SYSTEM AND METHOD FOR MANAGEMENT OF HEALTH CARE SERVICES
First Claim
1. A system for managing health care comprising:
- means for communicating between at least one consumer of health care services and other stakeholders in health care services, the other stakeholders including at least one health care benefits plan and insurer, at least one health care provider, at least one contributor of a defined contribution to the at least one consumer;
the means for communication further comprising;
means for insuring compliance with government regulation or other rules affecting items in the group including the administration of health care benefits, the provision of health care services, and the management of data concerning consumers of health care benefits and health care transactions associated with the same;
means for determining eligibility of the at least one consumer for a particular health care service to be provided by the at least one health care provider; and
means for processing claims on behalf of the at least one consumer for payment of or reimbursement for the particular health care service provided by the at least one health care provider.
3 Assignments
0 Petitions
Accused Products
Abstract
The present invention is a system and method for management of consumer services such as health care services which combines new financial structure for health insurance and health benefit plan, payment methods, health plan design, benefit development algorithms, unique procurement methods for health care benefits with and without application to an individual consumer'"'"'s personal state of health, and is integrated with financial services and asset management products, and benefits for an individual consumer'"'"'s future medical and/or retirement savings, for healthcare needs. The method and system employs a combination of the defined benefit and defined contribution approaches which combination is referred to herein as “defined-care.” Defined-care model or the healthcare asset management model has two primary components, one which is referred to herein as a “health management and retirement account”, and the other of which is an infrastructure “connected portal” that interfaces through a technology platform with the health management and retirement accounts and the account holders. The foundation of this infrastructure according to the present invention is a technology platform across which a variety of processes are implemented. In the technology platform for the infrastructure of the present invention, the conventional processes and the new processes are integrated, thereby allowing a change to one process to be adopted by or otherwise accommodated by the other processes.
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Citations
72 Claims
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1. A system for managing health care comprising:
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means for communicating between at least one consumer of health care services and other stakeholders in health care services, the other stakeholders including at least one health care benefits plan and insurer, at least one health care provider, at least one contributor of a defined contribution to the at least one consumer;
the means for communication further comprising;means for insuring compliance with government regulation or other rules affecting items in the group including the administration of health care benefits, the provision of health care services, and the management of data concerning consumers of health care benefits and health care transactions associated with the same; means for determining eligibility of the at least one consumer for a particular health care service to be provided by the at least one health care provider; and means for processing claims on behalf of the at least one consumer for payment of or reimbursement for the particular health care service provided by the at least one health care provider. - View Dependent Claims (2, 3, 4, 5)
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6. A method of establishing an infrastructure for the management of health care services comprising:
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establishing a technology platform over which a plurality of consumers of health care services can communicate with contributors of defined contribution health care assets for the plurality of consumers and with other stakeholders in health care benefits, the other stakeholders including health care plans and health care providers; administering the technology platform so that all entities which interface with it remain compliant with government regulations and other appropriate rules affecting the management of health care services; and maintaining a database which receives and provides information to those in communication with the technology platform which information regards health care statistics relating to the plurality of consumers and the health care transactions of the plurality of consumers.
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7. A method of management of health care services comprising:
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receiving employee census information from one or more employees; determining catastrophic care coverage for each of said one or more employees from said census information; determining a health trust fund for funding said catastrophic care coverage for each of said one or more employees; and funding said health trust fund up to a deductible of a high-deductible insurance policy with premium savings received by an employer purchasing said high-deductible insurance policy. - View Dependent Claims (8, 9, 10, 11, 12, 13, 14, 15)
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16. A system of management of health care services comprising:
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means for receiving employee census information from one or more employees; means for determining catastrophic care coverage for each of said one or more employees from said census information; means for determining a health trust fund for funding said catastrophic care coverage for each of said one or more employees; and means for funding said health trust fund up to a deductible of a high-deductible insurance policy with premium savings received by an employer purchasing said high-deductible insurance policy. - View Dependent Claims (17, 18, 19, 20)
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21. A method for managing health care comprising the steps of:
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providing an employee interface to a uniform health management system; establishing a health management and retirement account (HMRA) for one or more employees, said health management and retirement account providing funding of health care; and providing an integrated health care technology platform for providing deliverance of said funding from said HMRA to a health care provider or insurance provider, establishing mandatory health care benefits and optional health care benefits for each of said one or more employees and providing administration of said funding, mandatory health care benefits and optional health care benefits. - View Dependent Claims (22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34)
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35. A system for managing health care comprising:
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means for providing an employee interface to a uniform health management system; means for establishing a health management and retirement account (HMRA) for one or more employees, said health management and retirement account providing finding of health care; and means for providing an integrated health care technology platform for providing deliverance of said funding from said HMRA to a health care provider or insurance provider, establishing mandatory health care benefits and optional health care benefits for each of said one or more employees and providing administration of said funding, mandatory health care benefits and optional health care benefits. - View Dependent Claims (36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72)
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Specification