Private Health Insurance Exchange System and Method

Abstract

Systems and methods for the distribution, equalization and mitigation of risks in an insurance exchange, and specifically to that of a private health insurance exchange system and method that rewards / punishes those attempting to poach or game it. The system and method also includes a way to create an insurance exchange so that those providers participating may get all or a fraction of any losses that exceed pre-established limits reimbursed to them as part of a payment by those providers participating in the exchange who received gains exceeding their expectations.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS[0001]This application claims priority to co-pending U.S. Provisional patent application Ser. No. 61 / 832,913 titled “Mechanism for Movement of a Mirror in an Interferometer, an Interferometer Incorporating the Same and a Fourier Transform Spectrometer Incorporating the SamePrivate Health Insurance Exchange System and Method”, filed on Jun. 9, 2013 the disclosure of which is herein incorporated by reference in its entirety.PATENTS CITED[0002]The following documents and references are incorporated by reference in their entirety, Kelly et al (US Pat. Pub. No.-2008 / 0221944), Ilgenfritz (U.S. Pat. No. 8,612,266), Krughoff et al (US Pat. Pub. No. 2014 / 0114674), Varanasi et al U.S. Pat. No. 8,251,567), McNamee et al (U.S. Pat. No. 8,260,638,), Fisher et al (US Pat. Pub. No. 2009 / 0164256), Shea et al (US Pat. Pub. No. 2005 / 0197952), Kumar et al (US Pat. Pub. No. 2006 / 0100912).FIELD OF THE INVENTION[0003]The present invention relates to a system and met...

AI Technical Summary

Benefits of technology

The present invention is about a system and method for sharing risks among insurance policyholders through a health exchange. The system includes interface components for confirming the agreement to share risks, computer components for calculating a range of medical loss ratios (MLRs) for each service provider, and recommending a range of suitable premiums based on the MLRs. The system also has computer components for collecting data and evaluating the performance of each insurance member over a period of time against the established MLRs, as well as providing computer components for calculating individual and combined companies MLRs to assess financial obligations or rewards for each service provider. The method may also use a pre-agreed adjusted experience factor in the assessment of financial rewards or obligations. The technical effects of the invention are to allow for a more efficient and effective sharing of risks among insurers, while reducing costs and improving performance.

Problems solved by technology

Although the American Care Act makes significant progress in terms of access and fairness in the insurance marketplace, there is concern that the fundamental causes of rising costs have not been addressed.

If the provider underestimates, then the company will expend significantly more resources than those billed, losing money.

The above in effect means that those providing the expensive coverage, are bound to have only employees with many expenses, reducing the pool of healthy members necessary to distribute the risks.

But the natural fragmentation of covered insurance groups creates the possibility of insurance companies ‘gaming the system’ in order to subscribe only healthy adults.

Images