CN101107620A - 管理健康保险计划业务的方法和系统 - Google Patents

管理健康保险计划业务的方法和系统 Download PDF

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CN101107620A
CN101107620A CNA2005800470595A CN200580047059A CN101107620A CN 101107620 A CN101107620 A CN 101107620A CN A2005800470595 A CNA2005800470595 A CN A2005800470595A CN 200580047059 A CN200580047059 A CN 200580047059A CN 101107620 A CN101107620 A CN 101107620A
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阿德里安·戈雷
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Abstract

一种管理健康保险计划业务的方法，其中，作为保险费或缴款的回报，此健康保险计划的提供者承担责任，并且为支付这些了保险费或进行缴款的成员保险所投保的健康服务、或者管理支付所投保的健康护理费用的帐户。该方法包括：计算成员使用发给该成员的信用卡或付款卡支出的数额；以及增加成员在成员用于支付健康服务的医疗储蓄账户中可用的基金数额，或增加健康保险计划所承担的责任数额。增加的数额是成员使用发给该成员的信用卡或付款卡支出的数额的百分比。

Description

管理健康保险计划业务的方法和系统
技术领域
本发明涉及一种管理健康保险计划的业务的方法和系统。
背景技术
传统的健康保险计划由作为保险费或缴款的回报而承担责任的健康计划保险人操作，并且为支付保险费或进行缴款的成员(或为由成员的雇主支付保险费或缴款的成员)保险所投保的健康服务，或者管理支付所投保的健康护理费用的帐户(由成员或成员的雇主缴款)。
这些类型的健康保险计划的目的在于使成员得到他们另外可能无法得到的最佳的健康服务。
从成员的观点来看，任何有助于成员更仔细管理她/他的医疗费用并且使他/她能够更容易支付这些费用的动机都是有利的，尤其是在迅速发展的消费者驱使的健康护理环境下。
本发明设法处理这些动机。
发明内容
根据一个示例性实施例，提供了一种管理健康保险计划的业务的方法，其中，作为保险费或缴款的回报，此健康保险计划的提供者要承担责任，并且为支付保险费或进行缴款的成员保险所投保的健康服务，或者管理支付所投保的健康护理费用的帐户，该方法包括：
计算成员使用发给该成员的信用卡或付款卡支出的数额；以及
增加成员在该成员用于支付健康服务的医疗储蓄账户中可用的基金数额，其中，增加的数额是成员使用发给该成员的信用卡或付款卡支出的数额的百分比。
该方法还可以包括：计算成员在由健康保险人或健康保险计划的第三方管理人操作的激励计划中赚得的点数，其中，基于在激励计划中赚得的点数确定用于确定医疗储蓄账户中基金增加的数额的百分比。
根据另一个示例性实施例，进一步提供了一种管理健康保险计划的业务的方法，其中，作为保险费或缴款的回报，上述健康保险计划的提供者承担责任，并且为支付保险费或进行缴款的成员保险所投保的健康服务，或者管理支付所投保的健康护理费用的帐户，该方法包括：
计算成员使用发给成员的信用卡或付款卡支出的数额；以及
增加健康保险计划承担的责任数额，其中，增加的数额是成员使用发给该成员的信用卡或付款卡支出的数额的百分比。
该方法还可以包括：计算成员在由健康保险人或健康保险计划的第三方管理人操作的激励计划中赚得的点数，其中，基于在激励计划中赚得的点数确定用于确定医疗储蓄账户中基金增加的数额的百分比。
根据另一个示例性实施例，进一步提供了一种用于管理健康保险计划的业务的电子系统，包括：
计算模块，用于计算成员使用发给该成员的信用卡或付款卡支出的数额；以及
基金分配模块，用于增加成员在该成员用于支付健康服务的医疗储蓄账户中可用的基金数额，其中，增加的数额是成员使用发给成员的信用卡或付款卡支出的数额的百分比。
该系统可以包括：激励机制点计算模块，计算成员在由健康保险人或健康保险计划的第三方管理人操作的激励计划中赚得的点数，其中，基于在激励计划中赚得的点数确定用于确定医疗储蓄账户中基金增加的数额的百分比。
根据另一个示例性实施例，进一步提供了一种用于管理健康保险计划的业务的电子系统，包括：
计算模块，用于计算成员使用发给该成员的信用卡或付款卡支出的数额；以及
基金分配模块，用于增加健康保险计划承担的责任数额，其中，增加的数额是成员使用发给该成员的信用卡或付款卡支出的数额的百分比。
该系统可以包括：激励机制点计算模块，用于计算成员在由健康保险人或健康保险计划的第三方管理人操作的激励计划中赚得的点数，其中，基于在激励计划中赚得的点数确定用于确定医疗储蓄账户中基金增加的数额的所述百分比。
附图说明
图1是示出了示例性实施例的方法的流程图；
图2是示出了另一个示例性实施例的方法的流程图；以及
图3是示出了用于实施本文所述的方法的示例性系统的框图。
具体实施方式
本发明得以应用于管理健康保险计划的业务和操作领域。通常，作为保险费或缴款的回报，此健康保险计划的保险人要承担责任，并且为支付保险费或进行缴款(或为由成员的雇主支付保险费或缴款的成员)的成员保险所投保的健康服务，或者管理支付所投保的健康护理费用的各个健康护理和纳税立法(由成员或成员的雇主缴款)所支配的个人医疗基金或任何其他类似的基金。
在一些国家，这些健康计划被称为医疗机制或医疗救助机制。
存在各种模式的健康计划。例如，在一种模式下，健康保险人支付成员尤其是协议范围内的达到预定限制的所有健康服务。这个预定极限是健康保险人的责任的极限。
在一种替换模式下，成员具有由各个健康护理和纳税立法支配的个人医疗基金或医疗储蓄账户、或任何其他类似基金，其中，各个健康护理和纳税立法由健康保险人或健康计划的第三方管理人管理，但是由成员和/或成员的雇主投资。接下来，由健康保险人或第三方管理人从这个个人医疗基金中支付相当于预定数额的健康保险人要求的与健康有关的索赔。只有在达到预定数额之后，健康保险人才会产生责任并且支付相当于另一个预定数额的所投保的健康有关的费用。
在这种方法中，成员通常向健康保险人支付包含风险酬金部分(作为保险人承担所投保的健康服务的责任的回报)和基金部分(经存入以使成员的个人医疗基金与由各个健康护理和纳税立法所支配的任何其他类似基金相平衡)的数额。这个基金部分是保险人和第三方管理人将首先用于支付成员产生的某些列举的与所保险的健康有关的费用。
本发明得以应用于这两种模式中，例如，以及应用于所使用的其他模式的健康计划中。
根据本发明，计算成员在发给成员的付款卡或信用卡上支出的数额。
信用卡或付款卡可以是能够或不能被健康保险人标记的第三方金融机构的付款卡或信用卡。另外，健康保险人本身可以发布信用卡或付款卡。
基于所计算的成员使用发给该成员的信用卡或付款卡而支出的数额，增加保险计划为了该成员所承担的责任数额，或者增加个人医疗基金中可用的基金数额。通常将该数额计算为在给定周期内在信用卡或付款卡上所花费的总额的百分比。
该方法还可包括：计算成员在由健康保险人或健康保险计划的第三方管理人操作的激励计划中赚得的点数，其中，基于在激励计划中赚得的点数确定用于确定健康保险计划中的责任增加或个人医疗基金中的基金增加的百分比。
目前，此激励计划的一个实例是由管理传统保赔健康保险计划连同所谓的VitalityTM计划(在申请人共同待决的美国专利公开案第09/982,274中所披露，其内容结合于此作为参考)的投保人管理的。
Vitality计划利用规定的健康相关设施和/或服务来奖励成员。例如，奖励成员利用健身房、Smoke EndersTM和WeighlessTM。
通过点分配系统并视分配给成员的总点数来奖励成员，酬劳属于四个状态之一。在Vitality计划的实施过程中，已按照价值升序的顺序来命名这些状态，蓝色、铜色、银色、和金色。首先，所有成员都出于蓝色状态。一旦成员积累了预定的点数，就将他/她的Vitality状态提升到下一个适当的等级。
有了以上建议，以下是用于计算百分比的一个表格实例：
Vitality状态 信用卡/付款卡花费的百分比
    蓝色     2％
    铜色     5％
    银色     10％
    金色     20％
这些百分比可随着大量操作、竞争和商业因素而显著变化。
使用实例中的上述内容导致以下：
  在付款卡或信用卡上花费的数额     Vitality状态   存入个人医疗基金的数额
    1000美元     蓝色     20美元
    1000美元     铜色     50美元
    1000美元     银色     100美元
    1000美元     金色     200美元
应了解，通过成员简单使用信用卡或付款卡来进行消费，通过在成员的个人医疗基金或由各个健康护理和纳税立法所支配的任何其他类似基金上赚得信用，可以使成员更能够承受健康护理，或使健康保险人的责任增加。
图3示出了用于实施上述方法的示例性系统。
通常，由健康保险计划的管理者来操作服务器10。服务器包括：计算模块12，用于计算成员使用发给该成员的信用卡或付款卡支出的数额。
服务器还包括：基金分配模块14，用于增加成员在该成员用于支付健康服务的医疗储蓄账户中可用的基金数额，或增加健康保险计划为该成员所承担的责任数额。
如上所述，增加的数额是成员使用发给该成员的信用卡或付款卡支出的数额的百分比。
激励机制点计算模块16用于计算成员在由健康保险人或健康保险计划的第三方管理人操作的激励计划中赚得的点数，其中基于在激励计划中获得的点数来确定用以确定医疗储蓄账户中的基金增加数额的百分比。
该系统可包括用于存储信息以实施方法的数据库18。
另外，金融机构的服务器20经由通信网络22连接至服务器10。在成员的付款卡或信用卡是第三方金融机构的付款卡或信用卡的情况下，这可能是必需的。
上述模块可通过机器可读介质来实施，该介质包含当被机器执行时使机器能够执行上述任何方法的指令。
应了解，本发明的实施例并不仅限于这种结构，而是可以同样应用于分布式、或对等式的结构系统中。因此，所示模块可位于由一个或多个机构操作的一个或多个服务器上。

Claims (9)

1.一种管理健康保险计划的业务的方法，其中，作为保险费或缴款的回报，上述健康保险计划的提供者要承担责任，并且为支付保险费或进行缴款的成员保险所投保的健康服务，或者管理支付所投保的健康护理费用的帐户，所述方法包括：
计算成员使用发给所述成员的信用卡或付款卡支出的数额；以及
增加所述成员在所述成员用于支付健康服务的医疗储蓄账户中可用的基金数额，其中，增加的所述数额是所述成员使用发给所述成员的所述信用卡或付款卡支出的所述数额的百分比。
2.根据权利要求1所述的方法，所述方法包括：计算所述成员在由所述健康保险人或所述健康保险计划的第三方管理人操作的激励计划中赚得的点数，其中，基于在所述激励计划中赚得的所述点数确定用于确定所述医疗储蓄账户中所述基金增加的数额的所述百分比。
3.一种管理健康保险计划的业务的方法，其中，作为保险费或缴款的回报，上述健康保险计划的提供者要承担责任，并且为支付保险费或进行缴款的成员保险所投保的健康服务，或者管理支付所投保的健康护理费用的帐户，所述方法包括：
计算成员使用发给所述成员的信用卡或付款卡支出的数额；以及
增加所述健康保险计划承担的责任数额，其中，增加的所述数额是所述成员使用发给所述成员的所述信用卡或付款卡支出的所述数额的百分比。
4.根据权利要求3所述的方法，所述方法包括：计算所述成员在由所述健康保险人或所述健康保险计划的第三方管理人操作的激励计划中赚得的点数，其中，基于在所述激励计划中赚得的所述点数确定用于确定所述医疗储蓄账户中所述基金增加的数额的所述百分比。
5.一种用于管理健康保险计划的业务的电子系统，包括：
计算模块，用于计算成员使用发给所述成员的信用卡或付款卡支出的数额；以及
基金分配模块，用于增加所述成员在所述成员用于支付健康服务的医疗储蓄账户中可用的基金数额，其中，增加的所述数额是所述成员使用发给所述成员的所述信用卡或付款卡支出的所述数额的百分比。
6.根据权利要求5所述的电子系统，所述系统包括：激励机制点计算模块，计算所述成员在由所述健康保险人或所述健康保险计划的第三方管理人操作的激励计划中赚得的点数，其中，基于在所述激励计划中赚得的所述点数确定用于确定所述医疗储蓄账户中所述基金增加的数额的所述百分比。
7.一种用于管理健康保险计划的业务的电子系统，包括：
计算模块，用于计算成员使用发给所述成员的信用卡或付款卡支出的数额；以及
基金分配模块，用于增加所述健康保险计划承担的责任数额，其中，增加的所述数额是所述成员使用发给所述成员的所述信用卡或付款卡支出的所述数额的百分比。
8.根据权利要求7所述的电子系统，所述系统包括：激励机制点计算模块，用于计算所述成员在由所述健康保险人或所述健康保险计划的第三方管理人操作的激励计划中赚得的点数，其中，基于在所述激励计划中赚得的所述点数确定用于确定所述医疗储蓄账户中所述基金增加的数额的所述百分比。
9.一种机器可读介质，包含当被机器执行时使所述机器执行包括以下步骤的方法的指令：
计算成员使用发给所述成员的信用卡或付款卡支出的数额；以及
增加所述成员在所述成员用于支付健康服务的医疗储蓄账户中可用的基金数额，其中，增加的所述数额是所述成员使用发给所述成员的所述信用卡或付款卡支出的所述数额的百分比。
CNA2005800470595A 2005-01-07 2005-12-21 管理健康保险计划业务的方法和系统 Pending CN101107620A (zh)

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