Patent Application
20050209894
Current eye care policies typically provide policyholders with annual eye examinations and free or reduced-cost vision correction products, such as eyeglasses or contact lenses. However, there is a need for improved insurance policies that provide additional types of vision-related coverage.
Generally described, various embodiments of the present invention provide an improvement over the known prior art by providing a system and computing device for issuing a vision protection policy that provides policyholders with vision-related coverage that is in addition to routine coverage for eye examinations and/or vision correction products. A system for processing a claim received by a vision protection policyholder is also provided.
According to one aspect of the present invention, a system for issuing a vision protection policy is provided. One embodiment of the system includes a processor and a memory coupled to the processor and storing an application that the processor executes to: (1) receive applicant data related to a prospective policy participant; (2) apply one or more business rules stored in the memory to the applicant data to determine whether the prospective policy participant qualifies for the vision protection policy; and (3) transmit the vision protection policy to a policy participant, wherein the policy participant is comprised of the prospective policy participant determined to qualify for the vision protection policy. In this embodiment, the vision protection policy provides a combination of a routine eye care benefit and one or more of an eye condition benefit, an eye surgery benefit, and a permanent visual impairment benefit.
In one embodiment, the routine eye care benefit provided by the vision protection policy is comprised of an eye examination benefit that at least partially covers a cost associated with at least one medical examination of the policy participant's eyes. In another embodiment, the routine eye care benefit further includes a vision correction benefit that at least partially covers a cost associated with purchasing one or more vision correction materials. In one embodiment, the vision correction benefit further provides for a vision correction payment to be made to the policy participant in response to the policy participant undergoing a medical procedure to improve the policy participant's vision.
In one embodiment, the eye condition benefit of the vision protection policy provides for one or more eye condition benefit payments to be made in response to the policy participant being diagnosed with a particular eye disease or disorder. According to another embodiment, the eye surgery benefit provides for one or more eye surgery benefit payments to be made to the policy participant in response to the policy participant undergoing a surgical procedure related to a particular eye disease or disorder. In yet another embodiment, the visual impairment benefit of the vision protection policy provides for at least one payment to be made in response to the policy participant being diagnosed with a visual impairment for which there is no, or substantially no, reasonable prognosis of recovery.
According to another aspect of the present invention, a system for processing a vision protection policy claim is provided. One embodiment of the system includes a processor and a memory coupled to the processor and storing an application that the processor executes to: (1) receive a vision protection policy claim from a policy participant; (2) determine whether the policy participant incurred one or more expenses relating to routine eye care; (3) determine whether the policy participant has been diagnosed with an eye disease or disorder; (4) determine whether the policy participant has undergone a surgical procedure related to an eye disease or disorder; (5) determine whether the policy participant has been diagnosed with a visual impairment for which there is no, or substantially no, reasonable medical prognosis of recovery; and (6) authorize provision of a combination of a routine eye care benefit, an eye condition benefit, an eye surgery benefit, and a permanent visual impairment benefit based on the determinations made in steps (2) through (5).
According to yet another aspect of the invention, a computing device is provided. One embodiment of the device includes a processor and a memory coupled to the processor and storing an application that the processor executes to: (1) receive applicant data pertaining to a vision protection policy from a prospective policy participant; and (2) transmit the applicant data to an insurance company computer. In this embodiment the vision protection policy provides a combination of a routine eye care benefit and one or more of an eye condition benefit, an eye surgery benefit, and a permanent visual impairment benefit, and the applicant data relates to this combination of benefits.
Having thus described the invention in general terms, reference will now be made to the accompanying drawings, which are not necessarily drawn to scale, and wherein:
The present invention now will be described more fully with reference to the accompanying drawings, in which some, but not all embodiments of the invention are shown. Indeed, this invention may be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will satisfy applicable legal requirements. Like numbers refer to like elements throughout.
As will be appreciated by one skilled in the art, the present invention may be embodied as a method, a data processing system, or a computer program product. Accordingly, the present invention may take the form of an entirely hardware embodiment, an entirely software embodiment, or an embodiment combining software and hardware aspects. Furthermore, the present invention may take the form of a computer program product on a computer-readable storage medium having computer-readable program instructions (e.g., computer software) embodied in the storage medium. More particularly, the present invention may take the form of web-implemented computer software. Any suitable computer-readable storage medium may be utilized including hard disks, CD-ROMs, optical storage devices, or magnetic storage devices.
The present invention is described below with reference to block diagrams and flowchart illustrations of methods, apparatuses (i.e., systems) and computer program products according to an embodiment of the invention. It will be understood that each block of the block diagrams and flowchart illustrations, and combinations of blocks in the block diagrams and flowchart illustrations, respectively, can be implemented by computer program instructions. These computer program instructions may be loaded onto a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions which execute on the computer or other programmable data processing apparatus create a means for implementing the functions specified in the flowchart block or blocks.
These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including computer-readable instructions for implementing the function specified in the flowchart block or blocks. The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer-implemented process such that the instructions that execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart block or blocks.
Accordingly, blocks of the block diagrams and flowchart illustrations support combinations of means for performing the specified functions, combinations of steps for performing the specified functions and program instruction means for performing the specified functions. It will also be understood that each block of the block diagrams and flowchart illustrations, and combinations of blocks in the block diagrams and flowchart illustrations, can be implemented by special purpose hardware-based computer systems that perform the specified functions or steps, or combinations of special purpose hardware and computer instructions.
Vision Protection Policy
A vision care and protection policy (also referred to as a “vision policy” or a “vision protection policy”) according to a particular embodiment of the invention comprises both a routine eye care benefit and one or more of the following benefits: (1) an eye condition benefit; (2) an eye surgery benefit; and (3) a permanent visual impairment benefit. Exemplary routine eye care benefits, eye condition benefits, eye surgery benefits, and permanent visual impairment benefits are described below.
Routine Eye Care Benefits
In various embodiments of the invention, a routine eye care benefit includes an eye examination benefit and/or a vision correction benefit. An eye examination benefit provides, for example, for a predetermined payment to be made when a charge is incurred for an eye examination for a person covered by the vision policy (a “policy participant”). In various embodiments, this payment may be made directly to the policy participant. In certain embodiments of the invention, the vision policy may provide for policy participants to receive one or more eye examinations at no cost, or substantially no cost, to the policy participant.
A vision correction benefit provides, for example, for a predetermined vision correction payment to be made when a policy participant purchases one or more vision correction materials. In one embodiment of the invention, the vision correction materials may include eyeglasses and/or contact lenses. The vision correction payment may be made, for example, directly to the policy participant. In certain embodiments of the invention, the vision policy may provide for policy participants to receive the vision correction materials at no cost, or substantially no cost, to the policy participant.
Also, in various embodiments of the invention, the vision correction benefit provides for a vision correction payment to be made to the policy participant in response to the policy participant undergoing a medical procedure to improve said policy participant's vision. Such a medical procedure may include, for example, refractive error correction surgery.
Eye Condition Benefit
A typical eye condition benefit provides for one or more eye condition benefit payments to be made in response to a policy participant being diagnosed with a particular eye disease or eye disorder. In various embodiments of the invention, such eye diseases and disorders may include, for example: glaucoma, proliferative diabetic retinopathy, macular degeneration, retinal detachment, and retinitis pigmentosa.
In certain embodiments of the invention, the vision policy provides that the eye condition benefit payments are to be paid regardless of other insurance coverage (and preferably regardless of any insurance coverage) that the policy participant may have for medical care related to the particular eye disease or disorder at issue. For example, in one embodiment, if the policy participant has other insurance coverage that would pay for treatment of a particular eye disease or disorder, any payments to be made under the vision policy would still be made if the policy participant were diagnosed with the particular eye disease or disorder. In a particular embodiment of the invention, the one or more eye condition benefit payments include a payment of a pre-defined amount (e.g., $1,000) to be made to the policy participant.
Eye Surgery Benefit
A typical eye surgery benefit provides for one or more eye surgery benefit payments to be made in response to a policy participant undergoing a surgical procedure related to a particular eye disease or disorder. The following table includes an exemplary listing of one-time eye surgery benefit payments to be made to a policy participant in response to the policy participant undergoing a corresponding listed surgical procedure:
In certain embodiments of the invention, the vision policy provides that eye surgery benefit payments are to be paid regardless of other insurance coverage (and preferably regardless of any insurance coverage) that the policy participant may have for the surgical procedure at issue. For example, in one embodiment, if the policy participant has other insurance coverage that would pay for the removal of cataracts in one of the policy participant's eyes, the provider of the vision policy would still make a payment of $800 to the policy participant.
Permanent Visual Impairment Benefit
A permanent visual impairment benefit according to one embodiment of the invention provides for at least one visual impairment payment to be made in response to the policy participant being diagnosed with a visual impairment for which there is no, or substantially no, reasonable medical prognosis of recovery. In particular, in one embodiment of the invention, the provider of the vision policy will pay the indemnity amounts listed below for the specific level (or levels) of visual impairment that apply to the policy participant's diagnosed stage of visual impairment.
As may be understood from the above table, in certain embodiments, if a policy participant is diagnosed with a Level 2, 3, or 4 visual impairment, benefits for previously unpaid lower levels of visual impairment will be paid in addition to benefits for the level diagnosed. For example, if a policy participant is diagnosed with a profound (Level 2) visual impairment, in the embodiment of the invention described above, the participant would receive a payment of $2,500 (which is the sum of (1) a payment of $1,750 for a Level 2 visual impairment and (2) a payment of $750 for a Level 1 visual impairment). In one embodiment of the invention, each level of visual impairment is payable up to a maximum of once per eye, per policy participant.
In one embodiment of the invention, a policy participant's level of visual impairment is determined as follows:
In certain embodiments of the invention, the vision policy provides that visual impairment payments are to be paid regardless of other insurance coverage (and preferably regardless of any insurance coverage) that the policy participant may have that is related to the visual impairment at issue.
Issuing Policy
System Architecture
The system further includes an office 50 in communication with the handheld device 40, and an Insurance Company computer 60 in communication with the office 50. The office 50, which may be operated directly by the Insurance Company or by some other entity affiliated with the Insurance Company, includes at least an interface 55 to facilitate the communication of Applicant data between the handheld device 40 and the Insurance Company computer 60. The interface 55 may be any known interface including, for example, a docking station that is connected to an IT infrastructure, such as a Local Area Network (LAN), Wide Area Network (WAN), or the Internet. Data can, therefore, be communicated from the office 50 to the Insurance Company computer 60 via any known means of communicating data including, for example, via the Internet, via a cable connection, by fax, via a telephone network, or even by a human operator located at the office 50.
Alternatively, the computing device 40 can be configured to communicate with the insurance company computer 60 directly without the need for office 50 and the interface 55. The computing device 40 can communicate with the Insurance Company computer 60 via a communications network such as the Internet, WAN, one or more LANs, wireless network, cellular network, etc.
The Insurance Company computer 60 includes at least a vision protection policy issuance module 62. The module 62 can be configured to retrieve data from, and store data to, a database 64. As shown, policy data 65, Applicant data 66 and business rules 67 can each be stored in the database 64 and accessed by the vision protection policy issuance module 62.
In addition, the Insurance Company computer 60 includes at least one storage device 250, such as a hard disk drive, a floppy disk drive, a CD-ROM drive, or optical disk drive, for storing information on various computer-readable media, such as a hard disk, a removable magnetic disk, or a CD-ROM disk. As will be appreciated by one of ordinary skill in the art, each of these storage devices 250 is connected to the system bus 220 by an appropriate interface. The storage devices 250 and their associated computer-readable media provide nonvolatile storage for a personal computer. It is important to note that the computer-readable media described above could be replaced by any other type of computer-readable media known in the art. Such media include, for example, magnetic cassettes, flash memory cards, digital video disks, and Bernoulli cartridges.
A number of program modules may be stored by the various storage devices 250 and within RAM 245. Such program modules include an operating system 260, and the vision protection policy issuance module 270. The vision protection policy issuance module 270 controls certain aspects of the operation of the Insurance Company computer 60, as is described in more detail below, with the assistance of the processor 210 and the operating system 260.
Also located within the Insurance Company computer 60 is a network interface 280, for interfacing and communicating with other elements of a computer network. It will be appreciated by one of ordinary skill in the art that one or more of the Insurance Company computer 60 components may be located geographically remotely from other Insurance Company computer 60 components. Furthermore, one or more of the components may be combined, and additional components performing functions described herein may be included in the Insurance Company computer 60.
Like the Insurance Company computer 60, a number of program modules may be stored by the various storage devices 350 and within RAM 345. Such program modules include an operating system 360, and an applicant data processing module 370. The applicant data processing module 370 controls certain aspects of the operation of the Computing Device 40, as is described in more detail below, with the assistance of the processor 310 and the operating system 360.
Method of Issuing Vision Protection Policy
In other embodiments, the process could likewise begin with a prospective policy participant entering his or her own Applicant data directly into an application form provided by the Insurance Company, and sending the application form to the Insurance Company. The application form could be in hard copy, requiring, for example, that the prospective policy participant enter the Applicant data by hand, and then mail or fax the form to the Insurance Company. The Applicant data could then be entered into the Insurance Company computer 60 by, for example, an Insurance Company employee. Alternatively, the application form could be provided over the Internet on a Web site operated by the Insurance Company, or by some other company affiliated with the Insurance Company. In this case the prospective policy participant could merely enter the data into the online version of the application form and then send the data electronically to the Insurance Company computer 60. In yet another embodiment, the prospective policy participant may contact an Insurance Company operator directly, by telephone or by other means, and communicate the Applicant data to the operator, who enters the data into the Insurance Company computer 60.
Once the Insurance Company computer 60 has received the Applicant data 66, in Step 403, the Insurance Company computer 60 stores the Applicant data 66 in a database 64 on the Insurance Company computer 60. The vision protection policy issuance module 62 then applies business rules 67, which are also stored in the database 64 on the Insurance Company computer 60, to the Applicant data 66 to determine whether the prospective policy participant qualifies for the vision protection policy (Step 404). This may include, for example, checking the applicant's name and address to determine whether they are valid, authenticating the applicant to ensure that the applicant is who he/she claims to be, determining whether the applicant is financially responsible based on a credit or payment history check, for example, determining whether the applicant's medical history and status are within risk parameters of the policy, determining whether the applicant has pre-existing conditions that should be excluded from policy coverage, determining whether the applicant is of legal age to enter a binding contract in the State in which a policy is sought, etc.
If the Insurance Company computer 60 determines that the applicant is not qualified for the policy based on the applicant data 66 and business rules 67, then the Insurance Company computer 60 rejects the application. Conversely, upon a determination by the Insurance Company computer 60 that the prospective policy participant qualifies for the vision protection policy, in Step 405 the Insurance Company issues the vision protection policy to the policy participant by, for example, generating policy data 65 that is specific to the prospective policy participant, storing the policy data 65 in the database 64, and transmitting the policy data 65 to the policy participant. The policy data 65 may be sent, for example, electronically, by mail, by fax or delivered by hand, to the policy participant directly, or via the salesperson.
Claim Processing
System Architecture
Like the Insurance Company computer 60 and the Computing Device 40, a number of program modules may be stored by the various storage devices 650 and within RAM 645. Such program modules include an operating system 660, and a claim processing module 670. The claim processing module 670 controls certain aspects of the operation of the claim Processing Server 550, as is described in more detail below, with the assistance of the processor 610 and the operating system 660.
Method of Processing Vision Protection Policy claim
If it is found that the policy participant has in fact incurred one of the routine eye care expenses covered by the vision protection policy, the claim Processing Module 670, in one embodiment, determines that the Insurance Company is to provide, in Step 704, at least partial reimbursement to the policy participant for the expenses incurred. The amount of reimbursement and the extent that these expenses are covered varies for different embodiments of the present invention. For example, in one embodiment, the policy participant is not reimbursed for any expenses incurred when undergoing a medical procedure to improve his or her vision; while in other embodiments, the policy participant may receive partial or full reimbursement for such expenses.
In Step 705 the claim Processing Module 670 determines whether the policy participant has been diagnosed with an eye disease or disorder for which coverage is provided by the vision protection policy. As discussed above, the diseases or disorders that are covered by the vision protection policy may include, for example, glaucoma, proliferative diabetic retinopathy, macular degeneration, retinal detachment, or retinitis pigmentosa. Certification of such disease or disorder may be required from the eye care provider on behalf of the policy participant or beneficiary. If the policy participant has been diagnosed with one of the covered diseases or disorders, the claim Processing Module 670 determines that the Insurance Company is to make, in Step 706, one or more eye condition benefit payments to the policy participant. In one embodiment, the one or more eye condition benefit payments include a payment of a pre-defined amount (e.g., $1000).
In Step 707, the claim Processing Module 670, in one embodiment, then determines whether the policy participant has undergone a surgical procedure related to an eye disease or disorder. Proof that the policy participant has incurred such surgical procedure may be required before payment of any benefit. Such proof may be in the form of an eye care provider's certification, for example. If the policy participant has undergone a surgical procedure related to an eye disease or disorder, in Steps 708 and 710, the claim Processing Module 670 first determines what type of surgical procedure was undergone, and then determines that the Insurance Company is to make one or more eye surgery benefit payments to the policy participant based on the type of surgical procedure undergone. For example, where the policy participant has undergone surgery to remove cataracts, the Insurance Company may provide an eye surgery benefit payment of $800.
In Step 711 the claim Processing Module 670, according to one embodiment of the present invention, determines whether the policy participant has been diagnosed with a visual impairment for which there is no, or substantially no, reasonable medical prognosis of recovery. Proof that the policy participant has suffered such visual impairment, as well as the level of impairment, may be required before payment of any benefit. If the policy participant has been so diagnosed, in Steps 712 and 714, the claim Processing Module 670 first determines the level of visual impairment that has been diagnosed, and then determines that the Insurance Company is to make at least one visual impairment payment to the policy participant based on the level of visual impairment. For example, as discussed above, a policy participant diagnosed with a Level 1 impairment (i.e., severe visual impairment) may receive up to $750 per eye; while a policy participant diagnosed with Level 4 impairment (i.e., total visual impairment) may receive up to $10,000 per eye.
If it is determined that the policy participant has not incurred expenses for routine eye care, been diagnosed with a disease or disorder, undergone a surgical procedure related to an eye disease or disorder, or been diagnosed with a visual impairment for which there is no, or substantially no, reasonable prognosis of recovery, the claim received is not valid and a denial letter is generated, after which the process ends (shown in Steps 716 and 718).
As will be understood by those of ordinary skill in the art, the steps of process described above need not be performed in the order in which they are described above. For instance, it is not necessary that the claim Processing Module 670 determine whether the policy participant has been diagnosed with an eye disease or disorder prior to determining whether the policy participant has undergone a surgical procedure or has been diagnosed with a visual impairment, as long as the necessary determinations are made to assess what benefits the policy participant should receive.
Modifications and Alternative Embodiments
Many modifications and other embodiments of the invention will come to mind to one skilled in the art to which this invention pertains having the benefit of the teachings presented in the foregoing descriptions. Accordingly, it should be understood that the invention is not to be limited to the specific embodiments disclosed and that modifications and other embodiments are intended to be included within the scope of the appended exemplary inventive concepts. Although specific terms are employed herein, they are used in a generic and descriptive sense only and not for purposes of limitation.
The present application claims priority from U.S. Provisional Application No. 60/634,883 filed Dec. 10, 2004, the contents of which are hereby incorporated herein by reference in their entirety.
| Number | Date | Country | |
|---|---|---|---|
| 60634883 | Dec 2004 | US |
