Managing the business of a medical insurance plan

• US 8,131,570 B2
• Filed: 10/17/2001
• Issued: 03/06/2012
• Est. Priority Date: 03/10/1998
• Status: Active Grant

• Current Assignee: Vitality Group International, Inc. (Discovery Limited)
• Original Assignee: Discovery Holdings Limited (Prudential PLC)
• Inventors: Levin, Ryan Lance, Gore, Adrian, Koopowitz, Neville Stanley
• Primary Examiner(s): Cobanoglu, Dilek B
• Application Number:
  US09/982,274
• Publication Number:
  US 20020111827A1
• Time in Patent Office: 3,793 Days
• Field of Search: 705/4, 705/2, 482/5, 482/81, 482/131, 273/249, 382/259, 707/5, 706/13, 600/300
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

The method of the invention provides incentives for medical scheme members to minimize medical expenses both by responsible use of the benefits of the scheme, and also by offering positive incentives to members to adopt a healthy lifestyle and to make use of preventative procedures and pretreatment medical advice facilities. A number of health-related facilities and/or services (such as membership of health clubs, gymnasiums or fitness programs) are offered to the medical scheme members, and the members are allocated points for using these facilities. Members are also allocated points for using predetermined preventive medical procedures and medical advice services. Rewards are allocated to members based on their points accrued, and the reward may include a payback of premium payments.

Claims

1. A method of managing the use of a medical insurance plan by members thereof, the method comprising:

loading member application forms in a computer system managed by an insurance provider, wherein a default setting associated with the medical insurance plan is for all members to be opted-in to receive rewards based on accumulated credit values exceeding predetermined values;

receiving, at the computer system managed by the insurance provider, one of a premium payment and a contribution payment from members of the medical insurance plan, wherein the insurance provider undertakes liability in the medical insurance plan in response to receiving one of the premium payment and the contribution payment;

providing at least one of

relevant health services and

assistance in defraying expenses incurred in connection with rendering such relevant health services,

by the computer system managed by the insurance provider to members who pay at least one of the premium payment and the contribution payment

defining, by the computer system managed by the insurance provider, at least one of a plurality of health-related facilities and a plurality of health-related services to be associated with the medical insurance plan;

offering, by the computer system managed by the insurance provider, the at least one of a plurality of health-related facilities and a plurality of health-related services to members of the medical insurance plan;

monitoring, by the computer system managed by the insurance provider, usage of the at least one of a plurality of health-related facilities and a plurality of health-related services by each member;

allocating, by the computer system managed by the insurance provider in response to the monitoring, a credit value to each member according to their use of the at least one of a plurality of health-related facilities and a plurality of health-related services; and

allocating, by the computer system managed by the insurance provider, rewards to members who accumulate credit values exceeding predetermined values.

2. The method according to claim 1, wherein the at least one of a plurality of health-related facilities and a plurality of health-related services includes at least one of the group consisting of:

membership of health clubs,

membership of gymnasiums,

membership of fitness programs,

weight loss programs, and

programs to quit smoking

3. The method according to claim 2, wherein the at least one of a plurality of health-related facilities and a plurality of health-related services further includes predetermined preventive medical procedures.

4. The method according to claim 3, wherein the preventive medical procedures include vaccinations.

5. The method according to claim 2, wherein the at least one of a plurality of health-related facilities and a plurality of health-related services further includes a medical advice service.

6. The method according to claim 2, wherein the at least one of a plurality of health-related facilities and a plurality of health-related services further includes predetermined procedures.

7. The method according to claim 6, wherein the predetermined procedures include at least one of the group consisting of

advance pre-authorization of hospitalization,

advance pre-authorization of treatment,

registration for electronic funds transfer, and

compliance with preferred procedures.

8. The method according to claim 1, wherein a reward allocated to a member is at least one of linked to a number of annual claims associated with the member and whether or not the member has been hospitalized in a predetermined period of time.

9. The method according to claim 8, wherein the reward allocated to the member includes at least one of the group consisting of:

prizes allocated on a basis of a draw,

a magnitude of a member'"'"'s credit value being related to a chance of winning the draw,

access to at least one of health-related facilities and health-related services for family members,

decreased premium payments according to a predetermined plan, and

increased benefit payments according to a predetermined plan.

10. The method according to claim 1, wherein a reward allocated to a member is not actually given to the member before at least one of a predetermined period has passed or the member has attained a predetermined age.

11. The method according to claim 10, wherein the reward allocated is forfeited by the member if they are not still a member of the medical insurance plan after the predetermined period has passed or after the member has attained such predetermined age.

12. The method according to claim 1, further comprises:

the insurance provider offering the at least one of a plurality of health-related facilities and a plurality of health-related services in conjunction with third party service providers that provide at least one of health related facilities and health-related services in the at least one of a plurality of health-related facilities and a plurality of health-related services offered by the insurance provider; and

monitoring usage of the at least one of health-related facilities and health-related services provided by the third party service providers by members by receiving information from the third party service providers detailing the usage of the at least one of health-related facilities and health-related services by the members.

13. The method according to claim 12, wherein the members only pay a once off activation fee to gain access to the at least one of a plurality of health-related facilities and a plurality of health-related services.

14. The method of claim 1, further comprising:

providing, by the insurance provider, one of a full payment and a partial payment to one of a health-related facility and a health-related service in the at least one of a plurality of health-related facilities and a plurality of health-related services that has been used by a member of the medical insurance plan, wherein the one of a full payment and a partial payment is on behalf of the member.

15. The method of claim 1, further comprising:

providing, by the insurance provider, discounted usage fees to the members for the at least one of a plurality of health-related facilities and a plurality of health-related services.

16. A method of managing the use of a medical insurance plan by members thereof, the method comprising:

loading member application forms in a computer system managed by an insurance provider;

receiving, at the computer system managed by the insurance provider, one of a premium payment and a contribution payment from members of the medical insurance plan, wherein the insurance provider undertakes liability in the medical insurance plan in response to receiving one of the premium payment and the contribution payment;

providing at least one of

relevant health services and

assistance in defraying expenses incurred in connection with rendering such relevant health services,

by the computer system managed by the insurance provider to members who pay at least one of the premium payment and the contribution payment;

defining, by the computer system managed by the insurance provider, at least one of a plurality of health-related facilities and a plurality of health-related services to be associated with the medical insurance plan;

offering, by the computer system managed by the insurance provider, the at least one of a plurality of health-related facilities and a plurality of health-related services to members of the medical insurance plan;

monitoring, by the computer system managed by the insurance provider, usage of the at least one of a plurality of health-related facilities and a plurality of health-related services by each member;

allocating, by the computer system managed by the insurance provider in response to the monitoring, a credit value to each member according to their use of the at least one of a plurality of health-related facilities and a plurality of health-related services; and

allocating, by the computer system managed by the insurance provider, rewards to members who accumulate credit values exceeding predetermined values.

17. The method according to claim 16, wherein a default setting associated with the medical insurance plan is for all members to be opted-in to receive rewards based on accumulated credit values exceeding predetermined values.