System and Method for Offering and Guaranteeing Renewal of Suspendable Healthcare Benefits

• US 20080077450A1
• Filed: 09/25/2006
• Published: 03/27/2008
• Est. Priority Date: 09/25/2006
• Status: Active Grant

• Current Assignee: Aetna Incorporated (CVS Health Corporation)
• Original Assignee: Aetna Incorporated (CVS Health Corporation)
• Inventors: Klippel, Charles
• Granted Patent: US 8,032,396 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

A system and method are described whereby a healthcare consumer purchases a suspendable plan while having group coverage and is able to suspend the benefits until group coverage becomes unavailable. When group coverage is not desired or is not available, the consumer can activate the benefits under the suspendable plan. Similarly, a healthcare consumer can buy a suspendable plan while not covered by a group plan and activate the benefits under the plan when not employed. The health plan organization, in turn, guarantees renewal of one or more benefits suspended under the plan throughout the life of the policy at the underwriting status determined when the consumer initially applied for suspendable coverage and, most likely, was in better health. When the consumer chooses to suspend one or more benefits under the plan, the healthcare plan organization reduces the plan premium to a residual premium reflecting the risk associated with providing a renewal guarantee.

Claims

1. A method for a health plan organization to guarantee renewal of a healthcare coverage plan, the method comprising:

determining a healthcare consumer'"'"'s underwriting status;

enrolling the consumer in the healthcare coverage plan for providing healthcare benefits to the consumer, the healthcare coverage plan comprising a benefit suspension feature for suspending at least one of the consumer'"'"'s benefits under the plan;

suspending the at least one of the consumer'"'"'s benefits according to the benefit suspension feature; and

guaranteeing renewal of the at least one suspended benefit according to the determined underwriting status.

2. The method of claim 1 wherein the renewal according to the underwriting status is guaranteed upon one or more predetermined conditions.

3. The method of claim 1 further comprising reducing a healthcare plan premium for the consumer when the at least one benefit is suspended.

4. The method of claim 3 wherein the reduced healthcare plan premium reflects risk associated with the guaranteeing renewal of the at least one suspended benefit.

5. The method of claim 1 further comprising providing alternative benefits when the at least one benefit is suspended.

6. The method of claim 1 further comprising accumulating a healthcare account for payment of non-covered healthcare expenses incurred when the at least one suspended benefit is renewed.

7. The method of claim 1 further comprising prepaying of renewal premium when the at least one benefit is suspended.

8. The method of claim 2 wherein the one or more predetermined conditions is at least one of a predetermined time period, an age limit.

9. A system for determining an underwriting status of a healthcare consumer and guaranteeing renewal of a healthcare coverage plan for the consumer, the system comprising:

a health information questionnaire for collecting health information from the consumer;

a database of medical claim history; and

a computer readable medium having thereon instructions for determining the consumer'"'"'s underwriting status based at least on the health information questionnaire and the database of medical claim history;

wherein the healthcare coverage plan comprises a benefit suspension feature for suspending at least one of the consumer'"'"'s benefits under the plan, and wherein renewal of the at least one benefit is guaranteed according to the underwriting status.

10. The system of claim 9 wherein the renewal according to the underwriting status is guaranteed upon one or more predetermined conditions.

11. The system of claim 9 further comprising a benefit renewal trigger for activating one or more benefits previously suspended with the benefit suspension feature, the benefit renewal trigger comprising one or both of:

the healthcare consumer being unable to obtain a group healthcare coverage plan;

or

the health care consumer having chosen not to obtain a group healthcare coverage plan.

12. The system of claim 9 further comprising a premium reduction feature for reducing a healthcare plan premium when the at least one of the consumer'"'"'s benefits under the healthcare plan is suspended.

13. The system of claim 9 wherein the healthcare coverage plan is of a predetermined duration.

14. The system of claim 9 wherein the healthcare coverage plan includes comprehensive hospital and physician coverage.

15. The system of claim 14 wherein the healthcare coverage plan further includes an annual benefits limit.

16. The system of claim 9 wherein the healthcare coverage plan is a limited benefit plan.

17. The system of claim 9 wherein the healthcare coverage plan includes ancillary care benefits.

18. A method for reducing a healthcare coverage plan premium, wherein a reduced premium reflects risk associated with guaranteeing renewal of at least one benefit under a healthcare coverage plan, the plan comprising a benefit suspension feature for suspending the at least one benefit, the method comprising:

determining an initial premium for a new healthcare consumer assuming a fully active healthcare coverage plan;

estimating a percent increase in a value of benefits the new healthcare consumer is likely to claim within a year;

determining a percent increase in a value of benefits claimed by existing similar healthcare consumers within the year; and

reducing the initial premium to a residual percentage based at least in part on a difference between the estimated and the determined percent increase values.

19. The method of claim 18 wherein the reduced premium is fixed.

20. The method of claim 18 wherein the reduced premium varies based on duration of benefit suspension.