Humana Inc.

Benjamin Slen

Cullen L Reed

Elizabeth D Bierbower

Maureen M Kinser

Jonathan T Lord

Sandra L Bartel

Khalid Nazir

Kyle M Burns

Traci Elliot

Rick Remmers

Melissa L Weaver

Lois E Gargotto

Lisa M Van Den Plas

Beth Bierbower

Beth Grice

Patrick Bryan

Carol J Baker

A health care plan system and method designed to reduce future claims costs through financial incentives with member engagement metrics. Targets are pre-set for member engagement metrics. Claims cost targets for the sponsor are set based on the sponsor meeting member engagement targets. A percentage of health care plan base administrative fees are at risk based on the sponsor's claims cost performance in relation to the claims cost target. If the claims cost target is missed, the health plan administrator repays or reduces administrative fees charged to the sponsor. If the claims cost target is met, the sponsor pays additional fees to the health plan administrator. Base administrative fees are also repaid or reduced if the health care plan administrator fails to meet service performance targets. The sponsor is appraised on progress of member engagement and service performance metrics through scorecards that are sent during the plan year.

Method for using financial incentives with member engagement metrics to reduce health care claim costs

A method for providing insurance coverage to a subscriber comprises offering an insurance policy to the subscriber wherein the insurance policy comprises providing allowances to pay for one or more expenses covered by the insurance policy and providing monetary credits to the subscriber for any unused portion of a given allowance where the monetary credits can be used to cover the cost of a subsequent allowed expense. The insurance policy may be a pharmacy benefits plan. The covered expenses may be pharmacy expenses. The allowed expenses may be medical expenses which qualify under Section 213 of the US Internal Revenue Code for payment by an employer without the subscriber having to declare the payment as taxable income.

Pharmacy personal care account

A method for providing insurance coverage to a subscriber comprises offering an insurance policy to said subscriber wherein said insurance policy comprises providing allowances to pay for one or more expenses covered by said insurance policy and providing monetary credits to said subscriber for any unused portion of a given allowance where said monetary credits can be used to cover the cost of a subsequent allowed expense. The insurance policy may be a pharmacy benefits plan. The covered expenses may be pharmacy expenses. The allowed expenses may be medical expenses which qualify under section 213 of the US Internal Revenue code for payment by an employer without said subscriber having to declare said payment as taxable income.

A method of transaction approval and substantiation employing accumulator logic for medical, dental, and vision claims. For example, a health care plan member may utilize an electronic payment card to pay for various health care related expenses where that electronic payment card is deducting from that member's flexible spending account, health reimbursement arrangement, or other such accounts. For substantiation of a card transaction, in addition to copay matching, paid claim matching, and recurring transaction matching for medical, dental, and vision claims, the method of the current invention further employs accumulator logic processing where the transaction is substantiated if the card swipe amount for that transaction is less than or equal to the sum in an accumulator for the previously paid claims in the appropriate medical, dental, or vision claim area.

Substantiation process for flexible spending accounts or similar accounts where electronic benefit cards are used

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Louisville, KY, United States of America

Benjamin Slen