Systems and methods for long-term health care with immediate and ongoing health care maintenance benefits

• US 20060161461A1
• Filed: 01/14/2005
• Published: 07/20/2006
• Est. Priority Date: 01/14/2005
• Status: Active Grant

• Current Assignee: Equitable Life & Casualty Insurance Company
• Original Assignee: Equitable Life & Casualty Insurance Company
• Inventors: Ross, Earl Roderick, Trani, Louis M.
• Granted Patent: US 7,890,354 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

Methods and systems related to long-term health care insurance. Long-term health care insurance policies are priced by stratifying potential purchasers according to risk factors which are explored during the underwriting process. In addition to coverage for long-term care, immediate health care benefits are provided to the purchasers in the form of an interactive health management program. The health management program may include contact between health care advisors and the availability of a wide range of health care services to provide positive health planning and resources to the policyholders. Underwriting and portions of the health management program may be provided through automation to reduce overhead expenses.

Claims

1. A method for offering long-term health insurance with personalized health management health benefits, the method comprising:

conducting a health status examination with a potential insured;

stratifying the risk of providing long-term insurance to the potential insured based upon the results of the health status examination;

setting an insurance rate for long-term care insurance for the potential insured based upon the risk stratification; and

developing a personalized health management plan for the potential insured based upon the results of the health status examination.

2. The method according to claim 1, further comprising generating a personal health report based on the results of the health status examination.

3. The method according to claim 2, further comprising providing a copy of the personal health report to the potential insured.

4. The method of claim 1, further comprising providing personalized health management services to the potential insured through a health management provider upon purchase of a long-term care policy by the potential insured.

5. The method according to claim 4, wherein providing personalized health management services to the potential insured through a health management provider comprises providing health management services through a health care entity that is separate from an entity providing the long-term care insurance.

6. The method according to claim 4, wherein providing personalized health management services to the potential insured comprises scheduling periodic contacts with the potential insured, based upon predicted health management needs and providing information concerning predicted health care issues.

7. The method according to claim 6, further comprising revising the predicted health management needs based upon information obtained during the periodic scheduled contacts.

8. The method according to claim 6, wherein providing information concerning predicted health care issues comprises providing information related to arthritis, asthma, cancer, chronic obstructive pulmonary disease, heart disease, depression or anxiety, diabetes, high blood pressure, stroke risks, obesity and weight management or osteoporosis.

9. The method according to claim 6, wherein providing information concerning predicted health care issues comprises providing referring the potential insured to a therapist for mental health counseling.

10. The method according to claim 4, wherein providing personalized health management services to the potential insured comprises scheduling periodic contacts with the potential insured, based upon predicted health management needs for providing referrals to services for anticipated health care needs.

11. The method according to claim 1, wherein developing a personalized health management plan for the potential insured based upon the results of the health status examination comprises comparing numerical values representing the status of the potential insured in various health issue that are obtained from the potential insured to known averages for those numerical values for a given relevant population of individuals.

12. The method according to claim 11, wherein developing a personalized health management plan for the potential insured based upon the results of the health status examination comprises comparing classifying the potential insured into a risk group based upon the deviance of a numerical value for the potential insured from an average for the given relevant population.

13. The method according to claim 4, wherein providing personalized health management services to the potential insured comprises responding to contacts initiated by the potential insured to provide information for health management issues.

14. The method according to claim 4, wherein providing personalized health management services to the potential insured comprises referring the insured to a Senor Care Specialist for assistance with selecting and obtaining long-term health care.

15. The method according to claim 14, wherein providing personalized health management services further comprises having the Senior Care Specialist provide information on important legal documents for seniors, Alzheimer'"'"'s Disease, prescription drug assistance programs, Aging Services, National Family Caregiver Support Services, and Adaptive Equipment to a caregiver of the potential insured.

16. The method according to claim 1, wherein stratifying the risk of providing long-term insurance to the potential insured based upon the results of the health status examination comprises assigning the potential insured to a risk group based upon the results of the health status examination.

17. The method according to claim 16, wherein setting an insurance rate for long-term care insurance for the potential insured based upon the risk stratification comprises setting an insurance rate based upon the assigned risk group of the potential insured.

18. The method according to claim 1, wherein conducting a health status examination with a potential insured comprises administering a health status assessment based on the SF-36 standard.

19. The method according to claim 1, wherein conducting a health status examination with a potential insured comprises administering a health status assessment by a personal interview, a medical exam or by computer-based questioning.

20. A system for providing long-term health care insurance to insured individuals, the system comprising:

an insurer for providing long-term health care benefits to an insured individual; and

a health management provider for providing health management services to an individual by preparing a personalized health management plan for the insured individual.

21. The system of claim 20, wherein the health management provider comprises an entity that schedules periodic contacts with insured individuals, based upon predicted health management needs and provides information concerning predicted health care issues or referrals to services for anticipated health care needs.