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

• US 7,890,354 B2
• Filed: 01/14/2005
• Issued: 02/15/2011
• 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.
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): PASS, NATALIE
• Application Number:
  US11/035,475
• Publication Number:
  US 20060161461A1
• Time in Patent Office: 2,223 Days
• Field of Search: 705/1, 705/36.R, 705/36, 705/38, 705/39, 705 2- 4, 706/45, 706/46, 434/127, 434/262, 434/185, 434/236, 600/300, 600/425, 707/100, 707/9
• 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 care insurance. Long-term 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, by an insurer, long-term care insurance with personalized health management health benefits provided to an insured prior to a need for utilization of benefits of the long-term care insurance, the method comprising:

the insurer conducting a health status examination of a potential insured, wherein the health status examination comprises a health status assessment;

the insurer generating a personal health report of the potential insured based upon the health status assessment, wherein generating a personal health report comprises utilizing a computer having a processor and following commands contained in software executing commands contained as lines of software code, in accordance with a protocol and examining a database of available resources;

the insurer offering a long-term care insurance policy providing health management health benefits to the potential insured at an insurance rate;

the potential insured purchasing the long-term care insurance policy so as to become an insured;

inputting, into the computer, data relating to the results of the health status assessment of the insured, which is then automatically routed in a communication to a health management provider as a document in paper form, in a computer readable format contained on computer readable media, or as a data transmission, said health management provider being a separate entity than the insurer;

the health management provider developing a personalized health management plan for the insured based upon results of the health status assessment conducted by the insurer and generated by the computer;

the health management provider providing personalized health management services to the insured based upon the personalized health management plan generated by the computer.

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 according to claim 1, wherein the provision by the health management provider of personalized health management services to the insured comprises scheduling periodic contacts with the insured, based upon predicted health management needs based on the health status assessment of the insured and providing information concerning predicted health care issues.

5. The method according to claim 4, further comprising revising predicted health management needs of the insured based upon information obtained during the periodic scheduled contacts by the health management provider of the insured.

6. The method according to claim 4, wherein providing information to the insured concerning predicted health care issues by the health management provider comprises the health management provider providing information to the insured 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.

7. The method according to claim 4, wherein providing information concerning predicted health care issues comprises referring the insured to a therapist for mental health counseling.

8. The method according to claim 1, wherein providing personalized health management services to the insured comprises the health management provider scheduling periodic contacts with the insured, based upon predicted health management needs for providing referrals to services for anticipated health care needs of the insured in view of the health status examination.

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

10. The method according to claim 9, wherein developing a personalized health management plan for the insured based upon results of the health status examination comprises classifying the insured into a risk group based upon the deviance of a numerical value for the insured from an average for the given relevant population of individuals.

11. The method according to claim 1, wherein providing personalized health management services by the health management provider to the insured comprises the health management provider responding to contacts initiated by the insured to provide information for health management issues.

12. The method according to claim 1, wherein providing personalized health management services to the insured comprises referring the insured to a Senior Care Specialist for assistance with selecting and obtaining long-term health care.

13. The method according to claim 12, wherein providing personalized health management services by the health management provider to the insured 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 insured.

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

15. The method according to claim 1, wherein the health status assessment comprises administration by the insurer of an SF-36®

health survey.

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

17. A system for providing a personalized health management plan and health management services to an insured individual under a long-term care insurance policy offering long-term care benefits, prior to a need of the insured individual for utilization of the long-term care benefits, the system comprising:

a computer having a processor and following commands contained in software executing commands contained as lines of software code, in accordance with a protocol and examining a database of available resources, wherein the software is operatively configured to enable;

an insurer to provide long-term care benefits to the insured individual under a long-term care insurance policy;

a separate health management provider to communicate with the insurer concerning the insured individual; and

the separate health management provider to provide a personalized health management plan and health management services to the insured individual based upon the communications with the insurer;

the communications with the insurer to comprise a communication selected from the group consisting of a document in paper form, a computer readable format contained on computer readable media, and a data transmission; and

the separate health management provider to prepare, under the long-term care insurance policy provided by the insurer, a personalized health management plan for the insured individual, which is generated by the computer prior to the need for utilization of long-term care benefits of the long-term care insurance by the insured individual.

18. The system of claim 17, wherein the health management provider comprises an entity that schedules periodic contacts with the insured individual, based upon predicted health management needs based on a personal health status assessment of the insured individual and provides information to the insured individual concerning predicted health care issues or refers insured the individual to services for anticipated health care needs of the insured individual.

19. A method for offering, by an insurer, an insurance policy consisting of long-term care insurance together with personalized health management health benefits provided to an insured prior to a need for utilization of benefits of the long-term care insurance, the method comprising:

the insurer conducting a health status examination of a potential insured, wherein the health status examination comprises a health status assessment;

the insurer generating a personal health report of the potential insured based upon the health status assessment, wherein generating a personal health report comprises utilizing a computer having a processor and following commands contained in software executing commands contained as lines of software code, in accordance with a protocol and examining a database of available resources;

the insurer offering a long-term care insurance policy providing health management health benefits to the potential insured at an insurance rate;

the potential insured purchasing the long-term care insurance policy so as to become an insured;

inputting, into the computer, data relating to the results of the health status assessment of the insured, which is then automatically routed in a communication to a health management provider as a document in paper form, in a computer readable format contained on computer readable media, or as a data transmission, said health management provider being a separate entity than the insurer;

the health management provider developing a personalized health management plan for the insured based upon results of the health status assessment conducted by the insurer and generated by the computer;

the health management provider providing personalized health management services to the insured based upon the personalized health management plan generated by the computer.

20. A method for offering, by an insurer, an insurance policy consisting of long-term care insurance together with personalized health management health benefits provided to an insured prior to a need for utilization of benefits of the long-term care insurance, the method comprising:

the insurer conducting a health status examination of a potential insured, wherein the health status examination comprises a health status assessment;

the insurer generating a personal health report of the potential insured based upon the health status assessment, wherein generating a personal health report comprises utilizing a computer having a processor and following commands contained in software executing commands contained as lines of software code, in accordance with a protocol and examining a database of available resources;

wherein the personal health report is a visual representation of the health status of the potential insured depicted by the computer;

the insurer offering a long-term care insurance policy providing health management health benefits to the potential insured at an insurance rate;

the potential insured purchasing the long-term care insurance policy so as to become an insured;

inputting, into the computer, data relating to the results of the health status assessment of the insured, which is then automatically routed in a communication to a health management provider as a document in paper form, in a computer readable format contained on computer readable media, or as a data transmission, said health management provider being a separate entity than the insurer;

the health management provider developing a personalized health management plan for the insured based upon results of the health status assessment conducted by the insurer and generated by the computer; and

the health management provider providing personalized health management services to the insured based upon the personalized health management plan generated by the computer.