Insurance Notification System for Supplemental Coverage Eligibility
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Solution Overview
Problem
Employees often fail to utilize supplemental or secondary insurance benefits, leading to missed opportunities for additional coverage, as they do not submit claims to secondary insurance providers despite having coverage available.
Innovation Solution
A system and method for identifying users with primary insurance claims and determining eligibility for supplemental coverage, then notifying users of potential coverage through a notification system that matches user data with insurance claim information to encourage submission of claims to secondary insurance providers.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If employees obtain supplemental or secondary insurance, then coverage benefits are improved, but utilization rate deteriorates (employees do not submit claims)
Solution Approach 1:
The system implements feedback by automatically notifying employees about their supplemental insurance coverage eligibility and benefits. The notification system provides employees with information about their coverage status, encouraging them to submit claims they would otherwise miss, thereby improving utilization rates while maintaining coverage benefits.
2Loss of information
If employees are notified of supplemental coverage eligibility, then awareness is improved, but system complexity increases
Solution Approach 1:
The notification system operates autonomously by automatically matching employee data with insurance claim information to identify eligible employees. The system self-generates and sends notifications without requiring manual intervention, reducing operational complexity while improving awareness of supplemental coverage among employees.
Solution Approach 2:
The system performs preliminary matching of employee data with insurance information before claims are submitted. By pre-identifying eligible employees and sending notifications in advance, the system simplifies the subsequent claims process and reduces the complexity of real-time processing.
Data Source
AI summary
Systems, methods, apparatuses and computer-readable media for receiving data associated with a plurality of users, such as a group of employees receiving benefits from an employer. The plurality of users may have a primary insurance provider. Insurance information associated with one or more covered services or claims submitted may be received from the primary insurance provider and matched to the plurality of users to identify a portion (or any) of the users who have submitted a claim or received covered services. In some arrangements, a determination may be made as to whether the identified users have supplemental coverage. If so, a notification may be transmitted to the user indicating eligibility for coverage.