U.S. patent application number 10/983188 was filed with the patent office on 2006-05-25 for virtual share exchange apparatus and method.
Invention is credited to Anthony F. Meggs.
Application Number | 20060111934 10/983188 |
Document ID | / |
Family ID | 36462014 |
Filed Date | 2006-05-25 |
United States Patent
Application |
20060111934 |
Kind Code |
A1 |
Meggs; Anthony F. |
May 25, 2006 |
Virtual share exchange apparatus and method
Abstract
A method and apparatus that includes a method and apparatus for
pooling resources into a common fund such that the risk benefit is
held low by assigning rating to the individual members as well as
allowing people with similar characteristic or profiles to
participate in the pool.
Inventors: |
Meggs; Anthony F.;
(Melbourne, FL) |
Correspondence
Address: |
BAKER & HOSTETLER LLP
Washington Square, Suite 1100
1050 Connecticut Avenue, N.W.
WASHINGTON
DC
20036
US
|
Family ID: |
36462014 |
Appl. No.: |
10/983188 |
Filed: |
November 8, 2004 |
Current U.S.
Class: |
705/2 |
Current CPC
Class: |
G06Q 20/40 20130101;
G06Q 10/10 20130101; G06Q 40/08 20130101 |
Class at
Publication: |
705/002 |
International
Class: |
G06Q 10/00 20060101
G06Q010/00 |
Claims
1. A method for sharing resources among a group of individuals in a
processor based system in order to create a stronger risk pool,
comprising: providing data relating to a first member of the group;
providing data relating to a second member of the group; receiving
a request for a benefit from the first member; and assigning a
portion of the request to a second member.
2. The method as in claim 1, further comprising assigning a health
rating to the first member based on health data submitted by the
first member.
3. The method as in claim 1, further comprising assigning a benefit
rating to the first member based on the data submitted by the first
member.
4. The method as in claim 1, further comprising determining an
eligible benefit for the first member based upon the benefit
rating.
5. The method as in claim 1, further comprising determining an
eligible benefit rating based upon the health rating.
6. The method as in claim 2, further comprising determining
assigning a benefit rating to the first member based on the data
submitted by the first member and determining an eligible benefit
from the request based upon the health rating and the benefit
rating.
7. The method as in claim 1, further comprising determining the
eligible needs of the group.
8. The method as in claim 1, further comprising determining a share
rating for the first member.
9. The method as in claim 5, wherein the share rating is calculated
by the dividing the total shares submitted in dollars of the first
member into the total share requests in dollars of the first
member.
10. The method as in claim 1, wherein the data of the first member
is selected from the group consisting of name, dependents, age,
sex, religious domination, height, weight and body mass index
(BMI).
11. The method as in claim 1, further comprising processing a
transaction initiated by the second member to satisfy the portion
the assigned request.
12. The method as in claim 11, wherein the step of processing of
the transaction is accomplished by debiting or crediting an
account.
13. The method as in claim 12, wherein the account is a bank
account.
14. The method as in claim 1, wherein the system is available
through a computer network.
15. The method as in claim 14. wherein the computer network is the
Internet.
16. The method as in claim 14, wherein the computer network is a
local area network or a wide area network.
17. The method as in claim 14, wherein the system is configured to
permit the individuals of the group to login into the system.
18. The method as in claim 14, wherein the system is configured to
allow the individuals to view an overview of share requests, need
posting, share posting and exchange posting.
19. The method as in claim 1, determining a deductible level for
the first member.
20. The method as in claim 19, wherein the deductible level is
based upon the data provided by the first member.
21. A system for allocating resources among a group of individuals
in a processor based system in order to create a stronger risk
pool, comprising: means for providing data relating to a first
member of the group; means for providing data relating to a second
member of the group; means for receiving a request for a benefit
from the first member; and means for assigning a portion of the
request to a second member.
22. The system as in claim 21, further comprising means for
assigning a health rating to the first member based on health data
submitted by the first member.
23. The system as in claim 21, further comprising means for
assigning a benefit rating to the first member based on the data
submitted by the first member.
24. The system as in claim 21, further comprising means for
determining an eligible benefit for the first member based upon the
benefit rating.
25. The system as in claim 21, further comprising means for
determining an eligible benefit rating based upon the health
rating.
26. The system as in claim 22, further comprising means for
determining assigning a benefit rating to the first member based on
the data submitted by the first member and determining an eligible
benefit from the request based upon the health rating and the
benefit rating.
27. The system as in claim 21, further comprising means for
determining the eligible needs of the group.
28. The system as in claim 21, further comprising means for
determining a share rating for the first member.
29. The system as in claim 25, wherein the share rating is
calculated by the dividing the total shares submitted in dollars of
the first member into the total share requests in dollars of the
first member.
30. The system as in claim 21, wherein the data of the first member
is selected from the group consisting of name, dependents, age,
sex, religious domination, height, weight and body mass index
(BMI).
31. The system as in claim 21, further comprising means for
processing a transaction initiated by the second member to satisfy
the portion the assigned request.
32. The system as in claim 31, wherein the means for processing
links to an account.
33. The system as in claim 32, wherein the account is a bank
account.
34. The system as in claim 21, wherein the system is available
through a computer network.
35. The system as in claim 34. wherein the computer network is the
Internet.
36. The system as in claim 34, wherein the computer network is a
local area network or a wide area network.
37. The system as in claim 34, wherein the system is configured to
permit the individuals of the group to login into the system.
38. The system as in claim 14, wherein the system is configured to
allow the individuals to view an overview of share requests, need
posting, share posting and exchange posting.
39. The system as in claim 21, determining a deductible level for
the first member.
40. The system as in claim 39, wherein the deductible level is
based upon the data provided by the first member.
41. A computer medium containing executable code for sharing
resources among a group of individuals in a processor based system
in order to create a stronger risk pool comprising: providing data
relating to a first member of the group; providing data relating to
a second member of the group; receiving a request for a benefit
from the first member; and assigning a portion of the request to a
second member.
42. The computer medium as in claim 41, further comprising
assigning a health rating to the first member based on health data
submitted by the first member.
43. The computer medium as in claim 41, further comprising
assigning a benefit rating to the first member based on the data
submitted by the first member.
44. The computer medium as in claim 41, further comprising
determining an eligible benefit for the first member based upon the
benefit rating.
45. The computer medium as in claim 41, further comprising
determining an eligible benefit rating based upon the health
rating.
46. The computer medium as in claim 42, further comprising
determining assigning a benefit rating to the first member based on
the data submitted by the first member and determining an eligible
benefit from the request based upon the health rating and the
benefit rating.
47. The computer medium as in claim 41, further comprising
determining the eligible needs of the group.
48. The computer medium as in claim 41, further comprising
determining a share rating for the first member.
49. The computer medium as in claim 45, wherein the share rating is
calculated by the dividing the total shares submitted in dollars of
the first member into the total share requests in dollars of the
first member.
50. The computer medium as in claim 41, wherein the data of the
first member is selected from the group consisting of name,
dependents, age, sex, religious domination, height, weight and body
mass index (BMI).
51. The computer medium as in claim 41, further comprising
processing a transaction initiated by the second member to satisfy
the portion the assigned request.
52. The computer medium as in claim 51, wherein the step of
processing of the transaction is accomplished by debiting or
crediting an account.
53. An apparatus for enabling individuals to share resources in
order to create a stronger risk pool, comprising: a central
repository configured to contain data provided by the individuals;
a needs posting configured to accept a request for a resources from
an first individual; and a share posting configured to assign the
request of the resources to a second individual.
54. The apparatus as in claim 53, further comprising a transactions
processor activated by the second individual in response to the
share posting and configured to assign resources to the first
individual.
55. The apparatus as in claim 54, further comprising a disclosure
repository configured to include the legal disclosures of varying
jurisdictions.
56. The apparatus as in claim 55, further comprising a rating
device configured to assign ratings to the individuals based on the
data.
57. The apparatus as in claim 56, wherein the rating device assign
a health rating.
58. The apparatus as in claim 56, wherein the rating device assigns
a share rating.
59. The apparatus as in claim 56, wherein the rating device assigns
a benefit. rating.
Description
FIELD OF THE INVENTION
[0001] The present invention relates generally to association
benefit plans. More particularly, the present invention relates to
the creation of a method and apparatus that enables similar
individuals to join or become part of a group or association that
shares burdens in a defined way, such as a member to member
relationship, such that the impact is lessened as opposed to an
individual undertaking the burden themselves or in groups that do
not include similar people with similar characteristics.
BACKGROUND OF THE INVENTION
[0002] Grouping of individuals is common in many facets of our
everyday life in order to achieve certain benefits or advantages.
The grouping is done largely in the insurance industry. By pooling
resources into a common fund, the group members are able to afford
insurance coverage for such things as health, automobile and life.
Without being able to pool resources, the individual would have to
bear the entire costs for such things as health or automobile
expenses.
[0003] With respect to health care, the average consumer would not
be able to afford much more than the basic healthcare coverage if
grouping of resources was not available. Cutting edge surgical or
drug treatments would be difficult, if not, impossible for the
average consumer based upon current medical rates being charged in
the medical industry.
[0004] By placing all individuals into one group, insurance
coverage and the benefits obtained there from are made more
affordable. This coverage is primarily based, though, upon the
overall health of the group. There will be individuals in the group
that would just use the insurance for yearly checkups and there
will other individuals, who will use the system much more
extensively. It is the later group that has a greater effect on the
premiums in the group. For those that do not use the insurance that
frequently, being lumped with the more extensive users is a
downside or disadvantage. On the other side, the individuals, who
demand a greater share of the benefits, have the advantage of
keeping their premiums lower than usual because of the individuals
that demand little if any benefits from the program.
[0005] As can be seen, one of the benefits of insurance programs is
the ability to pool resources so that the group as a whole is able
to share in its benefits. However, a downside of this is that the
group is generally composed of individuals that either makes
frequent requests for the benefits or others that do not require
benefits that often. Another disadvantage is that the
beneficiaries, at any point, could lead unhealthy or at risk
lifestyles such as high risk diets, low exercise, smoking,
excessive alcohol intake and the use of illicit drugs. By engaging
in such lifestyles, these individuals are at a greater likelihood
to use the health insurance and its benefits. With more of these
people using the benefits, the more likely the premiums and
associated costs with providing these benefits for all the
individuals increases.
[0006] An additional disadvantage of the present system for pooling
resources is that the benefits are distributed to the individuals
such that no other individual in the participating in the program
has any real sense of what types of requests are being made and
what types of service are being paid for by the insurance company.
This disadvantage with such a system is that a beneficiary is less
likely to be held accountable in a system where it is known how
much everyone in the group has contributed and how each and every
person in the group has requested in the form of benefits.
[0007] Accordingly, it is desirable to provide a method and
apparatus that enables similar individuals with similar backgrounds
to pool their resources such that the cost to each individual is
reduced as opposed to groups with a plethora of individuals.
Additionally, there is a need that such method and apparatus is
available to all participating individuals such that there are able
to access or view all the requests for benefits that are received
as well as all contributions made by the participating members.
SUMMARY OF THE INVENTION
[0008] The foregoing needs are met, to a great extent, by the
present invention, wherein in one aspect an apparatus is provided
that in some embodiments permits people with similar backgrounds
and similar experiences to share resources and share the resulting
benefits. The individuals and the resulting risk is held lower then
traditional business models by assigned ratings to the individuals
in any number of categories as well as limiting the types of
individuals that are permitted to enter the group. The sharing of
resources in the preferred embodiment is based on a member to
member association.
[0009] In accordance with one embodiment of the present invention,
a method for sharing resources among a group of individuals in a
processor based system in order to create a stronger risk pool
includes providing data relating to a first member of the group,
providing data relating to a second member of the group, receiving
a request for a benefit from the first member and assigning a
portion of the request to a second member.
[0010] In accordance with another embodiment of the present
invention, a system for allocating resources among a group of
individuals in a processor based system in order to create a
stronger risk pool includes means for providing data relating to a
first member of the group, means for providing data relating to a
second member of the group, means for receiving a request for a
benefit from the first member and means for assigning a portion of
the request to a second member.
[0011] In accordance with yet another embodiment of the present
invention, a computer medium containing executable code for sharing
resources among a group of individuals in a processor based system
in order to create a stronger risk pool includes providing data
relating to a first member of the group, providing data relating to
a second member of the group, receiving a request for a benefit
from the first member and assigning a portion of the request to a
second member.
[0012] In accordance with yet another embodiment of the present
invention, an apparatus for enabling individuals to share resources
in order to create a stronger risk pool includes a central
repository configured to contain data provided by the individuals,
a needs posting configured to accept a request for a resources from
an first individual and a share posting configured to assign the
request of the resources to a second individual.
[0013] There has thus been outlined, rather broadly, certain
embodiments of the invention in order that the detailed description
thereof herein may be better understood, and in order that the
present contribution to the art may be better appreciated. There
are, of course, additional embodiments of the invention that will
be described below and which will form the subject matter of the
claims appended hereto.
[0014] In this respect, before explaining at least one embodiment
of the invention in detail, it is to be understood that the
invention is not limited in its application to the details of
construction and to the arrangements of the components set forth in
the following description or illustrated in the drawings. The
invention is capable of embodiments in addition to those described
and of being practiced and carried out in various ways. Also, it is
to be understood that the phraseology and terminology employed
herein, as well as the abstract, are for the purpose of description
and should not be regarded as limiting.
[0015] As such, those skilled in the art will appreciate that the
conception upon which this disclosure is based may readily be
utilized as a basis for the designing of other structures, methods
and systems for carrying out the several purposes of the present
invention. It is important, therefore, that the claims be regarded
as including such equivalent constructions insofar as they do not
depart from the spirit and scope of the present invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] FIG. 1 is an example of the present invention illustrating a
member profile according to a preferred embodiment of the present
invention.
[0017] FIG. 2 is an example of the present invention illustrating
the virtual share exchange according to a preferred embodiment of
the present invention.
[0018] FIG. 3 is a schematic of the present invention according to
a preferred embodiment of the present invention.
DETAILED DESCRIPTION
[0019] The invention will now be described with reference to the
drawing figures, in which like reference numerals refer to like
parts throughout. An embodiment in accordance with the present
invention provides a method and apparatus in which beneficiaries of
similar backgrounds share or allocate their resources to achieve
intended benefits as well as achieve an overall cost savings. An
additional benefit is it that all members or participants of the
group are able to monitor the status of the contributions and
benefits.
[0020] Over the centuries, friends, neighbors and communities have
shared their wealth and income to meet the needs of those less
fortunate or those facing calamity. Sharing in the burdens of one's
neighbor might be found within the confines of the organized church
and is typically a random "as needed" event. More recently, a
number of organizations such as faith-based groups have begun to
create associations for the specific purpose of sharing in each
others everyday needs and burdens. For the purpose of this writing,
these organized groups are called mutual sharing associations or
MSAs. MSAs are a fast growing and legitimate alternative to
traditional insurance. It is estimated that more than 50,000
families will participate in associations that share in the
everyday healthcare expenses of their members. As this phenomenon
grows, mutual sharing is beginning to extend beyond healthcare
needs and into new categories such as income protection
(disability), legal protection (liability) and property protection
(property & casualty).
[0021] The reasons for participating in a mutual sharing
association are many. MSAs provide a sense of community for people
of like values, lifestyles and faiths. MSAs typically provide
visibility into the individual needs that are being shared so
members can exchange prayers, words of encouragement and emotional
support. MSAs can build stronger risk pools than traditional
insurance by stipulating specific lifestyle requirements as a
condition for membership. MSAs are traditionally "non-profit"
entities and often reduce the household expenditures typically paid
to "for-profit" insurance companies by more than 50%.
[0022] The future and potential impact of MSAs have yet to be felt
in the marketplace. In fact, in a world where time, distance, and
space is reduced by electronic networks, people of like minds,
values and faiths will find it easier to meet and participate in
organize exchanges of interests. Additionally, legislative changes
that ease restrictions on the creation of association benefit plans
will combine with the heavy promotion and marketing of health
savings accounts (HSA) and high deductible "catastrophic" health
care plans to generate market tailwinds and risk mitigation tools
necessary for dramatic growth. MSAs, with a history and track
record of accountability and stewardship, will find themselves to
be at the center of an ideal market opportunity.
[0023] While the market opportunity is great, the business
processes of MSAs need to be able to meet the demands of the larger
general market. However, it is important to note that some of the
business processes can cause distress and conflict with regulatory
agencies that ultimately suppress a MSA's ability to aggressively
grow its market influence.
[0024] To capitalize on their market potential and shed their
regulatory burdens, MSAs need some innovative processes in their
structure that accomplish the following:
[0025] 1) Markets, transacts and fulfills services through an
obvious context of shared values, faith, interests and
community;
[0026] 2) Embraces and adopts innovative uses of traditional
insurance to mitigate association and member risk;
[0027] 3) Creates an obvious delineation between traditional
insurance and sharing by focusing sharing plans on deductibles and
out-of-pocket expenses that accompany high deductible insurance
plans;
[0028] 4) Matches and presents a specific "member need" with every
"share request" in a real-time transaction initiated by the
member;
[0029] 5) Transacts a direct "account-to-account" process;
[0030] 6) Displays all regulatory disclosures prior to the exchange
(transaction) of shares; and
[0031] 7) Provides complete visibility and history into all share
transactions
[0032] Thus, MSAs wanting to gain a greater influence into their
respective constituent communities should begin to prepare
themselves for this emerging market boom by leveraging technology
to web-enable their current paper-based processes into a Virtual
Share Exchange (VSE) and free themselves from the weight and
suppression of regulatory concerns.
[0033] In summary, the present invention is virtual share exchange
that integrates content, interactive services, business logic and
transactional processing required for managing a mutual sharing
association. The preferred embodiment of the present invention uses
a web portal as a communication medium to reach the intended
beneficiaries.
[0034] An embodiment of the present inventive apparatus and method
is illustrated in FIG. 1. FIG. 1 illustrates a summary of a secure
profile based information management tool that allows a member to
manage all "sharing" information. In the present invention, this is
referred to as TAGS (Trusted Agent and Gifting System).
[0035] In order to effectively manage a VSE, members must be able
to build and manage personal profiles called TAGS. TAGS provide
associations the means to capture and manage member specific
information and execute share transactions in accordance with
member desires. While TAGS can be customized to capture broad
categories of information and can be used in an endless number of
processes and transactions, there are six (6) TAG functions that
are used in the preferred embodiment. These functions are found to
be some of the most successful practices for better management of a
VSE. These functions are:
[0036] 1. Captures all household demographics and psychographics
necessary to effectively manage the functions and purpose of the
Virtual Share Exchange;
[0037] 2. Stipulates at least one (1) "share account" that will be
used for debiting shares;
[0038] 3. Stipulates at least one (1) "gift account" that will
receive shares that are debited;
[0039] 4. Stipulates at least one (1) "needs accounts" that will be
credited should the member receive shares from other members to
meet a need;
[0040] 5. Captures all financial information required to transact
the debiting and crediting between accounts;
[0041] 6. Provides white list and black list functionality to
indicate the information that the member is willing to share with
the community;
[0042] Provided in FIG. 1 is an example of a TAGS profile 10 that
demonstrates the types of information that can be captured and
archived. This information is provided by a member and then used by
the VSE to process benefits and/or requests.
[0043] The first section 12 of the TAGS profile 10 represents
demographic information captured on the primary member and his/her
household. In the preferred embodiment, the information collected
is the primary member 14 and the corresponding residential address
information 16. Additionally, there is a beneficiary section 18
that lists all the members participating in the VSE.
[0044] The second section 20 represents the account and financial
information needed to participate in a specific exchange, as well
as different types of exchanges that the member has chosen to
participate in.
[0045] The third section 22 is a collection of additional profile
information that may be valuable to publish to the association
and/or third parties. In the TAGS profile 10, the information
collected in this section are such things as your household income,
political party preference, occupation, employment and other
corresponding information.
[0046] In the preferred embodiment, it is possible to hide or not
share specific information in the VSE. In the TAGS profile 10, this
is indicated by the boxes 23 to the right of the each of the
sections 12, 20, 22. These boxes in the TAGS profile 10 are color
coded to indicate what information may or may not be publicized
within the exchange or to the public at large. What information is
not disclosed is left up the discretion of the member. However, it
is likely that financial information such as that disclosed in the
second section 20 will not be disclosed to third parties.
[0047] Capturing and archiving member information into TAGS profile
10 enables an association with the necessary data to successfully
transact the sharing of needs and information to the specific
requirements of its members, as well as provides the data and
information required to successfully complete a direct sharing
transaction.
[0048] Direct Sharing is a method for posting, publishing and
transacting the sharing of eligible needs in a way that
consistently meets the strict requirements of regulatory agencies.
State regulatory agencies such as the Department of Insurance are
keenly sensitive to how the sharing of needs and burdens is
actually processed. In order to help alleviate the regulatory
burdens, it is important that the business practices of MSAs create
an obvious delineation from the practices of insurance companies
and their indemnity contracts. While there are subtle differences
between the states and their specific requirements for mutual
sharing associations, there are four requirements that appear to be
consistent across all states and should be complied in order to
transact an exchange of mutual sharing in an effective manner. The
requirements are: [0049] 1. Matching a specific share with a
specific need; [0050] 2. The exchange must use a members-to-member
direct sharing process and not pool funds; [0051] 3. The exchange
must not build reserves; and [0052] 4. The exchange must make
obvious attempts to disclose to its members that the service is not
insurance and does not imply a guarantee of benefits
[0053] FIG. 2 illustrates how a Virtual Share Exchange can leverage
information and data captured in the TAGS profile 10 of its members
to transact the direct sharing of needs in a way that complies with
Department of Insurance and state regulatory requirements.
[0054] FIG. 2 is an example of a VSE that processes the sharing of
medical needs. In this example, the fourth section 24 displays all
the eligible needs that have been posted into the VSE. Each house
household is listed by the member name 26 that was supplied in the
TAGS profile 10. For example, the Beck household 28 is listed and
it currently states that they have a need of $1772.00.
[0055] The fifth section 30 represents the aggregate totals of
needs and members in the exchange. In this section, the average
share has been calculated by dividing the eligible needs by the
weighted "share rating" of the exchange and the total number of
members who participate in the exchange. The use and purpose of
share ratings is discussed in detail later in this document.
However, aggregating the total needs posted and then calculating an
average or equal share to be submitted by all members, effectively
complies with the Department of Insurance restriction of not
building reserves. Calculated "equal shares" effectively brings the
exchange to a zero balance once all shares are collected. The sixth
section 32 provides the transactional function for submitting a
share to meet a specific need. In FIG. 2, the sixth section 32 is
illustrating a need from the Beck household 28 in more detail. For
example, the household is listed along with share rating 34, the
need posted 36, the co-pay 38 and the Share collected 40.
[0056] The sixth section 32 also lists the Share posting 42 for the
Messerli Household. This Share posting 42 has been matched to the
Beck Household 28. The VSE, through the share posting, is
requesting the Messerli household to contribute to the Becks'
Household's need. The Messerlis are being requested to pay $163.91
towards the Beck's request, which was determined by the present
invention to be their share of Beck's need of $1772.00. In
actuality, they are shown to have entered an amount in this section
of $180.00. To process the payment, the Messerlis would click on
the submit button 44. In this instance, the Messerli has decided to
pay more than their allotted amount to the Beck's need. In the
event that the Beck's have not paid amount, the submit button 44
that allows the Becks to pay the Share request 42. In the preferred
embodiment, this Share request is being processed through the
financial information given in second section 20 of the TAGS
profile 10.
[0057] The seventh section presents a summary view of the member's
TAG profile 10 and the specific account information that will be
used in share transactions. Information such as the breakdown of
the household as well as the financial information is provided. The
latter information being severely limited in order to protect the
information from unintended recipients.
[0058] As members authenticate or login into the VSE, the present
invention determines if the member has a Share Request resulting
from a matched need posting is due or not. If he does, the member
will be ushered to a screen view much like FIG. 2. In the sixth
section 42 of this screen view, the member is being presented with
a specific "need" that has been posted and a request to submit his
equal share to meet that need. Matching a specific need with a
specific share request is a critical requirement of regulatory
agencies and is accomplished as the VSE works its way down the list
of posted needs (see fourth section 24).
[0059] The VSE finds the next available need and posts that need
and its information in the sixth "Need Posting" section 42. In a
parallel process, the present invention inputs the calculated
average share amount in the "Share Posting" section, as well as any
other fees that the exchange chooses or needs to collect.
[0060] The sixth section 42 also provides the member with a "share
submit" function. By clicking on the share submit button 44, the
member is approving and initiating the debiting of his "Share
Account" in an amount equal to or at least a portion of the share
request and any additional fees to be collected. The VSE then
credits the "Needs Account" of the member who has had his need
posted into the exchange and the "Gifts Accounts" of any additional
fees. Thus, the VSE has now complied with the Department of
Insurance's member-to-member direct sharing restriction, by
replacing what has traditionally been a mailbox-to-mailbox process
with an account-to-account electronic process.
[0061] To further strengthen Department of Insurance compliance,
members, who are to receive shares to meet their needs, will be
notified by the VSE that shares have been collected. This
notification, in the preferred embodiment, is done through e-mail
but it is understood that the means of communication such as text
messaging, a telephone call, facsimile, paging and the postal
service are all within the scope of this invention. These members
will then authenticate into the VSE to accept the shares. At this
point, the member can choose to either have the VSE send their care
provider an electronic check (written off the needs account) for
services rendered or pay the doctor or service provider directly. A
member's TAGS profile 10 can be used to give a member the choice to
automate this function.
[0062] Prior to completing the "share submit" process, the member
is prompted to accept any specific state disclosures to ensure that
the VSE is comply with all regulatory disclosure requirements. The
VSE uses the member's residence information captured by his TAGS
profile 10 and provides disclosures specific to their situation
such as the state of residence. The present invention keeps an
updated database on all the legal disclosures required by the
varying jurisdictions.
[0063] Mutual sharing associations are able to effectively compete
against the guarantee of indemnity contracts, whose guarantee is
only as good as the financial health of the carrier, by leveraging
the collective moral will of values oriented individuals who feel a
commitment towards their fellow man.
[0064] VSEs provide a means for MSAs to display the collective
moral will of its members by displaying "Share Ratings." A share
rating is a calculated metric that measures a member's persistency
and level of participation in the sharing of member needs. While
share ratings formulas and calculations can be unique to each and
every mutual sharing association, an example of a typical share
rating is provided below.
EXAMPLE
[0065] Share Rating=Total ($) Share Requests/Total ($) Shares
Submitted
[0066] This is the formula that is used to calculate the share
ratings found in the fourth section 24 of FIG. 2. So in the case of
the Messerli household, this household has submitted 100% of the
total share requests and has done so 100% percent of the time (see
FIG. 1). Share ratings can be used to manage the effectiveness of
the VSE in a number of different ways or scenarios. The following
are examples of a few ways that this can be accomplished. [0067] 1.
A weighted Share Rating that calculates the aggregate participation
of all exchange members can be used to display the strength and
commitment of the association (see Exchange Share Rating in the
fifth section 39 of FIG. 2). For example, a VSE with more than
15,000 households and a share rating over a 10 year period of 97%
would indicate a relatively high commitment of the overall group.
[0068] 2. A weighted Share Rating for the entire exchange (Exchange
Share Rating) can be used to calculate the Net Eligible Needs. Net
Eligible Needs that have been factored by a weighted Exchange Share
Rating automatically take in account the attrition and delinquency
of exchange members to ensure a likely zero balance at the end of
each month (see Exchange Share Rating in the fifth section 30 of
FIG. 2). While a zero balance is not guaranteed, it would be
transparently clear to the Department of Insurance that the VSE is
not trying to build reserves. Should the VSE have an excess in
shares in a given period, then the excess could be applied to next
month's posted needs to effectively increase the VSE's share
rating. [0069] 3. Individual Share Ratings can be used as an
incentive for members to keep their persistency and participation
high, by prioritizing the sharing of posted needs from members with
the highest Share Rating (see the fourth section 24 in FIG. 2)
[0070] 4. Individual Share Ratings can be used as an incentive for
members to submit shares above their share requests, by
prioritizing the sharing of posted needs from members with the
highest Share Rating (see the fourth section in FIG. 2). Excess
funds are always used against next months needs or to assist other
ministries and charities.
[0071] Benefit ratings provide members of differing income levels
the opportunity to equally participate in the sharing and benefits
of an exchange. Mutual Sharing Associations can configure multiple
benefit levels into the VSE that allow a member to participate in
the exchange to the means of his income.
[0072] An example of the benefit rating can be seen in FIG. 2. In
this figure, the Deshepper household has elected a 50% benefit
level (see fourth section 24). The members of the exchange,
therefore, will share in 50% of the Deshepper's posted needs.
However, share requests presented to the Deshepper household will
be 50% less than those who have selected a 100% benefit level.
Having a lower benefit level allows a family to maintain high share
ratings while at the same time managing the level of participation
within their budget.
[0073] This selection of benefit levels are made in the TAGS
profile 10 and can be changed at anytime based on changes in the
member's income. In the preferred embodiment, the association would
institute time constraints as to when the new benefit level becomes
effective.
[0074] As illustrated in FIG. 2, this particular VSE uses a Health
Rating or a Lifestyle Rating to manage the financial burdens
(risks) of the exchange. Mutual Sharing Associations, whose share
amounts are impacted by the collective lifestyle choices of its
membership, will want to consider using Lifestyle Ratings to
encourage specific behaviors and choices.
[0075] Lifestyle ratings impact the net benefit level of posted
needs. In the preferred embodiment, the association uses a health
rating to encourage its members to make healthy choices that reduce
the medical needs of the association. Take the Hendrick family, the
net benefit and sharing that they can expect to receive is 60%,
because they have made poor lifestyle choices that have placed them
in an unhealthy condition.
[0076] Lifestyle Ratings protect members, who are making right
choices from members who are making wrong choices. Lifestyle
Ratings reinforce communities of like values and commitment.
Ultimately, the reduction of need postings corresponds with
reductions in share requests, thus improving the viability and
persistency of the VSE.
[0077] Note that the preferred embodiment, in the present
application, has been described predominantly in terms of health
care coverage. However, the invention is applicable to other forms
of resource pooling such as but not limited to investments, life
insurance, automobile insurance, home insurance and other similar
resource pooling activities.
[0078] FIG. 3 is a schematic of the overall invention according to
the preferred embodiment. The preferred embodiment includes a
number of components that enable it to process the overriding
concept. The VSE structure 48 includes a central repository 50,
where all the TAGS profiles 10 are maintained for each and every
member.
[0079] Linked to the central repository 50 are the needs 52
submitted by each member for benefits. Referring back to FIG. 2,
the fifth section 30 details the need posted by the Beck household
for the amount of $1,772.00.
[0080] The present invention, upon receiving the need and through
the needs assignor 54, assigns the need 52 to another member of the
group. Again referring back to FIG. 2, the Messerli household is
assigned a portion of the Beck's needs posting and presented to
them through the Share posting 56. Upon acceptance of their portion
of the need posting, a Share posting processing 58 is activated.
This action moves the resources allocated from the requestee to the
requestor. In FIG. 2, the Messerli household has moved $180.00 from
their bank account to the Beck's deposit account. In the present
invention, before processing the Share posting, the member is
provided with all the applicable disclosures as required by the
legal jurisdictions applicable to that member. These disclosure are
updated as need as provided through the disclosure device 60.
[0081] The present invention also includes a rating device 62 that
can determine any applicable rating that the VSE wishes to
determine. This would be a user defined function that can be
edited, altered or newly enacted at any time. In the preferred
embodiment, the rating device 62 determine the Share Rating,
benefit rating and health rating for each member of the group.
[0082] Additionally, the present invention provides the members
with an exchange summary 64. This can be seen is fourth section of
FIG. 2. The exchange summary 64 lists each member with their need
posting as well as their copay and various ratings.
[0083] The VSE is linked to a computer network 66 through the
communication port 68. The computer network can be the Internet, a
local area network, a wide area network or any other configuration
that permits a member to gain access to the VSE from a remote
location. FIG. 3 also details three members 70, 72, 74 of the VSE
gaining access to the VSE from a remote location such as their
home, office or other remote location to conduct activities such as
posting a need or processing an assigned share posting.
[0084] The many features and advantages of the invention are
apparent from the detailed specification, and thus, it is intended
by the appended claims to cover all such features and advantages of
the invention which fall within the true spirit and scope of the
invention. Further, since numerous modifications and variations
will readily occur to those skilled in the art, it is not desired
to limit the invention to the exact construction and operation
illustrated and described, and accordingly, all suitable
modifications and equivalents may be resorted to, falling within
the scope of the invention.
* * * * *