Health plan management method and apparatus

• US 8,214,230 B1
• Filed: 10/09/2009
• Issued: 07/03/2012
• Est. Priority Date: 11/21/2000
• Status: Expired due to Term

• 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:
  US12/576,985
• Time in Patent Office: 998 Days
• Field of Search: 705/2, 705/4, 705/35, 705/36.R, 235/379
• 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 providing an employer-sponsored health plan and a year-to-year accruable health spending account, the method comprising:

presenting at least one insurance option for a given time period to a member, the at least one insurance option includes a first option for a cafeteria-style health plan;

querying for an insurance option selection from the at least one insurance option;

receiving the insurance option selection; and

if the insurance option selection comprises the first option for the cafeteria-style health plan;

establishing the year-to-year accruable health selection spending account for the member;

transferring a first amount from an employer funded account to the year-to-year accruable health spending account, the first amount substantially equivalent to a contribution amount by the employer to the year-to-year accruable health spending account; and

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

wherein;

presenting the at least one insurance option, querying for the insurance option selection, receiving the insurance option selection, and transferring the first amount are all performed using a computer system.

2. The method of claim 1, wherein:

the at least one insurance option further comprises a second option for a high-deductible health plan.

3. The method of claim 1, further comprising:

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

wherein;

presenting the at least one insurance option further comprises;

presenting a cost of each of the at least one insurance option for the given time period to the member.

4. The method of claim 3, wherein:

receiving the insurance option selection comprises;

receiving the insurance option selection wherein a cost of the insurance option selection is less than the value of the employer-funded defined contribution.

5. The method of claim 1, further comprising:

calculating an out-of-pocket premium cost for the insurance option selection.

6. The method of claim 5, further comprising:

presenting the out-of-pocket premium cost for the insurance option selection to the member.

7. The method of claim 1, wherein:

the year-to-year accruable health spending account is associated with a pooled fund and is not individually funded.

8. The method of claim 1, wherein:

carrying forward any unused balance from a current year in the year-to-year accruable health spending account for reimbursing the member for qualified medical expenses incurred during a subsequent year.

9. The method of claim 8, wherein:

transferring the sum from the year-to-year accruable health spending account further comprises;

transferring the sum from the year-to-year accruable health spending account to reimburse the member for the qualified medical expense during the current year; and

transferring another sum from the year-to-year accruable health spending account to reimburse the member for another qualified medical expense during the subsequent year,

wherein;

the another sum comprises at least a portion of the unused balance from the current year in the year-to-year accruable health spending account.

10. The method of claim 1, wherein:

the year-to-year accruable health spending account is funded only by the employer.

11. The method of claim 1, further comprising:

upon the member moving to a new employer, establishing a new year-to-year accruable health spending account associated with the new employer for the benefit of the member; and

transferring any unused balance in the year-to-year accruable health spending account to the new year-to-year accruable health spending account.

12. The method of claim 1, wherein:

transferring the sum further comprises;

transferring the sum from the year-to-year accruable health spending account to the member to reimburse the member for the qualified medical expense.

13. The method of claim 1, further comprising:

establishing a flexible spending account for the member.

14. The method of claim 1, wherein:

receiving the insurance option selection comprises;

receiving the insurance option selection wherein the insurance option selection comprises a decline of the employer-sponsored health plan or one of the at least one insurance option.

15. A method of managing health care spending by an employee, the method comprising:

establishing a year-to-year accruable health spending account compliant with Section 105 of Internal Revenue Code of 1986 for the employee;

providing a cafeteria-style health plan for the employee;

reimbursing the employee for one or more qualified medical expenses incurred during a first year by debiting the year-to-year accruable health spending account; and

carrying forward any unused balance in the year-to-year accruable health spending account for qualified medical expenses incurred during a subsequent year by the employee,

wherein;

the cafeteria-style health plan is not a high-deductible health plan; and

said establishing, providing, reimbursing, and carrying forward are all performed using a computer system.

16. The method of claim 15, further comprising:

establishing, by the computer system, a flexible spending account for the employee.

17. The method of claim 15, wherein the year-to-year accruable health spending account is funded only by the employer.

18. A computer implemented method of paying out-of-pocket health care expenses for a member of an employer-sponsored health plan, the method comprising:

enrolling, by a computer system, the member in a cafeteria-style health plan;

establishing, by the computer system, a year-to-year accruable health spending account for the member;

establishing, by the computer system, a flexible spending account for the member;

determining, by the computer system, a directed contribution amount to be paid by the employer to the year-to-year accruable health spending account;

transferring, by the computer system, a first amount from an employer-funded account to the year-to-year accruable health spending account;

withdrawing, by the computer system a first sum from the flexible spending account to reimburse the member for a medical expense;

withdrawing, by the computer system, 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; and

carrying forward, by the computer system, any unused balance from a current year in the year-to-year accruable health spending account for reimbursing the member for qualified medical expenses incurred during a subsequent year.

19. The method of claim 18, wherein:

the cafeteria-style health plan is not a high-deductible health plan.

20. The method of claim 18, wherein:

the year-to-year accruable health spending account is funded only by the employer.