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Benefit management

  • US 8,515,781 B2
  • Filed: 04/09/2009
  • Issued: 08/20/2013
  • Est. Priority Date: 10/15/2003
  • Status: Active Grant
First Claim
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1. A system for benefits management, comprising:

  • a server including an application interface and access to a data store having one or more client files, wherein a client file includes system user definable sets of business rule instructions executed by a processor to manage and administer benefits and includes fund use rule instructions executed by a processor to access and apply funds to payment of claims from a plurality of accounts; and

    a program operable on the server to apply the system user definable sets of business rules to select a hierarchy for payment from the plurality of accounts,wherein the instructions are executed by the processor to;

    allow a plan sponsor to define a first defined set of the fund use rules in order to define and make electronic payment directly to a first part of a non-carrier claim category portion of an electronically transmitted claim, according to control rights and ranking provided first to the plan sponsor for establishing a first tier of the hierarchy for electronic payment of the first part of the non-carrier claim category portion, from between two or more different employee benefit accounts managed and administered by the plan sponsor, according to the plan sponsor ranking, indicating a numerical ranking, between the two or more different accounts;

    allow a plan sponsor to define a second defined set of the fund use rules in order to define and make electronic payment directly to a second part of the non-carrier claim category portion of the electronically transmitted claim, according to control rights and ranking provided first to the plan sponsor for establishing a second tier of the hierarchy for electronic payment of the second part of the non-carrier claim category portion, from between two or more different employee benefit accounts managed and administered by the plan sponsor, according to the plan sponsor ranking, indicating a numerical ranking, between the at least two different accounts;

    allow a plan member to define a third defined set of the fund use rules in order to define and make electronic payment directly to a remaining amount of the first part of the non-carrier claim category portion of the electronically transmitted claim, according to control rights and ranking provided second to the plan member as part of the first tier of the hierarchy for further electronic payment of the first part of the non-carrier claim category portion, from between the two or more different employee benefit accounts managed and administered by the plan sponsor, according to the plan member ranking, indicating a numerical ranking, between the two or more different accounts;

    allow a plan member to define a fourth defined set of the fund use rules in order to define and make electronic payment directly to a remaining amount of the second part of the non-carrier claim category portion of the electronically transmitted claim, according to control rights and ranking provided second to the plan member as part of the second tier of the hierarchy for further electronic payment of the second part of the non-carrier claim category portion, from between the two or more different employee benefit accounts managed and administered by the plan sponsor, according to the plan member ranking, indicating a numerical ranking, between the two or more different accounts;

    receive the electronically transmitted claim;

    apply the plan sponsor ranking and the plan member ranking automatically between the two or more accounts to make payment on the first part of the electronically transmitted claim based on the first tier of the hierarchy; and

    apply the plan sponsor ranking and the plan member ranking automatically between the two or more accounts to make payment on the second part of the electronically transmitted claim based on the second tier of the hierarchy.

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