Automated insurance enrollment, underwriting, and claims adjusting

• US 8,762,179 B2
• Filed: 11/14/2006
• Issued: 06/24/2014
• Est. Priority Date: 06/21/1999
• Status: Active Grant

• Current Assignee: Pets Best Insurance Services LLC (Synchrony Financial)
• Original Assignee: Pets Best Insurance Services LLC (Synchrony Financial)
• Inventors: Stephens, Jack, Crandall, Daniel W., Brown, Jeff, Emmen, Brian
• Primary Examiner(s): Subramanian, Narayanswamy
• Assistant Examiner(s): Puttaiah, Asha
• Application Number:
  US11/559,525
• Publication Number:
  US 20100017234A1
• Time in Patent Office: 2,779 Days
• Field of Search: 705/4
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

An insurance enrollment and underwriting method includes providing a first user interface with one or more controls for enabling a user to specify one or more health conditions in an enrollment application for pet health insurance. Data representing one or more health conditions specified through the first user interface is received. That data is electronically processed. Each condition is electronically flagged as a condition that is acceptable, precluded, or for manual review. A dollar limit of coverage for each of a plurality of diagnoses in lieu of one or more exclusions is calculated. The plurality of diagnoses include one or more diagnoses related to one or more of the health conditions. Where all conditions are and flagged as acceptable or determined to be acceptable following a manual review, an active policy is packaged to include coverage for each of the plurality of diagnoses up to each diagnosis'"'"' corresponding dollar limit of coverage.

Claims

1. A computer-implemented method for insurance enrollment and underwriting, comprising:

displaying on a display of a computer system a first user interface with one or more controls configured to receive user input to specify a breed of a pet to be insured and to specify one or more health conditions of the pet in an enrollment application for pet health insurance;

receiving on the computer system data representing the breed of the pet and one or more health conditions specified through the first user interface;

electronically processing on the computer system the data representing the one or more health conditions and electronically flagging each condition as a condition that is acceptable, precluded, or for manual review, wherein the flagging is based on the breed of the pet;

calculating on the computer system a geographic insurance rating, including;

identifying a location associated with the pet;

identifying a geographic risk zone;

comparing the location to the geographic risk zone to determine if the location is at least partially within the geographic risk zone; and

calculating an insurance rating according to the comparison;

calculating on the computer system a dollar limit of coverage for each of a plurality of diagnoses in lieu of one or more exclusions, the plurality of diagnoses including one or more diagnoses related to the breed of the pet and one or more of the health conditions, wherein calculating a dollar limit of coverage includes calculating a dollar limit of coverage for each of the plurality of diagnoses based at least in part on the geographic insurance rating;

where all conditions are flagged as acceptable or determined to be acceptable following a manual review, packaging an active insurance policy on the pet, wherein the insurance policy includes coverage for each of the plurality of diagnoses up to each diagnosis'"'"' corresponding dollar limit of coverage; and

displaying on the display a second user interface presenting information indicating approved enrollment, if all of the conditions are flagged as acceptable.

2. The computer-implemented method of claim 1, further comprising:

displaying on the display a third user interface presenting information indicating declined enrollment if at least one of the conditions is flagged as precluded; and

displaying on the display a fourth user interface presenting information indicating a need for a manual review if none of the conditions is flagged as precluded and at least one of the conditions is flagged as for manual review.

3. The computer-implemented method of claim 1, further comprising, after displaying the second user interface, establishing for storage on a computer-readable storage medium an electronic record associated with the active policy for pet health insurance, the electronic record including the data representing the one or more health conditions specified through the first user interface and data representing an effective date for the policy.

4. The computer-implemented method of claim 3, further comprising:

displaying on the display a fifth user interface having controls for enabling a user to submit a claim with respect to the active policy, the controls enabling the user to specify a diagnosis for which coverage is requested;

receiving data representing the diagnosis;

electronically processing the data representing the diagnosis with the electronic record associated with the active policy, including comparing the data representing the diagnosis with the data representing the one or more health conditions specified through the first user interface and comparing a date of the claim with the data representing the effective date of the active policy.

5. The computer-implemented method of claim 4, wherein electronically processing includes:

flagging the diagnosis as limited where the comparison of the data representing the diagnosis with the data representing the one or more health conditions reveals that the diagnosis is for a condition identified by the data representing the one or more health conditions; and

otherwise determining if the diagnosis is for a suspect condition or a non-suspect condition and;

flagging the diagnosis as covered if the diagnosis is for a non-suspect condition;

flagging the diagnosis for manual review if the diagnosis is for a suspect condition.

6. The computer-implemented method of claim 5, wherein determining comprises:

determining the diagnosis to be for a non-suspect condition if a length of time between the effective date of the active policy and the date of the claim exceeds a predetermined duration;

otherwise determining the diagnosis to be for a suspect condition.

7. The computer-implemented method of claim 6 further comprising selecting the predetermined duration according to the diagnosis.

8. The computer-implemented method of claim 5, further comprising:

displaying on the display a sixth user interface presenting information indicating claim approval if the diagnosis is flagged approved;

displaying on the display a seventh user interface presenting information indicating claim limitation, if the diagnosis is flagged limited; and

displaying on the display an eighth user interface presenting information indicating the need for a manual claim review if the diagnosis is flagged as for manual review.

9. A non-transitory computer readable storage medium having stored thereon computer readable instructions that, if executed by a computing device, cause the computing device to perform operations for insurance enrollment and underwriting, the operations comprising:

displaying on a display of a computer system a first user interface with one or more controls configured to receive user input to specify a breed of a pet to be insured and to specify one or more health conditions of the pet in an enrollment application for pet health insurance;

receiving data representing the breed of the pet and one or more health conditions specified through the first user interface;

electronically processing the data representing the one or more health conditions and electronically flagging each as a condition that is acceptable, precluded, or manual review, wherein the flagging is based on the breed of the pet; and

calculating on the computer system a geographic insurance rating, including;

identifying a location associated with the pet;

identifying a geographic risk zone;

comparing the location to the geographic risk zone to determine if the location is at least partially within the geographic risk zone; and

calculating an insurance rating according to the comparison;

where all conditions are and flagged as acceptable or determined to be acceptable following a manual review, calculating, a dollar limit of coverage for each of a plurality of diagnoses in lieu of one or more exclusions, the plurality of diagnoses including one or more diagnoses related to one or more of the health conditions, wherein calculating a dollar limit of coverage includes calculating a dollar limit of coverage for each of the plurality of diagnoses based at least in part on the geographic insurance rating, and packaging an active insurance policy on the pet, wherein the insurance policy includes coverage for each of the plurality of diagnoses up to each diagnosis'"'"' corresponding dollar limit of coverage; and

displaying on the display a second user interface presenting information indicating approved enrollment, if all of the conditions are flagged as acceptable.

10. The medium of claim 9, the operations further comprising:

displaying on the display a third user interface presenting information indicating declined enrollment if at least one of the conditions is flagged as precluded; and

displaying on the display a fourth user interface presenting information indicating a need for a manual review if none of the conditions is flagged as precluded and at least one of the conditions is flagged as for manual review.

11. The medium of claim 9, the operations further comprising, after displaying the second user interface, establishing for storage on a computer-readable storage medium an electronic record associated with an active policy for pet health insurance, the electronic record including the data representing the one or more health conditions specified through the first user interface and data representing an effective date for the policy.

12. The medium of claim 9, the operations further comprising:

displaying on the display a fifth user interface having controls for enabling a user to submit a claim with respect to the active policy, the controls enabling the user to specify a diagnosis for which coverage is requested;

receiving data representing the diagnosis;

electronically processing the data representing the diagnosis with the electronic record associated with the active policy, including comparing the data representing the diagnosis with the data representing the one or more health conditions specified through the first user interface and comparing a date of the claim with the data representing the effective date of the active policy.

13. The medium of claim 12, wherein the operation of electronically processing includes:

flagging the diagnosis as limited where the comparison of the data representing the diagnosis with the data representing the one or more health conditions reveals that the diagnosis is for a condition identified by the data representing the one or more health conditions; and

otherwise determining whether the diagnosis is for a suspect condition or a non-suspect condition and;

flagging the diagnosis as covered if the diagnosis is for a non-suspect condition;

flagging the diagnosis for manual review if the diagnosis is for a suspect condition.

14. The medium of claim 13, wherein the operation of determining if the diagnosis is for a suspect condition or non suspect condition includes:

determining the diagnosis to be for a non-suspect condition if a length of time between the effective date of the active policy and the date of the claim exceeds a predetermined duration;

otherwise determining the diagnosis to be for a suspect condition.

15. The medium of claim 14, the operations further comprising selecting the predetermined duration according to the diagnosis.

16. The medium of claim 13, the operations further comprising:

displaying on the display a sixth user interface presenting information indicating claim approval if the diagnosis is flagged approved;

displaying on the display a seventh user interface presenting information indicating claim limitation, if the diagnosis is flagged as limited; and

displaying on the display an eighth user interface presenting information indicating the need for a manual claim review if the diagnosis is flagged for manual review.

17. An insurance enrollment and underwriting system, comprising:

one or more server computing devices configured to be networked via a link that provides electronic communication between the one or more servers and one or more client computing devices, the one or more server computing devices comprising a processor operably connected to a non-transitory memory embodied with instructions that, when executed by the processor, cause the processor to perform operations for insurance enrollment and underwriting, the operations comprising;

providing to the one or more client computing devices a first user interface with one or more controls configured to receive user input to specify a breed of a pet to be insured and to specify one or more health conditions of the pet in an enrollment application for pet health insurance;

receiving from the one or more client computing devices data representing the breed of the pet and one or more health conditions specified through the first user interface;

electronically processing the data representing the breed of the pet and one or more health conditions specified through the first user interface to electronically flag each as a condition that is acceptable, precluded, or for manual review, wherein the flagging is based on the breed of the pet;

calculating on the computer system a geographic insurance rating, including;

identifying a location associated with the pet;

identifying a geographic risk zone;

comparing the location to the geographic risk zone to determine if the location is at least partially within the geographic risk zone; and

calculating an insurance rating according to the comparison;

where all conditions are flagged as acceptable or determined to be acceptable following a manual review, calculating, a dollar limit of coverage for each of a plurality of diagnoses in lieu of one or more exclusions, the plurality of diagnoses including one or more diagnoses related to the one or more of the health conditions, wherein calculating a dollar limit of coverage includes calculating a dollar limit of coverage for each of the plurality of diagnoses based at least in part on the geographic insurance rating, and packaging an active insurance policy on the pet, wherein the insurance policy includes coverage for each of the plurality of diagnoses up to each diagnosis'"'"' corresponding dollar limit of coverage; and

providing to the one or more client computing devices a second user interface presenting information indicating approved enrollment, if all of the conditions are flagged as acceptable.

18. The system of claim 17, wherein the operations further comprise:

providing to the one or more client computing devices a third user interface presenting information indicating declined enrollment if at least one of the conditions is flagged as precluded;

and

providing to the one or more client computing devices a fourth user interface presenting information indicating a need for a manual review if none of the conditions is flagged as precluded and at least one of the conditions is flagged as for manual review.

19. The system of claim 17, wherein, the operations further comprise, after displaying the second user interface, establishing for storage on a computer-readable storage medium an electronic record associated with an active policy for pet health insurance, the electronic record including the data representing the one or more health conditions specified through the first user interface and data representing an effective date for the policy.

20. The system of claim 17, wherein operations further comprise:

providing to the one or more computing devices a fifth user interface having controls configured to receive user input to submit a claim with respect to the active policy, the controls configured to receive user input to specify a diagnosis for which coverage is requested; and

receiving data representing the diagnosis,

electronically processing the data representing the diagnosis with the electronic record associated with the active policy, including comparing the data representing the diagnosis with the data representing the one or more health conditions specified through the first user interface, and

comparing a date of the claim with the data representing the effective date of the active policy.

21. The system of claim 20, wherein the operations further comprise:

flagging the diagnosis as limited where the comparison of the data representing the diagnosis with the data representing one or more health conditions reveals that the diagnosis is for a condition identified by the data representing the one or more health conditions; and

otherwise determining if the diagnosis is for a suspect condition or a non-suspect condition and;

flagging the diagnosis as covered if the diagnosis is for a non-suspect condition, or

flagging the diagnosis for manual review if the diagnosis is for a suspect condition.

22. The system of claim 21, wherein the operations further comprise determining if the diagnosis is for a suspect condition or a non-suspect condition by:

determining the diagnosis to be for a non-suspect condition if a difference between the date of the claim and the effective date of the active policy exceeds a predetermined duration;

otherwise determining the diagnosis to be for a suspect condition.

23. The system of claim 22, wherein operations further comprise selecting the predetermined duration according to the diagnosis.

24. The system of claim 21, wherein the operations further comprise:

returning a sixth user interface presenting information indicating claim approval if the diagnosis is flagged approved;

returning a seventh user interface presenting information indicating claim limitation, if the diagnosis is flagged as limited; and

returning an eighth user interface presenting information indicating the need for a manual claim review if the diagnosis is flagged for manual review.

25. A computer-implemented method for insurance enrollment and underwriting, comprising:

causing to be displayed on a display a first user interface with one or more controls configured to receive user input in an enrollment application for pet health insurance, the user input specifying a breed of a pet to be insured, one or more health conditions of the pet, and a location associated with the pet;

receiving, on a computer system, data specified through the first user interface, the data representing the breed of the pet, the one or more health conditions, and the location associated with the pet;

comparing the location associated with the pet to an identified geographic risk zone to determine if the location is at least partially within the geographic risk zone and calculating a geographic insurance rating according to the comparison;

electronically processing on the computer system the data representing the one or more health conditions and electronically flagging each condition as a condition that is acceptable, precluded, or for manual review, wherein the flagging is based on the breed of the pet;

calculating on the computer system a dollar limit of coverage for each of a plurality of diagnoses based at least in part on the geographic insurance rating, the plurality of diagnoses including one or more diagnoses related to the breed of the pet and one or more of the health conditions;

where all conditions are flagged as acceptable or determined to be acceptable following a manual review, packaging an active insurance policy on the pet, wherein the insurance policy includes coverage for each given diagnosis of the plurality of diagnoses up to the corresponding dollar limit of coverage of the given diagnosis; and

displaying on the display information indicating approved enrollment, if all of the conditions are flagged as acceptable.

26. The computer-implemented method of claim 25, further comprising:

displaying on the display information indicating declined enrollment if at least one of the conditions is flagged as precluded; and

displaying on the display information indicating a need for a manual review if none of the conditions is flagged as precluded and at least one of the conditions is flagged as for manual review.

27. The computer-implemented method of claim 25, further comprising, after displaying information indicating approved enrollment, establishing for storage on a computer-readable storage medium an electronic record associated with the active policy for pet health insurance, the electronic record including the data representing the one or more health conditions specified through the first user interface and data representing an effective date for the policy.

28. The computer-implemented method of claim 27, further comprising:

displaying on the display a user interface having controls for enabling a user to submit a claim with respect to the active policy, the controls enabling the user to specify a diagnosis for which coverage is requested;

receiving data representing the diagnosis;

electronically processing the data representing the diagnosis with the electronic record associated with the active policy, including comparing the data representing the diagnosis with the data representing the one or more health conditions specified through the first user interface and comparing a date of the claim with the data representing the effective date of the active policy.

29. The computer-implemented method of claim 28, wherein electronically processing includes:

flagging the diagnosis as limited where the comparison of the data representing the diagnosis with the data representing the one or more health conditions reveals that the diagnosis is for a condition identified by the data representing the one or more health conditions; and

otherwise determining if the diagnosis is for a suspect condition or a non-suspect condition and;

flagging the diagnosis as covered if the diagnosis is for a non-suspect condition;

flagging the diagnosis for manual review if the diagnosis is for a suspect condition.

30. The computer-implemented method of claim 29, wherein determining comprises:

determining the diagnosis to be for a non-suspect condition if a length of time between the effective date of the active policy and the date of the claim exceeds a predetermined duration;

otherwise determining the diagnosis to be for a suspect condition.

31. The computer-implemented method of claim 30 further comprising selecting the predetermined duration according to the diagnosis.

32. The computer-implemented method of claim 29, further comprising:

displaying on the display information indicating claim approval if the diagnosis is flagged approved;

displaying on the display information indicating claim limitation, if the diagnosis is flagged limited; and

displaying on the display information indicating the need for a manual claim review if the diagnosis is flagged as for manual review.

33. The computer-implemented method of claim 25, wherein the causing to be displayed on a display occurs as a result of a request for the first user interface by a client computing device transmitted to the computer system over a network.