It has been several years since the removal of annual and lifetime dollar limits under the Affordable Care Act’s requirements. Health systems and pharmaceutical manufacturers have uncovered a means to fund therapies and treatment for rare diseases previously not treatable or financially viable. While their outcomes are life preserving, their costs are tremendous – often in excess of several hundreds of thousands of dollars, if not millions, which can potentially be ongoing each year. Most often, these therapies treat dependent children (where wellness initiatives do not have an impact). Their rarity stymies purchasing programs and effective PPO discounting. The financial risks to health plan sponsors, particularly those that self-insure, are significant – impacting not just the plan, but the organization as well. Aside from the Human Resources and Benefits divisions of a company, the CFO and Finance department also need to be aware of the potential severity of a sudden, significant claimant. If it is an ongoing annual therapy, an unreserved future liability can be several millions of dollars – unlike anything previously seen in an active employee health plan. Expenses as high as $5 million or more have been recorded. Risk management in the form of stop loss is being tested as never before, and is increasingly applicable to plan sponsors as large as 20,000 employees or more.