Insurance support system

Abstract

This provides an insurance support system that is ideal for increasing the incentive for dental clinics to engage in preventive dentistry for their patients. [Solution] The mutual aid support server 100 registers dental information related to teeth eligible for benefits in the storage device 42, associating it with the clinic ID and patient ID. It also registers performance information related to the treatment received for the teeth eligible for benefits in the storage device 42, associating it with the clinic ID and patient ID. For dental clinics and patients related to benefit claims, it generates benefit information related to benefit payments based on the contract information, dental information, benefit claim information and performance information in the storage device 42. This allows the applicability or extent of mutual aid to be set for each patient's teeth, enabling dental clinics that are aware of the condition of the patient's teeth to control mutual aid risk.

Description

Technical Field

[0001] The present invention relates to a system for supporting insurance underwriting, and particularly to an insurance support system suitable for improving the incentive for a dental clinic to engage in preventive dentistry for patients.

Background Art

[0002] Conventionally, as a technique for supporting insurance underwriting, for example, the technique described in Patent Document 1 is known.

[0003] The technique described in Patent Document 1 compares the free medical expenses of a patient at a dental clinic with the payment amount to the patient regarding life insurance that should be collateral based on the life insurance information storage unit when the patient at the dental clinic is an insured person of life insurance including the dental contract. Then, based on the comparison result, in the payment of the free medical expenses to the dental clinic, a part of the medical expenses is borne, and it is determined whether to advance the free medical expenses to the dental clinic on behalf of the insured person, and the method and amount are calculated.

Prior Art Documents

Patent Documents

[0004]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0005] However, the technology described in Patent Document 1 had the problem that dental clinics did not have an incentive to engage in preventive dentistry for their patients. In other words, with the technology described in Patent Document 1, insurance money from insurance companies can be used to pay for private treatment fees, so while dental clinics may have an incentive to recommend expensive or frequent private treatments, this is counterproductive to dental clinics engaging in preventive dentistry for patients and minimizing the need for treatment for patients in the future. This is because if a patient's teeth are healthy, the clinic's revenue from treatment fees will be lower.

[0006] Therefore, the present invention has been made in view of the unresolved problems of the conventional technology, and aims to provide an insurance support system suitable for improving the incentive for dental clinics to engage in preventive dentistry for their patients. [Means for solving the problem]

[0007] [Invention 1] To achieve the above objective, the insurance support system of Invention 1 is an insurance support system that supports insurance underwriting and comprises: a contract information registration means for each of a plurality of dental clinics, where the dental clinic is the insurer and the patient who visits the dental clinic is the insured, and contract information relating to an insurance contract that provides benefits according to the dental treatment received by the insured by the insurer or by a dental clinic approved by the insurer, in association with insurer information relating to the insured and insured information relating to the insured; a benefit claim information registration means for registering benefit claim information relating to a claim for benefits related to the insurance contract, and performance information relating to the dental treatment received by the insured by the insurer relating to the claim or by a dental clinic approved by the insurer, in association with insurer information relating to the insurer and insured information relating to the insured; and a benefit information generation means for generating benefit information relating to benefits related to the insurance contract for the insurer and insured, based on the contract information, benefit claim information and performance information in the storage means.

[0008] In this configuration, contract information is registered in the storage means by the contract information registration means, and the payment claim information and performance information are registered in the storage means by the payment claim information registration means. Then, the payment information generation means generates payment information based on the contract information, payment claim information and performance information.

[0009] Here, in order to understand the technical scope of the present invention, "insurance contract," "insurer," "insured," and "insurance premium" refer to the "insurance contract," "insurer," "insured," and "insurance premium" as defined in Article 2 of the Insurance Act, and this includes "mutual aid contract," "mutual aid provider," "mutual aid beneficiary," and "mutual aid premium." In other words, the term "insurance" as described in the claims and the "means for solving the problem" section is a broader term that includes mutual aid and insurance in the narrow sense.

[0010] Furthermore, dental treatment includes, for example, diagnosis, treatment, preventive procedures, surgery, and other medical services related to dentistry, as well as medical services provided under health insurance, private practice, and other methods.

[0011] Furthermore, the storage means stores contract information by any means and at any time. The contract information may be stored in advance, or it may not be stored in advance, but rather stored in the system through external input or other means during operation. The same applies to the request information storage means and other storage means below.

[0012] Furthermore, storing contract information in association with insurer information includes, for example, (1) directly storing the contract information and insurer information in the same record, and (2) storing the information through one or more intermediate pieces of information, such as having a table that stores the contract information and intermediate information in association, and another table that stores the insurer information and intermediate information in association. In other words, any data structure can be adopted as long as it is possible to trace the contract information from the insurer information. Note that contract information only needs to be stored in the storage means in association with the insurer information, and it is not necessarily required that the insurer information be stored in the storage means. The same applies to the concept of storing information in association below.

[0013] Furthermore, this system may be implemented as a single device, apparatus, terminal, or other device, or as a network system in which multiple devices, apparatus, terminals, or other devices are connected in a communicative manner. In the latter case, each component may belong to any of the multiple devices, as long as it is connected in a communicative manner.

[0014] [Invention 2] Furthermore, the insurance support system of Invention 2 is the insurance support system of Invention 1 in which the contract information includes insured tooth information regarding the teeth of the insured that are eligible for benefits and whether or not benefits are available or to what extent, and the performance information is performance information regarding the treatment that the insured has received from the insurer for the teeth that are eligible for benefits.

[0015] With this configuration, the benefit information generation means generates benefit information for the insurer and insured person involved in the benefit claim, based on insured tooth information, benefit claim information, and performance information regarding the teeth covered by the insurer and the treatment history received by the insured person regarding the eligibility or extent of the benefit.

[0016] [Invention 3] Furthermore, the insurance support system of Invention 3 is an insurance support system of either Invention 1 or 2, wherein the benefit information is point information relating to points, and the system includes: an expense claim information registration means for registering expense claim information relating to the insurer's claim for expenses made by the insurer to the insured person in association with insurer information relating to the insurer and insured person information relating to the insured person; a point usage information registration means for registering point usage information relating to the use of points in association with insurer information relating to the insurer to whom the points are used and insured person information relating to the insured person applying for the use of the points; and a settlement information generation means for generating settlement information for expenses based on the expense claim information and point usage information in the storage means for the insurer and insured person relating to the claim for expenses.

[0017] With such a configuration, point information regarding points is generated by the benefit information generation means. The cost claim information is registered in the storage means by the cost claim information registration means, and the point usage information is registered in the storage means by the point usage information registration means. Then, the settlement information generation means generates settlement information based on the cost claim information and the point usage information.

Effect of the Invention

[0018] As described above, according to the insurance support system of Invention 1, for a dental clinic as the insurer, since the insurance premium income increases as the degree or frequency of treatment for a patient as the insured decreases, compared to the conventional situation, the dental clinic can improve the incentive to engage in preventive dentistry for patients.

[0019] Furthermore, according to the insurance support system of Invention 2, since it is possible to set the applicability or degree of insurance for each tooth of the insured, a dental clinic that grasps the tooth condition of the patient can control the insurance risk as the insurer.

[0020] Furthermore, according to the insurance support system of Invention 3, since the benefits related to the insurance contract can be received as points and used for dental treatment, etc. in the dental clinic, it is possible to seamlessly perform claims, benefits, and utilization related to the insurance contract.

Brief Description of the Drawings

[0021] [Figure 1] It is a block diagram showing the configuration of the network system. [Figure 2] It is a diagram showing the hardware configuration of the mutual aid support server 100. [Figure 3] It is a table showing the contents of the main contract and special terms of the mutual aid. [Figure 4] It is a table showing the purpose, concept, and benefit rate for each tooth of the underwriting criteria. [Figure 5] It is a diagram showing the data structure of various tables. [Figure 6] It is a diagram showing the flow when a dental clinic introduces and provides mutual aid. [Figure 7] It is a diagram showing the process when a patient visits a dental clinic for preventive treatment and receives benefits. [Figure 8] It is a diagram showing the process when a patient receives treatment at a dental clinic and receives benefits.

Embodiments for Carrying out the Invention

[0022] Hereinafter, embodiments of the present invention will be described. FIGS. 1 to 8 are diagrams showing this embodiment. In this embodiment, when an insurance company (hereinafter simply referred to as "insurance") that pays benefits according to the results of dental treatment received by the insured from the insurance company takes on the insurance, with the dental clinic as the insurer and the patients visiting the dental clinic as the insured, and when a service providing company provides a service (hereinafter referred to as "operation service") for taking on and operating the insurance to each dental clinic, it will be described.

[0023] 〔Configuration of This Embodiment〕 First, the configuration of this embodiment will be described. FIG. 1 is a block diagram showing the configuration of a network system.

[0024] As shown in FIG. 1, on the Internet 199, an insurance support server 100 that supports the acceptance of insurance, a hospital terminal 200 used by each of a plurality of dental clinics, and a patient terminal 300 used by each of a plurality of patients are communicably connected.

[0025] 〔Insurance Support Server 100〕 Next, the hardware configuration of the insurance support server 100 will be described.

[0026] FIG. 2 is a diagram showing the hardware configuration of the insurance support server 100. As shown in Figure 2, the mutual aid support server 100 consists of a CPU (Central Processing Unit) 30 that controls calculations and the entire system based on a control program, a ROM (Read Only Memory) 32 that stores the control program for the CPU 30 in a predetermined area, a RAM (Random Access Memory) 34 for storing data read from the ROM 32 and other memory, as well as calculation results necessary for the calculation process of the CPU 30, and an I / F (Interface) 38 that mediates data input and output to external devices. These components are connected to each other and enable data exchange via a bus 39, which is a signal line for data transfer.

[0027] I / F38 is connected to external devices including an input device 40 consisting of a keyboard and mouse for data input as a human interface, a storage device 42 for storing data and tables as files, and a display device 44 that displays a screen based on image signals. I / F38 also functions as a network adapter and is connected to signal lines for connecting to the Internet 199.

[0028] [Clinic terminal 200] Next, we will explain the hardware configuration of the 200 hospital terminals. The hospital terminal 200, like the mutual aid support server 100, has a hardware configuration similar to that of a typical computer, with a CPU, ROM, RAM, and I / F connected via a bus. The hospital terminal 200 can be configured as, for example, a desktop PC, smartphone, or tablet terminal.

[0029] [Patient terminal 300] Next, we will describe the hardware configuration of the patient terminal 300. The patient terminal 300, like the mutual aid support server 100, has a hardware configuration similar to that of a general computer, with a CPU, ROM, RAM, and I / F connected via a bus. The patient terminal 300 can be configured as, for example, a desktop PC, a smartphone, or a tablet device.

[0030] [Details of the mutual aid] Next, I will explain the details of the mutual aid program. Figure 3 is a table showing the contents of the main contract and special provisions of the mutual aid agreement.

[0031] As shown in Figure 3, a mutual aid contract consists of a main contract, which is mandatory, and optional riders.

[0032] The main contract includes coverage for visits to a dental clinic for preventive treatment as part of dental care (hereinafter referred to as "preventive visits") and coverage for treatment as part of dental care. Regarding the coverage for preventive visits, for example, a predetermined number of points (3,000 points in the example in Figure 3) are set as benefits, and 3,000 points are paid to the insured for each preventive visit, up to a maximum of twice a year. Regarding the coverage for treatment, for example, predetermined benefit amounts are set as benefits (50,000 yen, 50,000 yen, 100,000 yen, and 200,000 yen depending on the type of treatment in the example in Figure 3). For each treatment, the predetermined benefit amount is paid to the insured. The main contract also includes a predetermined mutual aid premium (1,500 yen per month in the example in Figure 3).

[0033] The special provisions include, for example, coverage for teeth whitening or cosmetic treatment. The coverage for teeth whitening or cosmetic treatment includes, for example, a predetermined benefit payment (15,000 yen in the example in Figure 3) and a predetermined mutual aid premium (800 yen per month in the example in Figure 3). If the patient meets certain conditions (for example, not having undergone any treatment for one year), they can receive teeth whitening or cosmetic treatment at a discount equivalent to the benefit payment.

[0034] Figure 4 is a table showing the purpose and rationale behind the underwriting criteria, as well as the benefit rate for each tooth. As shown in Figure 4, the main contract allows for setting a benefit rate for each patient's tooth. This means that patients who receive treatment will be paid an amount calculated by multiplying the benefit set for that treatment by the benefit rate set for the treated tooth.

[0035] In the example in Figure 4, four benefit rates are set according to the condition of the patient's teeth: 100%, 70%, 30%, and 0%. For example, if a tooth with a 100% benefit rate receives the root canal treatment shown in Figure 4, 100,000 yen × 100% = 100,000 yen will be reimbursed. If the same treatment is received on a tooth with a 30% benefit rate, 100,000 yen × 30% = 30,000 yen will be reimbursed.

[0036] [Storage device 42] Next, we will explain the data structure of the storage device 42. The memory device 42 stores various tables.

[0037] Figure 5 shows the data structure of various tables. As shown in Figure 5(a), the dental clinic information registration table 400 contains one record for each dental clinic. Each record contains a clinic ID to identify the dental clinic, the name of the dental clinic, the address of the dental clinic, and other information related to the dental clinic.

[0038] A patient information registration table 402 is provided for each dental clinic. As shown in Figure 5(b), one record is registered for each patient in the patient information registration table 402. Each record contains a patient ID to identify the patient, the patient's name, the patient's date of birth, the patient's gender, the patient's contact information (e.g., email address or phone number), the patient's account information, and other information about the patient.

[0039] As shown in Figure 5(c), the service information registration table 404 has one record registered for each dental clinic that receives the operational service. Each record contains the clinic ID of the dental clinic receiving the operational service, the date on which the operational service will be provided (start date), the details of the mutual aid coverage that the dental clinic can underwrite, the terms and conditions of the mutual aid policy, and other information related to the operational service.

[0040] The contract information registration table 406 is provided for each dental clinic. As shown in Figure 5(d), the contract information registration table 406 has one record registered for each patient who has joined the mutual aid program. Each record contains the patient's patient ID, the date of joining the mutual aid program (joining date), the coverage details of the mutual aid program the patient joined, and other information related to the mutual aid contract.

[0041] The dental information registration table 408 is provided for each dental clinic. As shown in Figure 5(e), the dental information registration table 408 registers one record for each patient who has joined the mutual aid program and for each tooth of that patient. Each record contains the patient ID, a tooth ID to identify the patient's tooth, the benefit rate, and other information related to the patient's tooth.

[0042] As shown in Figure 5(f), the billing information registration table 410 has one record registered for each benefit claim. Each record contains the following information: a billing ID to identify the benefit claim, the patient ID of the patient who made the claim, the clinic ID of the dental clinic where the patient received dental treatment, the date the claim was made (billing date), the benefit points paid as a result of the claim, the benefit amount paid as a result of the claim, the date the dental treatment that caused the claim was received (treatment date), the tooth ID of the tooth that caused the claim, the details of the dental treatment that caused the claim, the file name of the receipt related to the dental treatment that caused the claim, and other information related to the benefit claim.

[0043] As shown in Figure 5(g), the point history information registration table 412 registers one record for each point acquisition or use. Each record contains the patient ID of the patient who acquired or used the points, the clinic ID of the dental clinic where the patient acquired or used the points, the date the points were acquired (acquisition date) or used (usage date), the points acquired, the points used, the points held, and other information related to points.

[0044] Next, the operation of this embodiment will be described. In the following explanation, the service provider is referred to as the "operator," the insured party for a single mutual aid contract is referred to as the "dental clinic," and the insured party is referred to as the "patient." Furthermore, the clinic ID, patient ID, and tooth ID can be identified by the mutual aid support server 100 when the dental clinic or patient enters information about the dental clinic, patient, or tooth on the management screen of the mutual aid support server 100. A claim ID is issued by the mutual aid support server 100 for each claim. Additionally, information in tables 400-412 can be mutually referenced via the clinic ID, patient ID, tooth ID, and claim ID.

[0045] First, let's explain the case where a dental clinic introduces a mutual aid system. Figure 6 shows the process when a dental clinic introduces and provides mutual aid services.

[0046] When a dental clinic introduces a mutual aid system, the procedures and processes are carried out in the order of steps S100 to S108, as shown in Figure 6(a). Of these, information processing by a computer is performed in step S104. For information processing, the CPU 30 starts a predetermined program stored in a predetermined area of ​​the ROM 32 and executes according to that program.

[0047] In Step S100, the dental clinic decides to implement a mutual aid system. In Step S102, the planner and the dental clinic determine the details of the mutual aid coverage. For the main contract, if preventive visits are covered, the items and points to be paid for preventive visits are determined; if treatment is covered, the items and benefits for treatment are determined; and the mutual aid premium is determined. If any special riders are added, the items and benefits for treatment and other dental care, as well as the mutual aid premium, are determined for those riders.

[0048] In step S104, the operator creates a mutual aid agreement (a mutual aid contract concluded between the dental clinic and the patient) based on the determined coverage details. Service information related to the determined coverage details and the created mutual aid agreement is stored in the storage device 42, associated with the clinic ID and patient ID. The mutual aid support server 100 retrieves the service information from the storage device 42, and based on the retrieved service information, the clinic ID, start date, coverage details, and mutual aid agreement are registered in the service information registration table 404.

[0049] In step S106, the operator creates a mutual aid leaflet for patient explanation based on the mutual aid agreement that was created.

[0050] In Step S108, the provision of mutual aid will begin. Next, we will explain the case where a dental clinic provides mutual aid.

[0051] When a dental clinic provides mutual aid, the procedures and processing are carried out in the order of steps S150 to S160, as shown in Figure 6(b). Of these, computer information processing is performed in steps S150 to S158.

[0052] In step S150, the operator registers patient information for existing patients in bulk. The storage device 42 stores the patient information for existing patients as a CSV file or similar. The mutual aid support server 100 retrieves the patient information for existing patients from the storage device 42, and based on the retrieved patient information, the patient ID, name, date of birth, gender, and contact information are registered in the patient information registration table 402.

[0053] In step S152, the dental clinic individually registers patient information for new patients. The dental clinic logs into the management screen of the mutual aid support server 100 using the clinic terminal 200 and enters patient information for new patients, which is then sent to the mutual aid support server 100. Upon receiving the patient information, the mutual aid support server 100 registers the patient ID, name, date of birth, gender, and contact information in the patient information registration table 402 based on the received patient information. Registration can be performed each time a new patient is acquired.

[0054] In step S154, the dental clinic registers the benefit rate for each tooth for each patient based on the underwriting criteria set by the dental clinic. The dental clinic logs into the management screen of the mutual aid support server 100 using the clinic terminal 200 and enters the dental information regarding the patient's teeth and benefit rates, and the dental information is sent to the mutual aid support server 100. Upon receiving the dental information, the mutual aid support server 100 registers the patient ID, tooth ID, and benefit rate in the dental information registration table 408 based on the received dental information.

[0055] In step S156, the patient creates an account. When the patient reads a two-dimensional barcode, for example, provided by the dental clinic, using the patient terminal 300, it connects to the mutual aid support server 100 and displays the account creation screen. On the account creation screen using the patient terminal 300, the patient enters the information necessary for account creation (for example, user ID and password), and the entered information is sent to the mutual aid support server 100. When the mutual aid support server 100 receives the information necessary for account creation from the patient terminal 300, it issues an account for the patient based on the received information, and that account information is registered in the patient information registration table 402.

[0056] In step S158, the patient enrolls in the mutual aid contract from their own account. The patient logs in to the management screen of the mutual aid support server 100 on the patient terminal 300, enters the details of the mutual aid coverage (including whether or not there are special riders), and applies for enrollment. Contract information regarding the mutual aid contract is then sent to the mutual aid support server 100. Upon receiving the contract information, the mutual aid support server 100 registers the patient ID, enrollment date, and coverage details in the contract information registration table 406 based on the received contract information.

[0057] Step S160 initiates the mutual aid contract. Next, we will explain the case where a patient receives benefits for preventative dental visits.

[0058] Figure 7 shows the process for a patient to receive benefits when visiting a dental clinic for preventative care. When a patient visits a dental clinic for preventative care and receives benefits, the procedures and processing are carried out in the order of steps S200 to S212, as shown in Figure 7. Of these, computer information processing is performed in steps S204 to S210.

[0059] In Step S200, patients undergo preventative medical checkups. In Step S202, the dental clinic issues a receipt for preventative care visits.

[0060] In step S204, the patient attaches a receipt from their account and requests points. The patient logs into the management screen of the mutual aid support server 100 on the patient terminal 300, attaches the receipt file, and requests benefits related to preventive outpatient visits. Benefit claim information related to the benefit claim is then sent to the mutual aid support server 100. Upon receiving the benefit claim information, the mutual aid support server 100 registers the claim ID, patient ID, hospital ID, claim date, and receipt file in the claim information registration table 410 based on the received benefit claim information.

[0061] Furthermore, when a dental clinic logs in to the management screen of the mutual aid support server 100 using the clinic terminal 200 and enters performance information regarding preventive care visits, the performance information is sent to the mutual aid support server 100. Based on the performance information, the mutual aid support server 100 registers the billing ID, patient ID, clinic ID, treatment date, and details of dental treatment (preventive care visit) in the billing information registration table 410.

[0062] In step S206, the dental clinic approves the claim for benefits and pays the points. The clinic terminal 200 receives a notification from the mutual aid support server 100 that it should approve the claim for benefits, and when it logs into the management screen of the mutual aid support server 100, the claim details are displayed. When the dental clinic approves the claim details, approval information indicating that approval has been given is sent to the mutual aid support server 100. Upon receiving the approval information, the mutual aid support server 100 calculates the benefit points based on the information in the claim information registration table 410 and the contract information registration table 406. Specifically, the clinic ID, patient ID, and treatment details corresponding to the claim ID are obtained from the claim information registration table 410, and the coverage details corresponding to the clinic ID and patient ID are obtained from the contract information registration table 406. Then, the points corresponding to the treatment details among the coverage details are identified, and the benefit points are calculated. The calculated benefit points are registered in the claim information registration table 410 and the point history information registration table 412, associated with the claim ID, clinic ID, and patient ID.

[0063] In step S208, the patient applies to use points from their account. If the patient wishes to use points for dental treatment fees or the purchase of oral care goods, they inform the dental clinic of this at the time of payment. The patient logs in to the management screen of the mutual aid support server 100 using the patient terminal 300 and enters the point usage information, which is then sent to the mutual aid support server 100. Upon receiving the point usage information, the mutual aid support server 100 registers the patient ID, clinic ID, date of use, points used, and points held after use in the point history information registration table 412 based on the received point usage information.

[0064] In step S210, the dental clinic approves the application for point redemption and applies the points as a discount. The dental clinic logs into the management screen of the mutual aid support server 100 using the clinic terminal 200 and enters the expense claim information regarding the billing of dental treatment, etc., and the expense claim information is sent to the mutual aid support server 100. When the mutual aid support server 100 receives the expense claim information, it stores the received expense claim information in the storage device 42, associating it with the clinic ID and patient ID. Subsequently, the dental clinic receives a notification from the mutual aid support server 100 on the clinic terminal 200 that it should approve the application for point redemption, and when it accesses the management screen of the mutual aid support server 100, the application details are displayed. When the dental clinic approves the application details, approval information indicating that approval has been given is sent to the mutual aid support server 100. When the mutual aid support server 100 receives the approval information, expense settlement information is generated based on the expense claim information in the storage device 42 and the information in the point history information registration table 412. If the points used are greater than or equal to the cost, settlement information is generated indicating that the amount the patient must pay is 0 yen. If the points used are less than the cost, the difference between the cost and the points used is calculated, and settlement information is generated indicating that the amount the patient must pay is the difference. However, the points used cannot exceed the points held before use. The settlement information is stored in the storage device 42, associated with the hospital ID and patient ID. The mutual aid support server 100 issues a receipt based on the settlement information, and the hospital terminal 200 prints the receipt and gives it to the patient.

[0065] In Step S212, the administrator will periodically check the contents of the receipt and the approval date (for example, the number of days elapsed since the claim for benefits) to prevent fraud.

[0066] Next, we will explain the case where a patient receives treatment at a dental clinic and is eligible for benefits. Figure 8 shows the process when a patient receives treatment at a dental clinic and is eligible for reimbursement.

[0067] When a patient receives treatment and benefits from a dental clinic, the procedures and processing are carried out in the order of steps S300 to S318, as shown in Figure 8. Of these, computer information processing is performed in steps S304, S306, and S312 to S316.

[0068] In Step S300, the dental clinic determines that treatment is necessary for the tooth that is eligible for the benefit.

[0069] In step S302, the dental clinic creates a treatment plan and obtains the patient's consent to the treatment plan. The consent information regarding the patient's consent may be stored in the storage device 42 by the mutual aid support server 100, associated with the clinic ID and patient ID, through input at the clinic terminal 200 or the patient terminal 300.

[0070] In step S304, the dental clinic sends the treatment plan to the operator. The treatment plan information may be stored in the storage device 42 by the mutual aid support server 100, associated with the clinic ID and patient ID, through input at the clinic terminal 200 or the patient terminal 300.

[0071] In step S306, the operator conducts a review based on the treatment plan and notifies the dental clinic and the patient of the review results. Information regarding the review results may also be notified from the mutual aid support server 100 to the clinic terminal 200 and the patient terminal 300. Since the operator conducts a review in advance of treatment based on the treatment plan, the patient can receive a pseudo-second opinion on the treatment plan without having to visit another dental clinic.

[0072] In step S308, the dental clinic provides treatment to the patient based on the treatment plan. In step S310, the dental clinic issues a receipt for the treatment.

[0073] In step S312, the patient submits a claim for benefits by attaching a receipt from their account. The patient logs into the management screen of the mutual aid support server 100 using the patient terminal 300, attaches the receipt file, and submits a claim for benefits related to treatment. The claim information is then sent to the mutual aid support server 100. Upon receiving the claim information, the mutual aid support server 100 registers the claim ID, patient ID, hospital ID, claim date, and receipt file in the claim information registration table 410 based on the received claim information.

[0074] Furthermore, when a dental clinic logs in to the management screen of the mutual aid support server 100 using the clinic terminal 200 and enters performance information regarding treatment results, the performance information is sent to the mutual aid support server 100. Based on the performance information, the mutual aid support server 100 registers the billing ID, patient ID, clinic ID, treatment date, tooth ID, and details of dental treatment (treatment) in the billing information registration table 410.

[0075] In step S314, the dental clinic approves the claim for benefits and pays the benefits. The clinic terminal 200 receives a notification from the mutual aid support server 100 that it should approve the claim for benefits, and when it logs into the management screen of the mutual aid support server 100, the claim details are displayed. When the dental clinic approves the claim details, approval information indicating that approval has been given is sent to the mutual aid support server 100. Upon receiving the approval information, the mutual aid support server 100 calculates the benefits based on the information in the claim information registration table 410, the contract information registration table 406, and the dental information registration table 408. Specifically, the clinic ID, patient ID, dental ID, and treatment details corresponding to the claim ID are obtained from the claim information registration table 410, the coverage details corresponding to the clinic ID and patient ID are obtained from the contract information registration table 406, and the benefit rate corresponding to the patient ID and dental ID is obtained from the dental information registration table 408. Then, the benefit amount (full amount) corresponding to the treatment received is identified from the coverage details, and the benefit amount is calculated by multiplying the full benefit amount by the benefit rate. The calculated benefit amount is associated with the claim ID, clinic ID, patient ID, and dental ID and registered in the claim information registration table 410.

[0076] In step S316, the operator transfers the benefit payment to the patient's account. In Step S318, the administrator periodically checks receipt details and approval dates (for example, the number of days elapsed since the claim for benefits) to prevent fraud.

[0077] Next, the effects of this embodiment will be described. In this embodiment, the mutual aid support server 100 registers contract information related to mutual aid contracts in the storage device 42 for each dental clinic, associating it with the clinic ID and patient ID. It also registers benefit claim information related to benefit claims and performance information related to dental treatment performance in the storage device 42, associating it with the clinic ID and patient ID. For dental clinics and patients involved in benefit claims, it generates benefit information related to benefit points or benefit payments based on the contract information, benefit claim information and performance information in the storage device 42.

[0078] This means that dental clinics can increase their mutual aid premium income if the extent or number of treatments for patients decreases, thus improving their incentive to engage in preventive dentistry compared to the past.

[0079] Furthermore, in this embodiment, the mutual aid support server 100 registers dental information related to the teeth eligible for benefits in the storage device 42 in association with the clinic ID and patient ID, registers performance information related to the treatment received for the teeth eligible for benefits in the storage device 42 in association with the clinic ID and patient ID, and generates benefit information related to the benefit payment for the dental clinic and patient concerned based on the contract information, dental information, benefit claim information and performance information in the storage device 42.

[0080] This allows for setting the eligibility or extent of coverage for each patient's tooth, enabling dental clinics, who are familiar with the patient's dental condition, to control the insurance risk. Even patients with high insurance risk (for example, patients who already have cavities, or patients who should have teeth extracted but have chosen to keep them) can join the insurance program by setting the eligibility or extent of coverage for each tooth. Conversely, methods used in the insurance industry to determine eligibility for insurance (self-declaration of treatment history, hospitalization history, etc.) do not provide precise risk information, forcing clinics to conclude that patients with high insurance risk are "ineligible." Alternatively, they may accept insurance for patients with high insurance risk, worsening the soundness of the insurance program. By setting the eligibility or extent of coverage for each tooth, it becomes possible to accept insurance for situations such as "this tooth is ineligible, but other teeth are," allowing many patients to join.

[0081] Furthermore, in this embodiment, expense billing information related to the billing of fees for dental treatment, etc., is registered in the storage device 42 in association with the clinic ID and patient ID, point usage information related to the use of points is registered in the storage device 42 in association with the clinic ID and patient ID, and expense settlement information is generated for the dental clinic and patient concerned based on the expense billing information and point usage information in the storage device 42.

[0082] This allows benefits to be received as points, which can then be used for dental treatment at dental clinics, enabling seamless billing, payment, and use of the contract. Petty claims (claims that occur frequently but result in small benefit amounts) are difficult to commercialize as insurance products. This is because the high number of claims increases the administrative burden, but the expected mutual aid premium income does not justify it. In this embodiment, benefits are provided for preventive dental visits in order to incentivize insured persons to engage in preventive dental care, which is precisely a petty claim. Therefore, by providing benefits and allowing use in the form of points instead of cash, the administrative burden can be reduced, thereby achieving both the handling of petty claims and the securing of mutual aid premium income.

[0083] In this embodiment, step S104 corresponds to the contract information registration means of Invention 1, steps S204 and S312 correspond to the benefit claim information registration means of Invention 1, steps S206 and S314 correspond to the benefit information generation means of Invention 1, and step S208 corresponds to the point usage information registration means of Invention 3. Furthermore, step S210 corresponds to the expense claim information registration means of Invention 3 or the settlement information generation means of Invention 3, the storage device 42 corresponds to the storage means of Invention 1 or 3, the hospital ID corresponds to the insurer information of Invention 1 or 3, and the patient ID corresponds to the insured person information of Invention 1 or 3.

[0084] Furthermore, in this embodiment, the benefit points and benefit payments calculated in steps S206 and S314 correspond to the benefit information of invention 1 or 3.

[0085] [Variation] In the above embodiment and its modified form, registration to tables 400 to 412 can be performed by an operator.

[0086] Furthermore, in the above embodiment and its modified form, the mutual aid support server 100 acquires information from the storage device 42, but is not limited to this, and can also receive that information from the hospital terminal 200 or the patient terminal 300. Furthermore, the mutual aid support server 100 receives information from the hospital terminal 200, but is not limited to this, and can also acquire that information from the storage device 42 or receive that information from the patient terminal 300. Furthermore, the mutual aid support server 100 receives information from the patient terminal 300, but is not limited to this, and can also acquire that information from the storage device 42 or receive that information from the hospital terminal 200.

[0087] Furthermore, in the above embodiment and its modified form, points were provided as a benefit for preventive outpatient visits, but the system is not limited to this; monetary benefits can also be provided. Similarly, while monetary benefits were provided as a benefit for treatment, the system is not limited to this; points can also be provided. In other words, it is arbitrary whether to provide points, monetary benefits, or both for dental treatment. The dental treatments covered by the benefits can also be arbitrarily determined.

[0088] Furthermore, in the above embodiment and its modified form, the mutual aid is configured to provide benefits according to the dental treatment received by the insured by the mutual aid. However, it is not limited to this, and can be configured to provide benefits according to the dental treatment received by the insured by a dental clinic approved by the mutual aid, or to provide benefits according to the dental treatment received by the insured by both the mutual aid and a dental clinic approved by the mutual aid. In this case, the claim information registration table 410 registers information regarding the dental treatment received by the insured by a dental clinic approved by the mutual aid.

[0089] Furthermore, in the above embodiment and its modified form, the benefit points were calculated in step S206, but the system is not limited to this, and any calculation method can be adopted. For example, a benefit point (full amount) can be set for each treatment, and the benefit can be calculated by multiplying the benefit points corresponding to the treatment by the benefit rate. Similarly, although the benefit payment was calculated in step S314, the system is not limited to this, and any calculation method can be adopted. For example, one or more dental treatments eligible for benefit payments can be set, and the benefit payment can be calculated when the treatment falls under one of these categories. In addition, all dental treatments eligible for benefit payments may be paid in points, or all may be paid in cash.

[0090] Furthermore, in the above embodiment and its modifications, the mutual aid support server 100 is implemented as a single device, but it is not limited to this, and some functions can be configured on other servers, etc. Also, part or all of the mutual aid support server 100 can be configured as a virtual server on a server that provides cloud computing services.

[0091] Furthermore, in the above embodiment and its modified form, the mutual aid support server 100 is configured to use the storage device 42, but it is not limited to this, and can also be configured to use an external storage device such as a database server.

[0092] Furthermore, while the above embodiments and their modifications have described their application to a network system consisting of the Internet 199, the invention is not limited to this, and may also be applied to, for example, a so-called intranet that communicates using the same method as the Internet 199. Of course, it is not limited to networks that communicate using the same method as the Internet 199, but can be applied to any network using any communication method.

[0093] Furthermore, in the above embodiments and their modifications, the description has been that information processing is performed by executing a program that is pre-stored in ROM32. However, the invention is not limited to this, and a program describing these procedures may be read into RAM34 from a storage medium in which such a program is stored and then executed.

[0094] Here, "storage medium" refers to any storage medium that can be read by a computer, regardless of whether it is an electronic, magnetic, or optical reading medium, including semiconductor storage mediums such as RAM and ROM, magnetic storage mediums such as FD and HD, optical reading mediums such as CD, CDV, LD, and DVD, and magnetic / optical reading mediums such as MO.

[0095] Furthermore, the above embodiments and their variations are mutually applicable. Furthermore, the present invention is applicable not only to the embodiments described above and their modifications, but also to other cases without departing from the spirit of the present invention. For example, the present invention can be applied to cases where an insurance contract in the narrow sense is made, rather than a mutual aid contract. [Explanation of Symbols]

[0096] 100…Mutual aid support server, 30…CPU, 32…ROM, 34…RAM, 38…I / F, 40…Input device, 42…Storage device, 44…Display device, 199…Internet, 200…Clinic terminal, 300…Patient terminal, 400…Dental clinic information registration table, 402…Patient information registration table, 404…Service information registration table, 406…Contract information registration table, 408…Dental information registration table, 410…Billing information registration table, 412…Point history information registration table

Claims

1. An insurance support system that assists in underwriting insurance, A contract information registration means that registers contract information, which includes insured tooth information, in association with insured person information, in a storage means, information relating to an insurance contract in which an insurer provides benefits to an insured person according to the performance of dental treatment, and which includes insured tooth information relating to the teeth of the insured person that are eligible for benefits and whether or not benefits are available. A benefit claim information registration means that registers benefit claim information relating to the claim for benefits under the said insurance contract, and performance information relating to the treatment received by the insured person for the teeth covered by the said benefit in the storage means in association with the insured person's information; An insurance support system characterized by comprising a benefit information generation means that generates benefit information relating to the insurance contract based on the contract information, benefit claim information, and performance information of the storage means for the insured person who has made a claim for the aforementioned benefit.

2. In claim 1, The aforementioned benefit information is point information related to points, A cost billing information registration means that registers cost billing information relating to the billing of expenses made by the dental clinic to the insured person in the storage means in association with dental clinic information relating to the dental clinic and insured person information relating to the insured person, A point usage information registration means that registers point usage information relating to the use of the aforementioned points in association with dental clinic information relating to the dental clinic where the points are used and insured person information relating to the insured person applying for the use of the points, An insurance support system characterized by comprising a settlement information generation means that generates settlement information for the aforementioned expenses based on the expense billing information and point usage information of the storage means, with respect to the dental clinic and the insured person who are billed for the aforementioned expenses.

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