Pharmacy personal care account

• US 7,895,054 B2
• Filed: 08/04/2005
• Issued: 02/22/2011
• Est. Priority Date: 05/06/2004
• Status: Active Grant

• Current Assignee: Humana Incorporated
• Original Assignee: Humana Incorporated
• Inventors: Lord, Jonathan T., Bartel, Sandra L., Slen, Benjamin E., Bierbower, Elizabeth D., Kinser, Maureen M., Reed, Cullen L.
• Primary Examiner(s): Morgan; Robert W
• Assistant Examiner(s): LAM, ELIZA ANNE
• Application Number:
  US11/197,200
• Publication Number:
  US 20050267784A1
• Time in Patent Office: 2,028 Days
• Field of Search: 705 2- 3
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

A method for providing insurance coverage to a subscriber comprises offering an insurance policy to said subscriber wherein said insurance policy comprises providing allowances to pay for one or more expenses covered by said insurance policy and providing monetary credits to said subscriber for any unused portion of a given allowance where said monetary credits can be used to cover the cost of a subsequent allowed expense. The insurance policy may be a pharmacy benefits plan. The covered expenses may be pharmacy expenses. The allowed expenses may be medical expenses which qualify under section 213 of the US Internal Revenue code for payment by an employer without said subscriber having to declare said payment as taxable income.

Claims

1. A computerized method for an insurance company to provide insurance coverage to a subscriber, said method comprising;

a) storing in a database at a server insurance policy data, said insurance policy data comprising;

i. data for a plurality of allowances to pay for covered products or services, wherein each allowance for a covered product or service comprises to a maximum amount said insurance company pays for said covered product or service;

ii. data of the accumulation of monetary credits in a personal care account assigned to said subscriber, said monetary credits being equal to the difference between the cost of said covered product or service and the allowance for said covered product or service;

iii. a provision for said subscriber to cover the cost of at least a portion of an allowed expense using at least a portion of said accumulated monetary credits, said allowed expense specified in said insurance policy;

b) accepting the payment of a premium for said insurance policy, said step of accepting said payment of said premium being necessary for said insurance policy to be in force;

c) receiving at said server election information of said subscriber, said election information comprising personal identification data for said subscriber and said subscriber'"'"'s election of said insurance policy;

d) electronically transferring said election information to said insurance company;

e) storing said election information of said subscriber in association with said personal care account within said electronic database;

f) processing at a computer claim data for said covered product or service according to said insurance policy elected by said subscriber, said claim data comprising an actual cost for said covered product or service;

g) accessing at said computer said database to locate an allowance for said covered product or service;

h) calculating at said computer a monetary credit associated with said claim by calculating a difference between said allowance for said covered product or service and said actual cost for said covered expense; and

i) if said difference is;

i) positive, updating said database to increase by said monetary credit a balance in said personal care account for a subscriber; and

ii) negative or zero, leaving said balance in said personal care account for a subscriber unchanged.

2. The computerized method of claim 1 wherein said insurance policy comprises a pharmacy benefits plan wherein said covered products or services are prescription drugs and said allowed expenses are medical costs of said subscriber.

3. The computerized method of claim 2 wherein said allowances are determined by the anticipated impact of a given prescription drug on the anticipated subsequent health care costs that said subscriber would experience if said subscriber did not take said prescription drug when prescribed.

4. The computerized method of claim 2 wherein said medical costs are those that qualify for payment by an employer without said payment resulting in taxable gross income being assigned to said subscriber.

5. The computerized method of claim 4 wherein said medical costs are those that qualify under a tax code.

6. The computerized method of claim 1 wherein said personal care account is a modified Heath Reimbursement Account (HRA) account wherein said HRA has been modified to allow for an initial balance of zero and to allow for one or more additional election amounts to be credited to it during the course of a given plan year.

7. The computerized method of claim 1 wherein said insurance company is an employer, said insurance coverage is self funded by said employer, said subscribers are the employees of said employer and wherein said employer pays an administrative fee to a licensed insurance company such that said licensed insurance company will administer said insurance policy on behalf of said employer.

8. The computerized method of claim 1, wherein said monetary credits are redeemed by said subscriber to cover at least a portion of the cost of one or more of said allowed expenses provided by one or more allowed vendors.

9. The computerized method of claim 1, further comprising the step of:

processing at said computer a purchase for said allowed expense according to said insurance policy elected by said subscriber.

10. The computerized method of claim 9, further comprising the step of:

accessing said database to determine whether said purchase is an allowed expense.

11. The computerized method of claim 10, further comprising the step of:

crediting at least a portion of the cost of said purchase with said monetary credits of said subscriber if said purchase is an allowed expense provided by one or more allowed vendors.

12. The computerized method of claim 11, further comprising the step of:

if said purchase cost exceeds said monetary credits in said subscriber'"'"'s personal care account, requesting from said subscriber a payment of the difference between the amount of said monetary credits in said personal care account and said purchase cost.

13. The computerized method of claim 12, further comprising the step of:

updating said personal care account in said electronic database with said monetary credit credited for said purchase.

14. The computerized method of claim 1, further comprising the step of:

if said actual cost exceeds said allowance for a covered expense, requesting from said subscriber a payment of the difference.