System and method for modeling benefits

• US 20060089862A1
• Filed: 10/25/2004
• Published: 04/27/2006
• Est. Priority Date: 10/25/2004
• Status: Abandoned Application

• Current Assignee: Vitalspring Technologies Incorporated
• Original Assignee: Vitalspring Technologies Incorporated
• Inventors: Potarazu, Sreedhar V., Anandarao, Sudhir, Iyengar, Anand, Tierney, James T., Croney, Lawrence N., Ghate, Rahul
• Application Number:
  US10/972,300
• Publication Number:
  US 20060089862A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

Data of one or more individuals associated with a benefit plan are analyzed. The data can include information about benefits provided to the one or more individuals under the benefit plan, such as a medical benefit plan, a prescription benefit plan, or a retirement benefit plan. One or more expenses of the benefit plan are modeled at least partially based on the analyzed data. The modeling includes determining a change in the one or more expenses based on modification of a parameter of the benefit plan.

Claims

1. A processor-readable medium comprising code representing instructions to cause a processor to:

analyze data of at least one individual from a plurality of individuals associated with a benefit plan, the data including information about benefits provided to the at least one individual under the benefit plan; and

model at least one expense from a plurality of expenses of the benefit plan at least partially based on the analyzed data, the code representing instructions to cause a processor to model being configured to determine a change in at least one expense from the plurality of expenses based on a modification of a parameter of the benefit plan.

2. The processor-readable medium of claim 1, wherein the change in the at least one expense is determined substantially in real-time.

3. The processor-readable medium of claim 1, wherein the benefit plan includes at least one of:

a medical benefit plan, a pharmacy benefit plan, and a retirement benefit plan.

4. The processor-readable medium of claim 1, wherein the analyzed data includes a member condition group (MCG) associated with the at least one individual.

5. The processor-readable medium of claim 1, wherein the analyzed data includes information about an expenditure under the benefit plan for the at least one individual.

6. The processor-readable medium of claim 1, wherein the analyzed data includes enrollment information associated with at least one individual.

7. The processor-readable medium of claim 1, wherein the analyzed data includes information about an expenditure under the benefit plan for the at least one individual, the expenditure including at least one of:

a co-payment amount, a co-insurance amount, a deductible, an out-of-pocket maximum, a cost of medical treatment, a cost of a prescription, and a cost of a retirement-related event.

8. The processor-readable medium of claim 1, wherein the analyzed data includes information about an expenditure under the benefit plan for the at least one individual, the expenditure including at least one of:

an amount paid by an administrator of the benefit plan, an amount paid by an employer of an individual from the plurality of individuals, an amount paid by an individual from the plurality of individuals, and an amount paid under a government plan.

9. The processor-readable medium of claim 1, wherein the at least one expense includes at least one of:

an amount paid by an administrator of the benefit plan, an amount paid by an employer of an individual from the plurality of individuals, an amount paid by an individual from the plurality of individuals, and an amount paid under a government plan.

10. The processor-readable medium of claim 1, wherein the benefit plan is a medical benefit plan, the parameter including at least one of:

a co-payment amount, a co-insurance amount, a deductible, an out-of-pocket maximum amount, a network indicator, an expected enrollment change indicator, an inflation trend indicator, and an induction factor.

11. The processor-readable medium of claim 1, wherein the benefit plan is a pharmacy benefit plan, the parameter including at least one of:

a co-payment amount, a co-insurance amount, a deductible, an out-of-pocket maximum amount, a formulary indicator, a mandatory mail order requirement, an expected enrollment change indicator, an inflation trend indicator, an induction factor, and an option indicator.

12. The processor-readable medium of claim 1, wherein the benefit plan is a retirement benefit plan, the parameter including at least one of:

a health care plan integration indicator, a deductible, a co-insurance amount, an out-of-pocket maximum amount, a prescription drug benefit indicator, an induction factor, an expected enrollment change indicator, and an inflation trend indicator.

13. The processor-readable medium of claim 1, wherein the benefit plan is from a plurality of benefit plans, the code representing instructions to cause a processor to model the at least one expense being configured to model at least one expense from a plurality of expenses, each benefit from the plurality of benefit plans being at least partially based on the analyzed data, the code representing instructions to cause a processor to model being configured to determine a change in at least one expense from the plurality of expenses based on a modification of a parameter of the plurality of benefit plans.

14. A system, comprising:

a data repository configured to store information associated with a plurality of individuals; and

a processor in communication with the data repository, the processor being configured to associate information associated with at least one individual from the plurality of individuals with at least one parameter of a benefit plan associated with the at least one individual, the processor being further configured to determine how a modification of the at least one parameter would change at least one expense from a plurality of expenses associated with the benefit plan for each individual from the plurality of individuals.

15. The system of claim 14, wherein the processor is configured to associate the information associated with the at least one individual from the plurality of individuals with the at least one parameter of the benefit plan associated with the at least one individual based on a data model of the data repository.

16. The system of claim 14, wherein the data repository is one of a plurality of data repositories.

17. The system of claim 14, wherein the data repository includes multiple data repositories, having at least one of:

a prescription data repository, a medical data repository, and a retirement data repository.

18. The system of claim 14, wherein the data repository includes multiple data repositories, having at least one of:

a vision data repository, a dental data repository, a disability data repository, a workers compensation data repository, and a general ledger data repository.

19. The system of claim 14, further comprising:

an interface component in communication with the processor, the interface component being configured to cause the processor to execute instructions.

20. The system of claim 14, further comprising:

an interface component in communication with the processor via a network, the interface component being configured to cause the processor to execute instructions.

21. The system of claim 14, further comprising:

an interface component in communication with the processor, the interface component including an application server configured to cause the processor to execute instructions according to at least one predetermined rule.

22. The system of claim 14, further comprising:

an interface component in communication with the processor, the interface component being configured to cause the processor to execute instructions according to communications received via a network from a remote entity.

23. The system of claim 14, further comprising:

a remote interface component configured to receive input from a user and to send instructions based on the received input; and

an interface component in communication with the processor and the remote interface component, the interface component being configured to cause the processor to locally execute instructions received from the remote interface via a network.

24. A processor-readable medium comprising code representing instructions to cause a processor to:

receive a query associated with at least one parameter of a benefit plan, the query configured to request information about a change of expenses associated with the benefit plan based on a modification of the at least one parameter; and

determine in substantially real-time the information requested by the query using information associated with a plurality of individuals associated with the benefit plan.

25. The processor-readable medium of claim 24, further comprising code representing instructions to cause a processor to:

output the information requested by the query.

26. The processor-readable medium of claim 24, wherein the code representing instructions to cause a processor to determine is configured to request data associated with the query from a data repository, the code representing instructions to cause a processor to determine being further configured to apply at least one predetermined rule to data received from the data repository.

27. The processor-readable medium of claim 24, wherein the code representing instructions to cause a processor to determine is configured to request data associated with the query from a data repository using a request formatted using a database query language, the code representing instructions to cause a processor to determine being further configured to apply at least one predetermined rule to data received from the data repository using an instruction encoded using a lower-level programming language.

28. The processor-readable medium of claim 24, wherein the query is received from a remote device via a network.

29. The processor-readable medium of claim 24, wherein the query is formed at least partially based on input from a user.

30. The processor-readable medium of claim 24, wherein the code representing instructions to cause a processor to determine is configured to request the information about a change of expenses associated with the benefit plan at least partially based on information associated with the benefit plan.

31. The processor-readable medium of claim 24, wherein the requested information is stored in a data model including information associated with the benefit plan, the benefit plan including at least one of:

a medical benefit plan, a prescription benefit plan, a retirement benefit plan.