Benefits administration system and methods of use and doing business

Abstract

An automated benefit administration system and methods of use and doing business. The full system includes a wide range of features including application of business rules to enrollment, eligibility, and maintenance data input, making of business decisions based on the specific data entered, and issuing of notices based on business rule discrepancies including notices to third parties when deemed appropriate. The full system also is secure while providing remote access, including through the Internet, limits access based on user hierarchy, allows user customization of various features including communications vehicles (e-mail, letter correspondence, or facsimile) and of the format of certain communications, provides automatic enrollment in Cobra without re-entry of beneficiary data, accomplishes various types of financial reconciliation, accommodates differing organizational structures and groupings of entities, provides business rule over-ride capability for certain users, and provides robust information about carriers and their services.

Description

CROSS REFERENCE TO RELATED APPLICATIONS[0001]This application is a continuation of U.S. patent application Ser. No. 11 / 006,278, filed Dec. 6, 2004, entitled “Benefits Administration System and Methods of Use and Doing Business,” the disclosure of which is hereby incorporated by reference. U.S. patent application Ser. No. 11 / 006,278 claims the benefit of U.S. Provisional Patent Application Ser. No. 60 / 526,961, filed Dec. 5, 2003, entitled “Benefit Administration System and Methods of Use and Doing Business,” the disclosure of which is hereby incorporated by reference.[0002]The following document is a copyrighted text. All copyrights are reserved as allowed by law.BACKGROUND[0003]The present invention relates to benefits administration systems and methods of use and doing business. The present invention also relates to automated systems for administering benefits.[0004]In business and industry, benefits plans are common. They often include health care, savings or retirement plan, insu...

AI Technical Summary

Benefits of technology

[0027]In summary, the present invention relates to an automated benefit administration system and methods of use and doing business. In certain embodiments, a full system includes a wide range of features including application of business rules to enrollment, eligibility, and maintenance data input, making of business decisions based on the specific data entered, and issuing of notices based on business rule discrepancies including notices to third parties when deemed appropriate. The full system also is secure while providing remote access, including through the Internet, limits access based on user hierarchy, allows user customization of various features including communications vehicles (e-mail, letter correspondence, or facsimile) and of the format of certain communications, provides automatic enrollment in COBRA without re-entry of beneficiary data, accomplishes various types of financial reconciliation, accommodates differing organizational structures and groupings of entities, provides business rule over-ride capability for certain users, and provides robust information about carriers and their services.

Problems solved by technology

Administration of benefits has long presented a substantial challenge for business and industry.

em">j. The Phoenix system included numerous limitations and issues, however, including:k. limited carrier data such as not including data (only zip codes and rates);l. lack of automated creation of a Cobra record from information already in the system for a given beneficiary;m. with regard to issuance of notices for enrollment or re-qualification, lacked ability select sub-groups (e.g., groups under 5 employees) for issuance of notices only to them, and also lacked automatic termination of groups that do not re-qualify;n. providing notice of termination of a group to a carrier prior to expiration of a re-qualification period for the group including Cobra members of the group;o. lack of automatic changing of employee status upon change of employee coverage (e.g., by changing from employee-only coverage to employee and spouse coverage), along with lack of automated corrected billing as a result of the change;p. lack of automated reconciliation of cash upon closing of a batch of inputted premium checks, and automatic reconciling of premium notices with payments provided by multiple payments (e.g., multiple checks providing payment for a particular premium amount);q. limited application of business rules to ensure correct data entry and limiting of enrollment as allowed by the rules, and relatedly, no ability to issue notices other than on-screen notices of certain limited types of information that may be missing;r. limited ability to generate required notices, and limited or no ability to send notices through differing media (e-mail, mail, fax);s. no ability to allow system access through remote or separate networks, such as via the Internet;t. no ability to reconcile payments that do not exactly match invoice amounts, and no ability to issue notices based on matching discrepancies; andu. limited data handling capacity, requiring periodic purge data to run the system.< /

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