Health plan management method and apparatus

• US 7,624,026 B2
• Filed: 11/21/2001
• Issued: 11/24/2009
• Est. Priority Date: 11/21/2000
• Status: Active Grant

• Current Assignee: Cognizant Trizetto Software Group Incorporated (Cognizant Technology Solutions Corp.)
• Original Assignee: Trizetto Group Incorporated (Cognizant Technology Solutions Corp.)
• Inventors: DiPiero, Albert R., Sanders, David G.
• Primary Examiner(s): Frenel; Vanel
• Application Number:
  US09/990,123
• Publication Number:
  US 20020087444A1
• Time in Patent Office: 2,925 Days
• Field of Search: 705 2- 4
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/04 Payment circuits
• CPC Class Codes: G06Q 20/28 Pre-payment schemes, e.g. "pay before"
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/06 Asset management; Financial planning or analysis
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 70/00 ICT specially adapted for the handling or processing of medical references

Abstract

Techniques and apparatus for managing contributions to an accruable health spending account in an employer-sponsored plan offering a member an employer-funded defined contribution, at least one insurance premium option and the ability to specify an allocation of the defined contribution for payment of option premiums and, in turn, a directed contribution amount designated to such accruable account are disclosed. The accruable account may be used to reimburse the member for qualified medical expenses, and the member may pay any premium shortfall using a tax-advantaged process such as a premium only payment plan. Also disclosed are techniques and apparatus directed to presenting member-specific out-of-pocket expenses for a selected procedure offered by at least one health-care provider.

Claims

1. A method of funding a year-to-year accruable health spending account compliant with Section 105 of Internal Revenue Code of 1986, the year-to-year accruable health spending account is for a member of an employer-sponsored health plan, the method comprising:

determining a directed contribution amount in accordance with a process comprising;

presenting an employer-funded defined contribution having a value for a given time period;

presenting at least one insurance premium option, the at least one insurance premium option defining an option cost for the given time period;

querying for a premium option selection based on the at least one insurance premium option, the premium option selection including a selection allocation less than or equal to the option cost;

receiving the premium option selection; and

calculating the directed contribution amount to the year-to-year accruable health spending account compliant with Section 105 of Internal Revenue Code of 1986 by subtracting either the selection allocation or the option cost from the defined contribution value;

transferring a first amount from an employer funded account to the year-to-year accruable health spending account, the first amount substantially equivalent to the directed contribution amount determined in said determining step; and

withdrawing a sum from the year-to-year accruable health spending account to reimburse the member for a medical expense,

wherein;

determining the directed contribution amount, presenting the employer-funded defined contribution, presenting the at least one insurance premium option, querying for the premium option selection, receiving the premium option selection, calculating the directed contribution amount, transferring the first amount, and withdrawing the sum are all performed using a computer system.

2. The method of claim 1, wherein the given time period comprises at least one of a group consisting essentially of a day, a week, a month, and a year.

3. The method of claim 2, wherein the defined contribution value, the selection allocation, the option cost, and the directed contribution amount are expressed in one or more units of currency.

4. The method of claim 1, further comprising presenting the directed contribution amount.

5. The method of claim 1, further comprising presenting a predicted contribution amount for the year-to-year accruable health spending account, the predicted contribution amount based on either the defined contribution value or the option cost.

6. The method of claim 1, wherein said directed contribution amount calculating step comprises subtracting the selection allocation from the defined contribution value.

7. The method of claim 6, further comprising:

calculating a predicted contribution amount for the year-to-year accruable health spending account by subtracting the option cost from the defined contribution value; and

presenting the predicted contribution amount.

8. The method of claim 6, further comprising:

calculating an out-of-pocket premium cost for the premium option selection by subtracting the selection allocation from the option cost.

9. The method of claim 8, further comprising presenting the out-of-pocket premium cost.

10. A method of paying an insurance premium of an insurance policy covering a member of an employer-sponsored health plan, the insurance policy defining a payor having a premium account, the method comprising:

A) calculating the out-of-pocket cost in accordance with the method of claim 8;

B) transferring a first amount from member funds to the premium account, the first amount substantially equivalent to the calculated out-of-pocket premium cost; and

C) transferring a second amount from employer funds to the premium account, the second amount substantially equivalent to the selection allocation.

11. The method of claim 10, wherein said transferring steps B and C comprise a single financial transaction.

12. The method of claim 10, wherein said transferring steps B and C comprise distinct financial transactions.

13. The method of claim 10, wherein:

the member funds are pre-tax; and

said transferring steps B and C complies with section 125 of the Internal Revenue Code of 1986.

14. A method of funding a year-to-year accruable health spending account compliant with Section 105 of Internal Revenue Code of 1986, the year-to-year accruable health spending account is for a member of an employer- sponsored health plan, the method comprising:

determining a directed contribution amount in accordance with a process comprising;

presenting an employer-funded defined contribution having a value for a given time period;

presenting at least one insurance premium option, the at least one insurance premium option defining an option cost for the given time period;

querying for a premium option selection based on the at least one insurance premium option, the premium option selection including a selection allocation less than or equal to the option cost;

receiving the premium option selection; and

calculating the directed contribution amount to the year-to-year accruable health spending account compliant with Section 105 of Internal Revenue Code of 1986 by subtracting either the selection allocation or the option cost from the defined contribution value;

transferring a first amount from an employer funded account to the year-to-year accruable health spending account, the first amount substantially equivalent to the directed contribution amount determined in said determining step;

withdrawing a first sum from a flexible spending account to reimburse the member for a medical expense; and

withdrawing a second sum from the year-to-year accruable health spending account to reimburse the member for a remainder of the medical expense when the first sum is less than the medical expense,

wherein;

determining the directed contribution amount, presenting the employer-funded defined contribution, presenting the at least one insurance premium option, querying for the premium option selection, receiving the premium option selection, calculating the directed contribution amount, transferring the first amount, withdrawing the first sum, and withdrawing the second sum are all performed using a computer system.

15. The method of claim 14, wherein the given time period comprises at least one of a group consisting essentially of a day, a week, a month, and a year.

16. The method of claim 15, wherein the defined contribution value, the selection allocation, the option cost, and the directed contribution amount are expressed in one or more units of currency.

17. The method of claim 14, further comprising presenting the directed contribution amount.

18. The method of claim 14, further comprising presenting a predicted contribution amount for the year-to-year accruable health spending account, the predicted contribution amount based on either the defined contribution value or the option cost.

19. The method of claim 14, wherein said directed contribution amount calculating step comprises subtracting the selection allocation from the defined contribution value.

20. The method of claim 19, further comprising:

calculating a predicted contribution amount for the year-to-year accruable health spending account by subtracting the option cost from the defined contribution value; and

presenting the predicted contribution amount.

21. The method of claim 19, further comprising:

calculating an out-of-pocket premium cost for the premium option selection by subtracting the selection allocation from the option cost.

22. The method of claim 21, further comprising presenting the out-of-pocket premium cost.

23. A method of paying an insurance premium of an insurance policy covering a member of an employer-sponsored health plan, the insurance policy defining a payor having a premium account, the method comprising:

calculating the out-of-pocket cost in accordance with the method of claim 21;

transferring a first amount from member funds to the premium account, the first amount substantially equivalent to the calculated out-of-pocket premium cost; and

transferring a second amount from employer funds to the premium account, the second amount substantially equivalent to the selection allocation.

24. The method of claim 23, wherein said transferring steps B and C comprise a single financial transaction.

25. The method of claim 23, wherein said transferring steps B and C comprise distinct financial transactions.

26. The method of claim 23, wherein:

the member funds are pre-tax; and

said transferring steps B and C complies with section 125 of the Internal Revenue Code of 1986.