System and method for processing data related to group benefit insurance having critical illness coverage
First Claim
1. A computer system for processing data related to a group benefit insurance policy issued to a group policyholder to extend coverage to individual insureds and having a critical illness benefit, comprising:
- a data storage device storing data indicative of;
a plurality of categories of medical diagnoses;
a plurality of diagnoses associated with each of the categories;
a first occurrence value;
a second occurrence value; and
prior claims under the critical illness benefit by the insured; and
a processor in communication with the data storage device, the processor configured to;
receive via a network from a user-accessible device data associated with a current claim for a critical illness benefit, the data including data indicative of an insured and a diagnosis of a medical condition of the insured;
access from the data storage device the data indicative of diagnoses, categories, and prior claims;
determine a category corresponding the diagnosis of the current claim;
determine whether a prior claim had been paid to the insured for a diagnosis in the determined category;
responsive to determining that no prior claim had been paid to the insured for a diagnosis in the determined category, provide an output signal having data indicative of instructions to pay the insured the first occurrence value; and
responsive to determining that one and only one prior claim had been paid to the insured for a diagnosis in the determined category, provide an output signal having data indicative of instructions to pay the insured the second occurrence value.
1 Assignment
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Accused Products
Abstract
A computer system for processing data related to a group benefit insurance policy issued to a group policyholder to extend coverage to individual insureds and having a critical illness benefit includes a data storage device storing data indicative of: a plurality of categories of medical diagnoses; a plurality of diagnoses associated with each of the categories; a first occurrence value; a second occurrence value; and prior claims under the critical illness benefit by the insured. The system is configured to provide instructions for payment of the first occurrence value for a first diagnosis of an insured in a category, and the second occurrence value, which is less than the first occurrence value, for a second diagnosis of the insured in the same category.
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Citations
20 Claims
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1. A computer system for processing data related to a group benefit insurance policy issued to a group policyholder to extend coverage to individual insureds and having a critical illness benefit, comprising:
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a data storage device storing data indicative of;
a plurality of categories of medical diagnoses;
a plurality of diagnoses associated with each of the categories;
a first occurrence value;
a second occurrence value; and
prior claims under the critical illness benefit by the insured; anda processor in communication with the data storage device, the processor configured to; receive via a network from a user-accessible device data associated with a current claim for a critical illness benefit, the data including data indicative of an insured and a diagnosis of a medical condition of the insured; access from the data storage device the data indicative of diagnoses, categories, and prior claims; determine a category corresponding the diagnosis of the current claim; determine whether a prior claim had been paid to the insured for a diagnosis in the determined category; responsive to determining that no prior claim had been paid to the insured for a diagnosis in the determined category, provide an output signal having data indicative of instructions to pay the insured the first occurrence value; and responsive to determining that one and only one prior claim had been paid to the insured for a diagnosis in the determined category, provide an output signal having data indicative of instructions to pay the insured the second occurrence value. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. A computer-implemented method for processing data related to a group benefit insurance policy issued to a group policyholder to extend coverage to individual insureds and having a critical illness benefit, comprising:
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prompting a user at a user accessible device to provide data relating to a claim for critical illness benefit, the data relating to a current critical illness claim comprising data indicative of the insured and a medical diagnosis of the insured; receiving at an administrative system device data relating to the current critical illness claim, the administrative system device in communication with a data storage device storing data indicative of;
first and second categories of medical diagnoses;
a plurality of diagnoses associated with the first category and a plurality of diagnoses associated with the second category;
a first benefit amount associated with a first occurrence;
a second benefit amount, lower than the first benefit amount, associated with a second occurrence;associating by the administrative system the first category or the second category with the current critical illness claim; determining by the administrative system whether a benefit amount had previously been paid to the insured in the category associated with the current critical illness claim; responsive to determining that no benefit amount had previously been paid to the insured in the category associated with the current critical illness claim, for a diagnosis in the determined category, providing by the administrative system an output signal having data indicative of a determination to pay the insured the first occurrence value; and responsive to determining that one benefit amount had been paid to the insured in the category associated with the current critical illness claim, providing by the administrative system an output signal having data indicative of a determination to pay the insured the second occurrence value. - View Dependent Claims (13, 14, 15, 16, 17)
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18. A non-transitory computer-readable medium having processor executable instructions stored thereon, which instructions, when executed by the processor, cause the processor to:
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prompt a user at a user accessible device to provide data relating to a claim for critical illness benefit under a group benefit insurance policy issued to a group policyholder to extend coverage to individual insureds, the data relating to a current critical illness claim comprising data indicative of the insured and a medical diagnosis of the insured; receive data relating to the current critical illness claim, access from a data storage device data indicative of one or more of;
first and second categories of medical diagnoses;
a plurality of diagnoses associated with the first category and a plurality of diagnoses associated with the second category;
a first benefit amount associated with a first occurrence;
a second benefit amount, lower than the first benefit amount, associated with a second occurrence;associate the first category or the second category with the current critical illness claim; determine whether a benefit amount had previously been paid to the insured in the category associated with the current critical illness claim; responsive to determining that no benefit amount had previously been paid to the insured in the category associated with the current critical illness claim, for a diagnosis in the determined category, provide an output signal having data indicative of a determination to pay the insured the first occurrence value; and responsive to determining that one benefit amount had been paid to the insured in the category associated with the current critical illness claim, provide an output signal having data indicative of a determination to pay the insured the second occurrence value. - View Dependent Claims (19, 20)
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Specification