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Insurance Abstract
The present invention includes methods of administrating insurance
coverage for a group of insured. A healthcare/risk manager is assigned
to each insured to supervise and monitor the wellness of each insured.
Among other things, bundled services can include healthcare and
workers' compensation coverage.
Insurance Claims
1) A method for managing an assortment of administrative, human
resource and insurance responsibilities for a group of an employer's
employees; said method comprising the steps of: a) establishing
a coordinated benefits entity responsible for coordinating said
assortment of administrative, human resource and insurance responsibilities
for said group of said employer's employees; b) relegating said
administrative and insurance responsibilities to a professional
employment organization or an insurance carrier, wherein said professional
employment organization and said insurance carrier are affiliated
with said coordinated benefits entity; c) transferring select management
functions from said employer to said professional employment organization
such that said group of employees become co-employees of said professional
employment organization, wherein said professional employment organization
further assumes payroll and tax accounting responsibilities of said
employer; d) transferring management of health insurance and workers'
compensation responsibilities from said employer to said insurance
carrier; wherein said management of said health insurance and said
workers' compensation responsibilities further comprise the steps
of: i) issuing one or more policies for insuring health coverage
for any beneficiary of said health insurance; ii) issuing one or
more policies for insuring any potential recipient of said workers'
compensation benefits; iii) prior to an occurrence of an insurance
claim activating event, assigning a healthcare/risk manager to supervise
health status of each said beneficiary of said health insurance
and any said potential recipient of said workers' compensation benefits;
iv) upon said occurrence of an insurance claim activating event,
having said healthcare/risk manager monitor medical treatments and
subsequent compliance by any claimant; and v) reporting said healthcare/risk
manager's observations to said professional employment organization
of said coordinated benefit entity; and e) according to predetermined
parameters established by said coordinated benefit entity, communicating
said healthcare manager's observations to said employer.
2) The method of claim 1 further comprising the steps of: a) utilizing
a computer system to at least partially select said one or more
policies for insuring health coverage and workers' compensation
coverage; and b) using said computer system for assisting in management
of said assortment of said administrative, human resources and insurance
responsibilities.
3) The method of claim 2 wherein said professional employment organization
and said insurance carrier are each integral parts of said coordinated
benefits entity.
4) The method of claim 2 further comprising the step of prior to
said occurrence of an insurance claim activating event, having one
or more of representatives collect actuarial data regarding each
said employer's insurance, human resource and administrative practices.
5) A method for providing one or more bundles of insurance, human
resource and administrative services to one or more employers; said
method comprising the steps of: a) establishing a coordinated benefits
entity responsible for coordinating sales of one or more of said
bundles to one or more of said employers, wherein said coordinated
benefits entity further comprises: i) a clearing house for one or
more insurance carriers; and ii) at least one coordinator; b) affiliating
a plurality of representatives with said clearing house and said
coordinator; c) having one or more of said representatives sell
one or more bundles to one or more of said employers, wherein each
bundle sold further comprises: i) a professional employment organization
component; ii) a health insurance coverage component; and iii) a
workers' compensation coverage component; d) for each employer converting
to one or more of said bundles, prior to converting to one or more
of said bundles, having one or more of said representatives collect
actuarial data regarding each said converting employer's current
insurance, human resource and administrative practices; and e) reporting
said actuarial data to said coordinated benefits entity.
6) The method of claim 5 further comprising the step of collecting
actuarial data regarding said employer's employees' work patterns
for a period of one year prior to said employer converting to one
or more of said bundles.
7) The method of claim 6 further comprising the steps of: a) entering
said actuarial data into one or more computer systems, b) analyzing
said actuarial data; and c) utilizing said actuarial data to tailor
said one or more bundles for each said converting employer.
8) The method of claim 7 wherein said actuarial data comprises:
a) said employees' Monday absenteeism rate; b) said employees' compliances
with treatment schedules and regimens; c) said employees' compliances
with treatment schedules and regimens and corresponding absenteeism;
d) said employees' compliances with drug therapy; and e) said employees'
compliances with drug therapy and corresponding absenteeism.
9) The method of claim 6 further comprising the steps of: a) prior
to a claim activating event, assigning a healthcare/risk manager
to supervise wellness status of each potential beneficiary of said
one or more bundles; and b) subsequent to a claim activating event,
having said healthcare/risk manager monitor medical treatments and
ensuing compliance by any claimant.
10) The method of claim 9 further comprising the step of administrating
said one or more bundles via a professional employment organization.
11) A method of providing wellness services to a group of an employer's
employees; said method comprising the steps of: a) transferring
select administrative functions from said employer to a professional
employment organization such that said group of employer's employees
become co-employees of said professional employment organization;
b) creating a risk underwriting syndicate of insurance carriers
for underwriting risks of health insurance coverage and workers'
compensation benefits for said co-employees; c) making health insurance
coverage available for said co-employees and all insured covered
under said health insurance coverage; d) providing workers' compensation
benefits to any claimant of said co-employees; e) establishing an
entity for coordinating and integrating operations of said professional
employment organization and said risk underwriting syndicate; f)
administrating said health insurance coverage and said workers'
compensation benefits through said professional employment organization;
g) prior to an occurrence of any claim activating event, assigning
a healthcare/risk manager to supervise health status of said insured;
and h) upon an occurrence of a claim activating event, having said
healthcare/risk manager monitor medical treatments and subsequent
compliance by any of said insured.
12) The method of claim 11 further comprising the step of bundling
health insurance coverage and workers' compensation benefits for
said co-employees.
13) The method of claim 12 wherein said healthcare/risk manager
is a registered nurse or the equivalent of a registered nurse.
14) A method of reducing costs of doing business for an employer,
said method comprising the steps of: a) affiliating one or more
healthcare/risk managers with either: i) one or more insurance carriers
underwriting healthcare coverage and workers' compensation coverage;
or ii) one or more professional employment organizations; or iii)
said one or more insurance carriers and said one or more professional
employment organizations; b) assigning said one or more healthcare/risk
managers to regularly supervise persons insured by one or more insurance
policies, wherein said policies provide coverage for health insurance
claimants and workers' compensation claimants, and wherein said
healthcare/risk managers encourage supervised persons to lead a
generally healthier lifestyle; c) after any filing of a claim by
any claimant, having at least one of said healthcare/risk managers
monitor medical treatments and subsequent compliance of any claimant
filing said claim; d) establishing an entity for coordinating interaction
between said one or more insurance carriers and said one or more
professional employment organizations; and e) administrating said
healthcare coverage and said workers' compensation coverage as directed
by said entity.
15) The method of claim 14, wherein each said healthcare/risk manager
is a registered nurse or a similarly trained medical professional.
16) The method of claim 15 further the comprising the step of collecting
actuarial data regarding each of said insured persons, wherein said
actuarial data relates to: a) each said insured's wellness prior
to participation in said current method; and b) each said insured's
wellness post participation in said current method.
17) The method of claim 14 further comprising the step of affiliating
said entity with an insurance syndicate including a plurality of
insurance carriers for underwriting one or more insurance policies.
18) The method of claim 16, wherein said healthcare coverage and
said workers' compensation coverage are administrated by a professional
employment organization.
19) A method of reducing insurance costs of doing business for
an employer, said method comprising the steps of: a) affiliating
one or more healthcare/risk managers with either: i) one or more
insurance carriers underwriting healthcare coverage and workers'
compensation coverage; or ii) an entity for administrating said
healthcare coverage and said workers' compensation coverage; or
iii) said one or more insurance carriers and said entity; b) assigning
said one or more healthcare/risk managers to regularly supervise
persons insured by one or more insurance policies issued by said
one or more insurance carriers; c) having said one or more healthcare/risk
managers encourage supervised persons to lead a generally healthier
lifestyle; d) after any filing of a claim by any claimant against
any policy, having at least one of said healthcare/risk managers
monitor medical treatments and subsequent compliance of any claimant
filing said claim; and e) administrating said healthcare coverage
and said workers' compensation coverage as directed by said entity.
20) The method of claim 19, wherein each said healthcare/risk manager
is a registered nurse or a similarly trained medical professional.
21) The method of claim 20 further the comprising the step of collecting
actuarial data regarding each of said insured persons, wherein said
actuarial data relates to: a) each said insured's wellness prior
to participation in said current method; and b) each said insured's
wellness post participation in said current method.
22) The method of claim 21 further comprising the step of affiliating
said entity with an insurance syndicate including a plurality of
insurance carriers for underwriting one or more insurance policies.
23) The method of claim 22, wherein said healthcare coverage and
said workers' compensation coverage are administrated by a professional
employment organization.
24) The method of claim 22, wherein said healthcare coverage and
said workers' compensation coverage are administrated by one or
more of said plurality of insurance carriers.
25) A method for providing one or more bundles of insurance, human
resource and administrative services to one or more employers; said
method comprising the steps of: a) establishing an entity responsible
for coordinating sales of one or more of said bundles to one or
more of said employers; b) affiliating said entity with an insurance
syndicate; and c) selling one or more bundles to one or more employers,
wherein each bundle sold further comprises: i) a professional employment
organization component; ii) a health insurance coverage component;
and iii) a workers' compensation coverage component.
26) The method of claim 25 further comprising the steps of: a)
for each employer converting to one or more of said bundles, prior
to converting to one or more of said bundles collecting actuarial
data regarding each said converting employer's current insurance,
human resource and administrative practices; and b) reporting said
actuarial data to said entity.
27) The method of claim 26 further comprising the steps of: a)
collecting actuarial data regarding said employer's employees' work
patterns for a period of one year prior to said employer converting
to one or more of said bundles; and b) utilizing said actuarial
data to tailor said one or more bundles for each said converting
employer.
28) The method of claim 27 wherein said actuarial data comprises:
a) said employees' Monday absenteeism rate; b) said employees' compliances
with treatment schedules and regimens; c) said employees' compliances
with treatment schedules and regimens and corresponding absenteeism;
d) said employees' compliances with drug therapy; and e) said employees'
compliances with drug therapy and corresponding absenteeism.
29) The method of claim 28 further comprising the steps of: a)
prior to a claim activating event, assigning a healthcare/risk manager
to supervise wellness status of each potential beneficiary of said
one or more bundles; and b) subsequent to a claim activating event,
having said healthcare/risk manager monitor medical treatments and
ensuing compliance by any claimant.
Insurance Description
BACKGROUND OF THE INVENTION
[0001] 1. Field of the Invention
[0002] Among other things, the present invention is related to
methods of administrating insurance coverage for a group of insured.
A healthcare/risk manager is assigned to each insured to supervise
the wellness of each insured. After a claim event occurs, the healthcare/risk
manager monitors the treatments and subsequent compliance by the
claimant. Employers' are provided bundled services that can include
healthcare and workers' compensation coverage.
[0003] 2. Description of the Previous Art 1) US Published Patent
Application 20020022982 A1-Cooperstone, et al. discloses a method
and system for remotely managing business and employee administration
function. Cooperstone provides an integrated system and business
process for employee administration and human outsourcing to which
both companies and their employees can subscribe. The '982 system
is able to perform several types of administrative and human resource
services, such as: payroll/administrative services, including payroll
and tax filing, unemployment claims, COBRA and pre-tax plan administration;
insurance services, including group health, property and casualty,
and personal lines; retirement and savings plan administration,
including 401K and IRA retirement savings plans, and deferred compensation
plans; human resource services, including compliance material, employee
development tools and advisory services; business network services,
including discount procurement, purchasing cards, work share and
e-mail; and employee services, including credit card and discount
legal services.
[0004] 2) US Published Patent Application 20010044735 A1-Colburn,
et al. discloses an auditing and monitoring system for workers'
compensation claims. The '735 system begins with an evaluation of
the current status of an employer's total workers' compensation
program--evaluating the current agreement between an insurer or
Third Party Administrator (TPA) and the employer for claims management
techniques, epic service specifications and required interaction
between the two parties. After evaluation, modifications to the
agreement are suggested to incorporate best practices and measurable
goals into the existing agreement between the employer and the insurance
service provider. These best practices and measurable goals provide
the foundation by which the system evaluates the performance of
the assigned adjusters, thus enhancing their performance level which
ultimately creates a reduction in costs for the employer by decreasing
direct and indirect costs.
[0005] The Coburn system provides a methodology whereby the employer's
return to work policy or plan is evaluated. In the situations where
the return to work policy or plan does not exist, the system assists
in the implementation of such a plan. Where the return to work policy
or plan exists, the plan is evaluated and return to work best practices
and policies are recommended. Establishing an initial benchmark
or goal for each claim allows the employers to gain a better understanding
of the long-term potential liability for a particular case. This
'735 methodology offers an Initial Recommendations Report to the
employers within 72 hours of the initial claim report that allows
employers to know up front the scope of the claim and its projected
resolution. The initial report identifies high risk claimants and
provides for an aggressive approach to workers' compensation claims
that helps put the employee back to work and saves employers money
and resources.
[0006] 3) U.S. Pat. No. 6,381,576 B1-Gilbert enables a method,
apparatus, and data structure for capturing and representing diagnostic,
treatment, costs, and outcomes information in a form suitable for
effective analysis and health care guidance. The Gilbert method
is primarily directed toward a database structure that employs diagnostic
and treatment information data structure that contains both clinical
and financial information that permits effective filtering of CPT
codes as to accuracy and appropriateness.
[0007] 4) U.S. Pat. No. 6,484,144 B2-Martin, et al. enables a method
and system for healthcare treatment planning and assessment. Martin
is a method implemented in a data processing system for determining
an appropriate treatment for a patient. The '144 system receives
data reflecting a current state of the patient and computes a risk
value that reflects a likelihood of the patient developing a disease,
based on a subset of the diagnostic data. The Martin system then
analyzes a proposed treatment plan, considering the computed risk
value and the received diagnostic data.
[0008] 5) U.S. Pat. No. 4,648,037-Valentino enables a method and
apparatus for benefit and financial communication. The Valentino
system allows an employee to access information regarding current
employee benefits. In addition, the '037 method also provides a
forecast function of future value of accumulated savings.
[0009] 6) US Published Patent Application 20020059587 A1-Cofano,
et al. discloses a method and apparatus for providing personalized
services. The Cofano invention provides a method and apparatus allowing
remote access to personalized services which reduces or eliminates
the need for members or employees to expend valuable time personally
visiting service providers, such as doctors, travel agents, and
financial advisors.
SUMMARY OF THE INVENTION
[0010] According to predetermined parameters, a coordinated benefits
entity can control the communication dynamics between the professional
employment organization, an employer, an insurance syndicate, the
healthcare/risk managers, the representatives and the insured, beneficiaries
or claimants. Employers are sold a bundle of services that includes
the administration of healthcare and workers' compensation insurance
policies. Due to actuarial data collected, the coordinated benefits
entity can match the bundle of insurance services offered by one
or more insurance carriers to best meet the needs of the employer.
In an attempt to lower healthcare and workers' compensation expenses
of the employer, healthcare risk/managers supervise the wellness
of the insured prior to a claim activating event as well as monitor
the status of any claimant after the occurrence of an insurance
activating event. Healthcare/risk managers of the current method
are highly trained medical personnel such as registered nurses.
[0011] The present invention is a method of, among other things,
administrating health insurance and workers' compensation coverage
for a group of insured. Generally, a professional employment organization
administers the insurance coverage for an employer. The professional
employment organization can also provide services such as payroll
and tax accounting for the professional employment organization's
co-employees. And within the scope of the present method, the professional
employment organization or the coordinated benefits entity can also
administer such services as retirement planning and other types
of insurances and advice.
[0012] The group of insurance carriers, clearing house or syndicate
provide a pool of insurance polices that can be tailor to the employer's
needs. According to predetermined parameters, the coordinated benefits
entity fashions one or more bundles that can be administrated by
the professional employment organization. It is believed that the
coordinated benefits entity can tailor a bundle of services that
fits virtually any employer's insurance universe.
[0013] An aspect of the present invention is to provide wellness
services for a group of insured.
[0014] Still another aspect of the present invention is to provide
a method for managing an assortment of administrative, human resource
and insurance responsibilities for a group of an employer's employees.
[0015] It is another aspect of the present invention to enable
a method for providing one or more bundles of insurance, human resource
and administrative services to one or more employers.
[0016] Yet another aspect of the present invention is to provide
a method of collecting actuarial data regarding each of the insured,
wherein the actuarial data relates to the insured wellness prior
to participation in the current method and the insured's wellness
after participation in the current method.
[0017] Still another aspect of the present invention is to provide
a method of reducing healthcare and workers' compensation insurance
costs of doing business for an employer.
[0018] Yet still another aspect of the present invention is to
provide a healthier workplace for the employer's employees.
[0019] It is still another aspect of the present invention to provide
a method of reducing employee turnover.
[0020] Still another aspect of the present invention is to provide
an method of providing better healthcare for the insured.
[0021] It is still another aspect of the present invention to provide
a method of reducing employee accidents at the workplace.
[0022] An embodiment of the present invention can be described
as a method for managing an assortment of administrative, human
resource and insurance responsibilities for a group of an employer's
employees comprising the steps of: establishing a coordinated benefits
entity responsible for coordinating said assortment of administrative,
human resource and insurance responsibilities; relegating the administrative
and insurance responsibilities to a professional employment organization
or an insurance carrier; transferring select management functions
from the employer to the professional employment organization such
that the group of employees become co-employees of the professional
employment organization; transferring management of health insurance
and workers' compensation responsibilities from the employer to
the insurance carrier, wherein the management of the health insurance
and the workers' compensation responsibilities further comprise
the steps of: issuing one or more policies, prior to an occurrence
of an insurance claim activating event, assigning a healthcare/risk
manager to supervise health status of each insured and on the occurrence
of an insurance claim activating event, having the healthcare/risk
manager monitor medical treatments and subsequent compliance by
any claimant; and according to predetermined parameters established
by the coordinated benefit entity, communicating said healthcare
manager's observations to said employer.
[0023] Another embodiment of the present apparatus can be described
as a method for providing one or more bundles of insurance, human
resource and administrative services to one or more employers comprising
the steps of: establishing a coordinated benefits entity responsible
for coordinating sales of one or more of said bundles to one or
more of employers, wherein the coordinated benefits entity further
comprises: a clearing house for one or more insurance carriers;
affiliating a plurality of representatives with the clearing house;
having one or more of said representatives sell one or more bundles
to one or more of employers; for each employer converting to one
or more bundles, prior to converting to one or more bundles, having
one or more representatives collect actuarial data regarding each
converting employer's current insurance, human resource and administrative
practices; and reporting the actuarial data to the coordinated benefits
entity.
[0024] Yet another embodiment of the present invention and method
can be described as a method of providing wellness services to a
group of an employer's employees comprising the steps of: transferring
select administrative functions from the employer to a professional
employment organization; creating a risk underwriting syndicate
of insurance carriers for underwriting risks of health insurance
coverage and workers' compensation benefits; making health insurance
and workers' compensation coverage available for the insured; establishing
an entity for coordinating and integrating operations of the professional
employment organization and the risk underwriting syndicate; administrating
the health insurance coverage and the workers' compensation benefits
through the professional employment organization; prior to an occurrence
of any claim activating event, assigning a healthcare/risk manager
to supervise health status of the insured; and upon an occurrence
of a claim activating event, having the healthcare/risk manager
monitor medical treatments and subsequent compliance by any of the
insured.
[0025] In still another embodiment, the present invention can be
described as a method of reducing costs of doing business for an
employer comprising the steps of: affiliating one or more healthcare/risk
managers with an entity: assigning the one or more healthcare/risk
managers to regularly supervise persons insured by one or more insurance
policies; after any filing of a claim by any claimant, having at
least one of the healthcare/risk managers monitor medical treatments
and subsequent compliance of any claimant filing a claim; coordinating
interaction between one or more insurance carriers and the entity;
and administrating the healthcare coverage and the workers' compensation
coverage.
[0026] Yet another embodiment of the present device can be described
as a method of reducing insurance costs of doing business for an
employer comprising the steps of: affiliating one or more healthcare/risk
managers with an entity; assigning one or more healthcare/risk managers
to regularly supervise persons insured by one or more insurance
policies; having one or more healthcare/risk managers encourage
supervised persons to lead a generally healthier lifestyle; after
any filing of a claim by any claimant against any policy, having
at least one of the healthcare/risk managers monitor medical treatments
and subsequent compliance of any claimant; and administrating the
healthcare coverage and said workers' compensation coverage.
[0027] It is the novel and unique interaction of these simple elements
which creates the methods of the present invention. Pursuant to
Title 35 of the United States Code, descriptions of preferred embodiments
follow. However, it is to be understood that the best mode descriptions
do not limit the scope of the present invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0028] FIG. 1 is a depiction of an aspect of an embodiment of the
present method.
[0029] FIG. 2 is a depiction of another aspect of an embodiment
of the present method.
[0030] FIG. 3 is a depiction of another aspect of an embodiment
of the present method.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0031] Although the disclosure hereof is detailed to enable those
skilled in the art to practice the invention, the embodiments published
herein merely exemplify the present invention.
[0032] In the most general sense, a preferred embodiment of the
present invention is a method of managing an assortment of administrative,
human resource and insurance responsibilities for a group of employees.
With a view toward FIG. 1, employer (100) employs group (200) of
employees. When practicing one of the preferred embodiments, employer
(100) engages professional employment organization (PEO) (300) to
administer select employer responsibilities, such as payroll, tax
accounting, health insurance plans and workers' compensation benefits.
PEO (300) can be affiliated with Coordinated Benefits Entity (CBE)
(500) that can be affiliated with one or more insurance carriers
(400). In select preferred embodiments, PEO (300) and insurance
carriers (400) can be integral components of CBE (500), while in
other select preferred embodiments, CBE (500) is simply affiliated
with one or more insurance carriers (400). In accordance with the
present method and predetermined parameters, CBE (500) can control
the pathways and direction for informational exchange between employer
(100), PEO (300) and/or one or more insurance carriers or syndicate
(400).
[0033] Due to economies of scale, PEO (300) can provide, among
other things, the previously identified administrative services
to employer (100) more economically than if employer (100) directly
provided the services to group (200). In accordance with an embodiment
of the present invention, group (200) employees become co-employees
of PEO (300). And select embodiments of the present method can also
have PEO (300) offering retirement, other insurances and financial
services.
[0034] In many embodiments of the current method, employer (100)
determines the scope of health care coverage made available to group
(200) through PEO (300) and CBE (500) secures one or more insurance
carriers (400) to underwrite the health care coverage selected by
employer (100). In select embodiments, CBE (500) can make coverage
available directly to employer (100) rather than through PEO (300).
Insurance carriers (400) underwrite one or more health insurance
polices for group (200) and all insured covered by the health insurance
policy or policies. Within the scope of this preferred embodiment,
PEO (300) also administers workers' compensation benefits for employer
(100), and CBE (500) secures one or more insurance carriers or an
insurance syndicate (400) to underwrite the workers' compensation
care coverage. In select embodiments, CBE (500) can make workers'
compensation coverage available directly to employer (100) rather
than through PEO (300).
[0035] As shown in toward FIG. 1, healthcare/risk manager (600)
is affiliated with PEO (300); healthcare/risk manager (604) is affiliated
with one or more insurance carriers (400) and healthcare/risk manager
(602) is affiliated with CBE (500). In other embodiments, all three
healthcare/risk managers could be affiliated with a single component,
or two of the healthcare/risk managers could be associated with
the same component while the third healthcare/risk manager could
be affiliated with one of the remaining two components. Importantly,
preferred embodiments of the present invention can practice more
or less than three healthcare/risk managers.
[0036] In accordance with the present invention, CBE (500) establishes
parameters to govern the duties of healthcare/risk managers (600,
602 and 604) when interacting with group (200), any insured or claimant.
Examples of such parameters include but are not limited to evaluating
repetitive Monday morning absences by employees and reevaluation
the patient's injury within seven days after consultation with a
physician. Prior to an occurrence of a claim activating event, healthcare/risk
managers of the present embodiment supervise group (200) and all
insured to monitor wellness and health consequences associated with
any insured's lifestyle. From time to time, one or more healthcare/risk
managers can report on the status of any member of group (200) or
any insured to PEO (300), insurance syndicate (400) or CBE (500),
who may thereafter forward the healthcare/risk manager's observations
to employer (100). As the need presents itself, one or more healthcare/risk
managers (600, 602 and 604) can suggest to any insured changes to
enhance a healthier lifestyle for the insured. Suggestions can include
behaviors relating to diet, exercise, or other wellness issues.
After an occurrence of a claim activating event, one or more healthcare/risk
managers (600, 602 or 604) will monitor medical treatments and subsequent
compliance for any healthcare claimant or workers' compensation
claimant or beneficiary. Observations of the healthcare manager
can be reported to PEO (300) and/or CBE (500). PEO (300) may also
report the healthcare/risk manager's observations to employer (100).
In accordance with the current preferred embodiment, the healthcare/risk
manager can monitor medically related activities of the claimant--the
monitoring can be face-to-face, telephonic, or by any other means
acceptable in the art. Some examples of monitored activities include
medical appointments, frequency of medical appointments, post-treatment
therapies and compliance with the practitioner's treatment plan
and prescription regimen. And when the need arises, the healthcare/risk
manager can make suggestions to improve the claimant's treatment.
[0037] Among other things, FIG. 2 portrays insurance universe (190)
of insured within the scope of the present invention. Group (200)
of employer's (100) employees and PEO's (300) co-employees includes
employees (202, 204, 206, 208, 210, 212, 214, 216, 218, 220, 222
and 224) are a part of insurance universe (190). Spouses 202S, 204S,
206S, 218S, 222S and 224S and children 210C, 216C, 218C, 222C, 224C.sup.1,
224C.sup.2, 224C.sup.3, 224C.sup.4 and 224C.sup.5 also form part
of insurance universe (190). Only PEO's (300) co-employees (200-224)
are covered under the workers' compensation policy, but the healthcare
policy also covers family members of co-employees (200-224).
[0038] A simplistic representation of the supervising and monitoring
functions of healthcare/risk manager (600) is depicted in FIG. 2.
Periodically, healthcare/risk manager (600) supervises the wellness
status of each member of insurance universe (190). As portrayed,
healthcare/risk manager is supervising the wellness of co-employee
(216). At the same time, healthcare/risk manager is monitoring the
workers' compensation rehabilitation claim of co-employee (208)
who is undergoing physical therapy. And healthcare/risk manager
is also monitoring the status of co-employee's (224) health insurance
claim for child (224C.sup.5) who is being treated by the pediatrician
with antibiotics for a middle ear infection. In accordance with
the present embodiment, healthcare/risk manager (600) reports the
status of co-employee (208), co-employee (216) and child (224C.sup.5)
to PEO (300). PEO (300) can relay the reports to insurance carriers
(400) who may thereafter make suggestions to healthcare/risk manager
(600) regarding the wellness or treatments of co-employee (208),
co-employee (216) and child (224C.sup.5). Of course, healthcare/risk
manager is a highly trained medical professional, such as a registered
nurse or other equivalently trained medical professional, who can
make suggestions to co-employee (208), co-employee (216) and child
(224C.sup.5) independent from insurance carriers' (400) suggestions.
[0039] Another preferred embodiment of the present method is depicted
in FIG. 3. In a general sense, this embodiment is a method of providing
one or more bundles of insurance, human resources and administrative
services to employers. Coordinated benefits entity (CBE) (500) includes
a clearing house or syndicate (540) for one or more insurance carriers
(402, 404, 406, 408, 410, 412) and coordinator (570). The plurality
of insurance carriers (402, 404, 406, 408, 410, 412) underwrite
policies that cover health insurance risks or workers' compensation
risks or both. Clearing house (540) can be a person-to-person sales
environment, a computer system or a combination of both a person-to-person
(542, 544, 546) sales environment that includes a computer system
(548). In a similar fashion, coordinator (570) can be one or more
individuals (572 and 574), a computer system (578) or a combination
of one or more individuals (572 and 574) and a computer system (578).
Once of coordinator's (570) functions is to match the appropriate
insurance carrier's policy to employer (100). Clearing house (540)
and coordinator (570) intercommunicate in any manner acceptable
in the art, i.e., person-to-person, computer-to-computer, person-to-computer
or computer to person.
[0040] Representatives (802, 804 and 806) are affiliated with clearing
house (540) and representatives (808, 810 and 812) are affiliated
with coordinator (540). Any of representatives (802, 804, 806, 808,
810 and 812) can approach one or more employers (102, 104, 106 and
108) as allowed by law and offer to sell the employers one or more
bundles of insurance, human resource and administrative services.
Bundles of insurance, human resource and administrative services
sold by the representatives (802, 804, 806, 808, 810 and 812) include
a professional employment organization component, a health insurance
coverage component and a workers' compensation coverage component.
As shown in FIG. 3, representative (812) has sold a bundle of insurance,
human resource and administrative services to employer (102).
[0041] Another group of representatives (820, 822 and 824) are
also associated with CBE (500). Prior to providing the bundle of
insurance or insurance policies, human resource and administrative
services to converting employer (102), one or more representatives
(820, 822 and/or 824) collect actuarial data from employer (102)
regarding employer's current insurance, human resource and administrative
practices. Examples of actuarial data that can be collected by one
or more representatives (820, 822 and/or 824) include such observations
as employees' Monday absenteeism rate, employees' compliances with
treatment schedules and regimens, employees' compliances with treatment
schedules and regimens and their corresponding absenteeism rate,
employees' compliances with drug therapy and said employees' compliances
with drug therapy and their corresponding absenteeism rate. Other
types of actuarial data collected can relate to the insured's wellness
prior to participation in the current method as well as the insured's
wellness post participation in the current method.
[0042] Actuarial data collected by representatives (820, 822 and/or
824) can be subsequently incorporated into a database of computer
system (578), which, among other things, can thereafter be utilized
by coordinator (570) to better match insurance coverage for employers.
Computer system (578) can also be utilized to select or partially
select one or more policies for insuring health coverage and workers'
compensation coverage. And depending on the programming selected
by CEB (500), computer system (578) can also be used to assist with
the management of the assortment of administrative, human resources
and insurance responsibilities. In accordance with the present method,
the collected actuarial data can be analyzed to, among other things,
tailor bundles and/or other services for both employers and the
insured.
[0043] Having disclosed the invention as required by Title 35 of
the United States Code, Applicant now prays respectfully that Letters
Patent be granted for his invention in accordance with the scope
of the claims appended hereto.
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