Benefit management

Abstract

Methods, devices and systems are provided for benefit management. One system includes a server including an application interface and access to a data store having one or more client files. A client file can include a definable set of business rules for managing and administering benefits and can include fund use rules for accessing and applying funds to claims from one or more accounts. The system includes a program operable on the server to apply the definable set of business rules in connection with processing a claim.

What is claimed is: 
     
         1 . A system for benefits management, comprising:
 a server connected to a network, the server including an application interface and access to a data store having one or more client files, wherein a client file includes definable sets of business rule instructions executed by a processor to manage and administer benefits and includes fund use rule instructions executed by a processor to access and apply funds to payment of claims from a plurality of accounts;   a program executed by the processor on the server to:
 receive a plan sponsor numerical ranking hierarchy for electronic payment of a first part of a non-carrier claim category portion of an electronically transmitted claim from two or more different employee benefit accounts, the plan sponsor numerical ranking received as input to the server from a first remote device connected to the network; 
 receive a plan member numerical ranking hierarchy for electronic payment of a second part of the non-carrier claim category portion of the electronically transmitted claim, according to control rights delegated to the plan member, from the two or more different employee benefit accounts, the plan member numerical ranking received as input to the server from a second remote device connected to the network; 
 receive the electronically transmitted claim to the server within the system through security layers of the network; and 
 apply the plan sponsor ranking and the plan member ranking associated with the two or more different employee benefit accounts to make payment on the first part and the second part of the non-carrier category portion of the electronically transmitted claim according to the hierarchy. 
   
     
     
         2 . The system of  claim 1 , wherein the instructions are executed on the server to:
 receive plan sponsor or plan member changes, as input received to the server from the first remote device or the second remote device, to a particular numerical entry in the numerical ranking; and   convert to a new numerical ranking hierarchy for payment without having to adjust other numerical ranking values in the received numerical ranking hierarchy.   
     
     
         3 . The system of  claim 1 , wherein the instructions are executed on the server to allow the plan sponsor and plan member to enter independently, and at different times from one another, either through the first remote device or the second remote device, according to control rights of the plan sponsor and control rights delegated to the plan member within the system, the percentage or fixed amount for each non-carrier claim category and a different numerical ranking in association with the two or more employee benefit accounts for each of a number of different non-carrier claim categories. 
     
     
         4 . The system of  claim 1 , wherein the at least two different employee benefit accounts are selected from the group of:
 a health reimbursement arrangement (HRA) account;   a flex spending account (FSA);   a vacation account;   a fitness club account;   a retiree health benefits account; and   a health savings account (HSA).   
     
     
         5 . The system of  claim 1 , wherein:
 a first non-carrier claim category portion is a co-pay category of the electronically transmitted claim;   a second non-carrier claim category portion is a co-insurance category of the electronically transmitted claim; and   a third non-carrier claim category portion is a deductible category of the electronically transmitted claim.   
     
     
         6 . The system of  claim 1 , wherein the program can track adjudicated claims submitted by the plan member and can apply the definable set of business rules to manage available funds and track payments in a flexible spending account (FSA) and a health reimbursement arrangement (HRA) account secondary to application of a plan carrier's business rules for a health care insurance plan. 
     
     
         7 . The system of  claim 1 , wherein the instructions are executed by the processor to:
 allow changes and different definition to the plan sponsor ranking and the plan member ranking between the two or more accounts to establish different first tiers of a hierarchy and different second tiers of the hierarchy between non-carrier claim categories within particular classes of services; and   automatically apply changes and different definitions according to the different first tiers of the hierarchy and different second tiers of the hierarchy between non-carrier claim categories within particular classes of services to make payment on the first and the second part of the electronically transmitted claim.   
     
     
         8 . The system of  claim 7 , wherein particular classes of services include in-network classes and out-of-network classes for services selected from the group of:
 a preventive care service;   an office visit;   a hospital service;   an urgent care center service;   a prescription service;   a dental service;   a vision service;   a chemical dependency service; and   an emergency room service.   
     
     
         9 . The system of  claim 1 , wherein the instructions are executed by the processor to allow a plan sponsor and a plan member to define and make electronic payment directly to the first part and the second part of a non-carrier claim category portion of the electronically transmitted claim in the form of a percentage payment amount or a fixed payment amount independently among the first part and the second part, and independently among non-carrier claim categories within particular classes of services. 
     
     
         10 . The system of  claim 1 , wherein the one or more client files include one or more member files accessible from a remote device by one or more entities having authorized access rights, the one or more entities selected from the group of:
 a plan sponsor;   a plan member; and   a third party administrator.   
     
     
         11 . A non-transitory computer readable medium including a program having stored instructions executable by a processor on a server on a network to:
 first allow an insurance plan sponsor to establish a numerical ranking hierarchy for direct electronic payment to a first part of a non-carrier claim category portion of an electronically transmitted claim from two or more different employee benefit accounts managed and administered by the plan sponsor, the plan sponsor numerical ranking received as input to the server from a first remote device connected to the network through a security layer;   second allow a plan member to establish a numerical ranking for direct electronic payment to a second part of the non-carrier claim category portion of the electronically transmitted claim from two or more different employee accounts, the plan member numerical ranking received as input to the server from a second remote device connected to the network through the security layer, as according to control rights delegated by the plan sponsor to the plan member to access the hierarchy;   receive the electronically transmitted claim to the server from a third remote device; and   apply the plan sponsor ranking and the plan member ranking to record payment on the first part and the second part of the non-carrier category portion of the electronically transmitted claim.   
     
     
         12 . The non-transitory medium of  claim 11 , wherein the instructions are executed to allow the plan sponsor and plan member to change, through a GUI, a particular numerical entry in the numerical ranking, according to control rights of the plan sponsor, to reorder the hierarchy without having to re-enter each numerical value of the numerical ranking entered in association with the two or more different employee benefit accounts. 
     
     
         13 . The non-transitory medium of  claim 11 , wherein the instructions are executed to allow the plan sponsor and plan member to independently enter, according to control rights of the plan sponsor, a different numerical ranking in association with the two or more employee benefit accounts for each of a number of different non-carrier claim categories. 
     
     
         14 . The non-transitory medium of  claim 13 , wherein the instructions are executed by the processor to:
 allow the plan sponsor to define and make electronic payment directly to the first part of a non-carrier claim category portion of the electronically transmitted claim in the form of a percentage payment amount or a fixed payment amount independently among each of the number of different non-carrier claim categories and independently by each account associated with the numerical ranking in a given category; and   allow the plan member to define and make electronic payment directly to the second part of a non-carrier claim category portion of the electronically transmitted claim in the form of a percentage payment amount or a fixed payment amount independently among each of the number of different non-carrier claim categories and independently by each account associated with the numerical ranking in a given category.   
     
     
         15 . The non-transitory medium of  claim 13 , wherein the number of different non-carrier claim categories include a co-pay category, a co-insurance category, a deductible category, and an ineligible category. 
     
     
         16 . A non-transitory computer readable medium including a program having stored instructions executable by a processor on a server connected to a network to:
 receive a plan sponsor numerical ranking hierarchy for electronic payment of a first part of a non-carrier claim category portion of an electronically transmitted claim from two or more different employee benefit accounts, the plan sponsor numerical ranking received as input to the server from a first remote device connected to the network;   receive a plan member numerical ranking hierarchy for electronic payment of a second part of the non-carrier claim category portion of the electronically transmitted claim, according to control rights delegated to the plan member, from the two or more different employee benefit accounts, the plan member numerical ranking received as input to the server from a second remote device connected to the network;   receive the electronically transmitted claim from a third remote device connected to the network; and   apply the plan sponsor ranking and the plan member ranking associated with the accounts to record payment on the first part and the second part of the electronically transmitted claim.   
     
     
         17 . The medium of  claim 16 , wherein the executable instructions are executed to allow the plan sponsor and plan member to change, through a GUI, a particular numerical entry in the plan sponsor and the plan member numerical ranking, according to control rights of the plan sponsor, to reorder the hierarchy without having to re-enter each numerical value of the plan sponsor and the plan member numerical ranking. 
     
     
         18 . The medium of  claim 16 , wherein the instructions executable to define the plan sponsor numerical ranking includes instructions executable to enter a plan sponsor numerical ranking independently for each of a number of difference non-carrier claim categories. 
     
     
         19 . The medium of  claim 16 , wherein the instructions executable to define the plan member numerical ranking includes instructions executable to enter a plan member numerical ranking independently for each of a number of difference non-carrier claim categories. 
     
     
         20 . The medium of  claim 16 , wherein the instructions are executed to:
 track usage and available balances in the two or more different employee benefit accounts; and   convert to a next available one of the two or more different employee benefit accounts according to the numerical ranking hierarchy when either a usage percentage or defined amount has been reached in a particular one of the two or more different employee benefit accounts.