likelihood of transplant-related lasers
- Avoid unnecessary stop-loss rate increases driven by a single catastrophic event
The plan keeps more predictable costs, while members keep access to care.
Transplant carve-out policies are among the risk reduction strategies available through MedBen. To learn how a carve-out could fit your plan design, reach out to your broker or MedBen Marketing.