System and method for managing insurance accounts in response to leave data

Abstract

A computer system includes a data storage device including a database containing data for insurance policies covering individuals, a communication device to exchange data with an employer's computer system, and a processor in communication with the data storage device and communication device. A non-transitory storage medium stores program instructions operative with the processor to receive an eligibility data file including data for individuals covered by personal insurance; transmit to the employer computer system a bill file including payroll deductions data for the insurance premiums; receive from the employer computer system a remit file including actual payroll deductions made data and individual leave status data; determine which individuals are on leave based on a verification of an insurance payment; adjust and store data indicative of the premiums associated with individuals determined on leave; and transmit to the employer a payroll deduction modification request for individuals determined to be on the leave.

What is claimed is: 
     
         1 . A computer system for processing data relating to an insurance premium adjustment program, the system comprising:
 a data storage device that stores a database, the database containing data relating to a plurality of personal insurance policies that cover individuals;   a communication device configured to exchange data with a computer system of an employer having individual employees who are covered by at least one of the plurality of personal insurance policies;   a processor in communication with the data storage device and the communication device; and   a non-transitory storage medium in communication with the processor and storing program instructions, the processor operative with the program instructions to:
 receive via the communication device according to a pre-determined schedule an eligibility data file including data relating to the individuals employed by the employer covered by at least one of the plurality of personal insurance policies; 
 transmit to the employer computer system via the communication device a bill file based on the eligibility file, the bill file including data indicative of payroll deductions to be made from individual payroll amounts to fund insurance premiums for each of the individuals covered by at least one of the plurality of insurance policies; 
 receive from the employer computer system via the communication device a remit file, the remit file including data indicative of the payroll deductions actually made from the individual payroll amounts to fund the insurance premiums for each of the individuals covered by at least one of the plurality of insurance policies and leave status data for each of the individuals covered by at least one of the plurality of insurance policies; 
 determine, responsive to receipt of the remit file, which of the individuals are on a leave, the determination made based on a verification of whether an insurance payment has been made to the individuals for whom the leave status data is indicative of the individual being on the leave; 
 adjust, responsive to a determination of a leave, data indicative of the insurance premiums associated with the personal insurance policies of the individuals determined to be on the leave; 
 storing the adjusted data indicative of the insurance premiums in the database; and 
 transmit to the employer via the communication device a payroll deduction modification request for the individuals determined to be on the leave. 
   
     
     
         2 . The computer system of  claim 1 , wherein the leave comprises a disability leave. 
     
     
         3 . The computer system of  claim 2 , wherein adjusting data indicative of premiums comprises adjusting the data based on whether the disability leave is a short-term disability leave or a long-term disability leave. 
     
     
         4 . The computer system of  claim 1 , wherein the leave comprises one of a maternity leave, a paternity leave, a hospital confinement leave, and a rehabilitation facility leave. 
     
     
         5 . The computer system of  claim 1 , wherein the leave is associated with a specific injury. 
     
     
         6 . The computer system of  claim 1 , wherein the processor is further operative with the program instructions to terminate adjustment of the data indicative of the insurance premiums for an individual when the eligibility data file indicates that employment of the individual has been terminated. 
     
     
         7 . The computer system of  claim 1 , wherein the processor is further operative with the program instructions to adjust the data indicative of the insurance premiums to reduce, waive, or suspend the insurance premiums in response to a determination of a leave. 
     
     
         8 . A method of processing data in connection with an insurance premium adjustment program, the method comprising:
 receiving via a communication device according to a pre-determined schedule an eligibility data file including data relating to individuals employed by an employer;   transmitting to a computer system of the employer via the communication device a bill file based on the eligibility file, the bill file including data indicative of payroll deductions to be made from individual payroll amounts to fund insurance premiums for each of the individuals covered by an insurance plan;   receiving from the employer computer system via the communication device a remit file, the remit file including data indicative of the payroll deductions actually made from the individual payroll amounts to fund the insurance premiums for each of the individuals covered by an insurance plan and leave status data for each of the individuals;   determining, by a computer and responsive to receipt of the remit file, which of the individuals are on a leave, the determination made based on a verification of whether an insurance payment has been made to the individuals for whom the leave status data is indicative of the individual being on the leave;   adjusting, by the computer and responsive to a determination of disability, data indicative of the insurance premiums associated with the insurance plan covering the individuals determined to be on the leave;   transmitting to the employer computer system via the communication device a payroll deduction modification request for the individuals determined to be on the leave.   
     
     
         9 . The method of  claim 8 , wherein the leave comprises a disability leave. 
     
     
         10 . The method of  claim 9 , wherein adjusting data indicative of premiums comprises adjusting the data based on whether the disability leave is a short-term disability leave or a long-term disability leave. 
     
     
         11 . The method of  claim 8 , wherein the leave comprises a maternity leave, a paternity leave, a hospital confinement leave, or a rehabilitation facility leave. 
     
     
         12 . The method of  claim 8 , wherein the leave is associated with a specific injury. 
     
     
         13 . The method of  claim 8 , further comprising terminating by the computer adjustment of the data indicative of the insurance premiums for an individual when the eligibility data file indicates that employment of the individual has been terminated. 
     
     
         14 . The method of  claim 8 , further comprising adjusting by the computer the data indicative of the insurance premiums to reduce, waive, or suspend the insurance premiums in response to a determination of a leave. 
     
     
         15 . A computer system for processing data relating to insurance policies, the system comprising:
 a data storage device storing data relating to a plurality of personal insurance plans that cover individuals;   a communication device configured to send and receive data to a computer system of an employer having individuals employed by the employer who are covered by at least one of the plurality of personal insurance plans;   a processor in communication with the data storage device and the communication device; and   a non-transitory storage medium in communication with the processor and storing program instructions, the processor operative with the program instructions to:
 receive via the communication device according to a pre-determined schedule an eligibility data file including data relating to the individuals employed by the employer; 
 transmit to the employer computer system via the communication device a bill file based on the eligibility file, the bill file including data indicative of payroll deductions to be made from individual pay to fund an insurance premium for each of the individuals covered by the insurance plan; 
 receive from the employer via the communication device a remit file, the remit file including data indicative of the payroll deductions actually made from the individual pay to fund the insurance premium for each of the individuals covered by an insurance plan and leave status data for each of the individuals; 
 determine, responsive to receipt of the remit file, which of the individuals are on a leave, the determination made based on a verification of whether an insurance payment has been made to the individuals for whom the leave status data is indicative of the individual being on the leave; 
 adjust, responsive to a determination of disability, data in the data storage device indicative of at least one attribute of the personal insurance plans in response to the determination of which of the individuals are on the leave; and 
 store the adjusted data indicative of the insurance premiums in the data storage device. 
   
     
     
         16 . The computer system of  claim 15 , wherein the data indicative of at least one attribute comprises one of data indicative of a premium payable for the insurance plans, data indicative of a policy liability limit, and data indicative of a deductible. 
     
     
         17 . The computer system of  claim 15 , wherein the data indicative of at least one attribute comprises data indicative of a premium payable for the insurance plans, the leave comprises a disability leave, and adjusting data in the storage device comprises adjusting the data indicative of the premium based on whether the disability leave is a short-term disability leave or a long-term disability leave. 
     
     
         18 . The computer system of  claim 15 , wherein the leave comprises one of a maternity leave, a paternity leave, a hospital confinement leave, a rehabilitation facility leave, and a leave associated with a specific injury. 
     
     
         19 . The computer system of  claim 15 , wherein the processor is further operative with the program instructions to terminate adjustment of the data indicative of the insurance premiums for an individual when the eligibility data file indicates that employment of the individual has been terminated. 
     
     
         20 . The computer system of  claim 15 , wherein the processor is further operative with the program instructions to adjust the data indicative of the insurance premiums to reduce, waive, or suspend the insurance premiums in response to a determination of a leave.