Method of administrating insurance coverage

• US 20060247953A1
• Filed: 04/27/2005
• Published: 11/02/2006
• Est. Priority Date: 04/27/2005
• Status: Abandoned Application

• Current Assignee: Frank L. Amodeo, Robert Pollack
• Original Assignee: Frank L. Amodeo, Robert Pollack
• Inventors: Pollack, Robert, Amodeo, Frank L.
• Application Number:
  US11/115,587
• Publication Number:
  US 20060247953A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G06Q 40/12 Accounting

Abstract

The present invention includes methods of administrating insurance coverage for a group of insured. A healthcare/risk manager is assigned to each insured to supervise and monitor the wellness of each insured. Among other things, bundled services can include healthcare and workers'"'"' compensation coverage.

Claims

1. ) A method for managing an assortment of administrative, human resource and insurance responsibilities for a group of an employer'"'"'s employees;

said method comprising the steps of;

a) establishing a coordinated benefits entity responsible for coordinating said assortment of administrative, human resource and insurance responsibilities for said group of said employer'"'"'s employees;

b) relegating said administrative and insurance responsibilities to a professional employment organization or an insurance carrier, wherein said professional employment organization and said insurance carrier are affiliated with said coordinated benefits entity;

c) transferring select management functions from said employer to said professional employment organization such that said group of employees become co-employees of said professional employment organization, wherein said professional employment organization further assumes payroll and tax accounting responsibilities of said employer;

d) transferring management of health insurance and workers'"'"' compensation responsibilities from said employer to said insurance carrier;

wherein said management of said health insurance and said workers'"'"' compensation responsibilities further comprise the steps of;

i) issuing one or more policies for insuring health coverage for any beneficiary of said health insurance;

ii) issuing one or more policies for insuring any potential recipient of said workers'"'"' compensation benefits;

iii) prior to an occurrence of an insurance claim activating event, assigning a healthcare/risk manager to supervise health status of each said beneficiary of said health insurance and any said potential recipient of said workers'"'"' compensation benefits;

iv) upon said occurrence of an insurance claim activating event, having said healthcare/risk manager monitor medical treatments and subsequent compliance by any claimant; and

v) reporting said healthcare/risk manager'"'"'s observations to said professional employment organization of said coordinated benefit entity; and

e) according to predetermined parameters established by said coordinated benefit entity, communicating said healthcare manager'"'"'s observations to said employer.

2. ) The method of claim 1 further comprising the steps of:

a) utilizing a computer system to at least partially select said one or more policies for insuring health coverage and workers'"'"' compensation coverage; and

b) using said computer system for assisting in management of said assortment of said administrative, human resources and insurance responsibilities.

3. ) The method of claim 2 wherein said professional employment organization and said insurance carrier are each integral parts of said coordinated benefits entity.

4. ) The method of claim 2 further comprising the step of prior to said occurrence of an insurance claim activating event, having one or more of representatives collect actuarial data regarding each said employer'"'"'s insurance, human resource and administrative practices.

5. ) A method for providing one or more bundles of insurance, human resource and administrative services to one or more employers;

said method comprising the steps of;

a) establishing a coordinated benefits entity responsible for coordinating sales of one or more of said bundles to one or more of said employers, wherein said coordinated benefits entity further comprises;

i) a clearing house for one or more insurance carriers; and

ii) at least one coordinator;

b) affiliating a plurality of representatives with said clearing house and said coordinator;

c) having one or more of said representatives sell one or more bundles to one or more of said employers, wherein each bundle sold further comprises;

i) a professional employment organization component;

ii) a health insurance coverage component; and

iii) a workers'"'"' compensation coverage component;

d) for each employer converting to one or more of said bundles, prior to converting to one or more of said bundles, having one or more of said representatives collect actuarial data regarding each said converting employer'"'"'s current insurance, human resource and administrative practices; and

e) reporting said actuarial data to said coordinated benefits entity.

6. ) The method of claim 5 further comprising the step of collecting actuarial data regarding said employer'"'"'s employees'"'"' work patterns for a period of one year prior to said employer converting to one or more of said bundles.

7. ) The method of claim 6 further comprising the steps of:

a) entering said actuarial data into one or more computer systems,

b) analyzing said actuarial data; and

c) utilizing said actuarial data to tailor said one or more bundles for each said converting employer.

8. ) The method of claim 7 wherein said actuarial data comprises:

a) said employees'"'"' Monday absenteeism rate;

b) said employees'"'"' compliances with treatment schedules and regimens;

c) said employees'"'"' compliances with treatment schedules and regimens and corresponding absenteeism;

d) said employees'"'"' compliances with drug therapy; and

e) said employees'"'"' compliances with drug therapy and corresponding absenteeism.

9. ) The method of claim 6 further comprising the steps of:

a) prior to a claim activating event, assigning a healthcare/risk manager to supervise wellness status of each potential beneficiary of said one or more bundles; and

b) subsequent to a claim activating event, having said healthcare/risk manager monitor medical treatments and ensuing compliance by any claimant.

10. ) The method of claim 9 further comprising the step of administrating said one or more bundles via a professional employment organization.

11. ) A method of providing wellness services to a group of an employer'"'"'s employees;

said method comprising the steps of;

a) transferring select administrative functions from said employer to a professional employment organization such that said group of employer'"'"'s employees become co-employees of said professional employment organization;

b) creating a risk underwriting syndicate of insurance carriers for underwriting risks of health insurance coverage and workers'"'"' compensation benefits for said co-employees;

c) making health insurance coverage available for said co-employees and all insured covered under said health insurance coverage;

d) providing workers'"'"' compensation benefits to any claimant of said co-employees;

e) establishing an entity for coordinating and integrating operations of said professional employment organization and said risk underwriting syndicate;

f) administrating said health insurance coverage and said workers'"'"' compensation benefits through said professional employment organization;

g) prior to an occurrence of any claim activating event, assigning a healthcare/risk manager to supervise health status of said insured; and

h) upon an occurrence of a claim activating event, having said healthcare/risk manager monitor medical treatments and subsequent compliance by any of said insured.

12. ) The method of claim 11 further comprising the step of bundling health insurance coverage and workers'"'"' compensation benefits for said co-employees.

13. ) The method of claim 12 wherein said healthcare/risk manager is a registered nurse or the equivalent of a registered nurse.

14. ) A method of reducing costs of doing business for an employer, said method comprising the steps of:

a) affiliating one or more healthcare/risk managers with either;

i) one or more insurance carriers underwriting healthcare coverage and workers'"'"' compensation coverage;

or

ii) one or more professional employment organizations;

or

iii) said one or more insurance carriers and said one or more professional employment organizations;

b) assigning said one or more healthcare/risk managers to regularly supervise persons insured by one or more insurance policies, wherein said policies provide coverage for health insurance claimants and workers'"'"' compensation claimants, and wherein said healthcare/risk managers encourage supervised persons to lead a generally healthier lifestyle;

c) after any filing of a claim by any claimant, having at least one of said healthcare/risk managers monitor medical treatments and subsequent compliance of any claimant filing said claim;

d) establishing an entity for coordinating interaction between said one or more insurance carriers and said one or more professional employment organizations; and

e) administrating said healthcare coverage and said workers'"'"' compensation coverage as directed by said entity.

15. ) The method of claim 14, wherein each said healthcare/risk manager is a registered nurse or a similarly trained medical professional.

16. ) The method of claim 15 further the comprising the step of collecting actuarial data regarding each of said insured persons, wherein said actuarial data relates to:

a) each said insured'"'"'s wellness prior to participation in said current method; and

b) each said insured'"'"'s wellness post participation in said current method.

17. ) The method of claim 14 further comprising the step of affiliating said entity with an insurance syndicate including a plurality of insurance carriers for underwriting one or more insurance policies.

18. ) The method of claim 16, wherein said healthcare coverage and said workers'"'"' compensation coverage are administrated by a professional employment organization.

19. ) A method of reducing insurance costs of doing business for an employer, said method comprising the steps of:

a) affiliating one or more healthcare/risk managers with either;

i) one or more insurance carriers underwriting healthcare coverage and workers'"'"' compensation coverage;

or

ii) an entity for administrating said healthcare coverage and said workers'"'"' compensation coverage;

or

iii) said one or more insurance carriers and said entity;

b) assigning said one or more healthcare/risk managers to regularly supervise persons insured by one or more insurance policies issued by said one or more insurance carriers;

c) having said one or more healthcare/risk managers encourage supervised persons to lead a generally healthier lifestyle;

d) after any filing of a claim by any claimant against any policy, having at least one of said healthcare/risk managers monitor medical treatments and subsequent compliance of any claimant filing said claim; and

e) administrating said healthcare coverage and said workers'"'"' compensation coverage as directed by said entity.

20. ) The method of claim 19, wherein each said healthcare/risk manager is a registered nurse or a similarly trained medical professional.

21. ) The method of claim 20 further the comprising the step of collecting actuarial data regarding each of said insured persons, wherein said actuarial data relates to:

a) each said insured'"'"'s wellness prior to participation in said current method; and

b) each said insured'"'"'s wellness post participation in said current method.

22. ) The method of claim 21 further comprising the step of affiliating said entity with an insurance syndicate including a plurality of insurance carriers for underwriting one or more insurance policies.

23. ) The method of claim 22, wherein said healthcare coverage and said workers'"'"' compensation coverage are administrated by a professional employment organization.

24. ) The method of claim 22, wherein said healthcare coverage and said workers'"'"' compensation coverage are administrated by one or more of said plurality of insurance carriers.

25. ) A method for providing one or more bundles of insurance, human resource and administrative services to one or more employers;

said method comprising the steps of;

a) establishing an entity responsible for coordinating sales of one or more of said bundles to one or more of said employers;

b) affiliating said entity with an insurance syndicate; and

c) selling one or more bundles to one or more employers, wherein each bundle sold further comprises;

i) a professional employment organization component;

ii) a health insurance coverage component; and

iii) a workers'"'"' compensation coverage component.

26. ) The method of claim 25 further comprising the steps of:

a) for each employer converting to one or more of said bundles, prior to converting to one or more of said bundles collecting actuarial data regarding each said converting employer'"'"'s current insurance, human resource and administrative practices; and

b) reporting said actuarial data to said entity.

27. ) The method of claim 26 further comprising the steps of:

a) collecting actuarial data regarding said employer'"'"'s employees'"'"' work patterns for a period of one year prior to said employer converting to one or more of said bundles; and

b) utilizing said actuarial data to tailor said one or more bundles for each said converting employer.

28. ) The method of claim 27 wherein said actuarial data comprises:

a) said employees'"'"' Monday absenteeism rate;

b) said employees'"'"' compliances with treatment schedules and regimens;

c) said employees'"'"' compliances with treatment schedules and regimens and corresponding absenteeism;

d) said employees'"'"' compliances with drug therapy; and

e) said employees'"'"' compliances with drug therapy and corresponding absenteeism.

29. ) The method of claim 28 further comprising the steps of:

a) prior to a claim activating event, assigning a healthcare/risk manager to supervise wellness status of each potential beneficiary of said one or more bundles; and

b) subsequent to a claim activating event, having said healthcare/risk manager monitor medical treatments and ensuing compliance by any claimant.