Private Health Insurance Exchange System and Method

Abstract

Systems and methods for the distribution, equalization and mitigation of risks in an insurance exchange, and specifically to that of a private health insurance exchange system and method that rewards/punishes those attempting to poach or game it. The system and method also includes a way to create an insurance exchange so that those providers participating may get all or a fraction of any losses that exceed pre-established limits reimbursed to them as part of a payment by those providers participating in the exchange who received gains exceeding their expectations.

1 . A health exchange Riskshare© system comprising;
 interface components capable of confirming the establishment of an agreement to share risks from members of an insurance pool amongst two or more service providers; 
 computer components for calculating a range of medical loss ratios (MLR's) for each said service provider, and recommending a range of suitable premiums based on said MRL's; 
 computer components for collecting data and evaluating the performance of one or more of each said insurance members over a period of time against said established MLR's; and 
 computer components for calculating one or more of; individual company MLR and/or combined companies MLR to assess financial obligations or rewards for each said service provider based on their performance against said MLRs. 
 
     
     
         2 . the health exchange system of  claim 1  wherein;
 a pre-agreed adjusted experience factor is used in the assessment of financial rewards or obligations. 
 
     
     
         3 . A health exchange Riskshare© method comprising;
 providing interface components capable of confirming the establishment of an agreement to share risks from members of an insurance pool amongst two or more service providers; 
 providing computer components for calculating a range of medical loss ratios (MLR's) for each said service provider, and recommending a range of suitable premiums based on said MRL's; 
 providing computer components for collecting data and evaluating the performance of one or more of each said insurance members over a period of time against said established MLR's; and 
 providing computer components for calculating one or more of; individual company MLR and/or combined companies MLR to assess financial obligations or rewards for each said service provider based on their performance against said MLRs. 
 
     
     
         4 . the method of  claim 3  wherein;
 a pre-agreed adjusted experience factor is used in the assessment of financial rewards or obligations. 
 
     
     
         5 . A non-transitory computer program product storing thereon a computer program that, when executed by one or more computer processors, causes said computer processor to establish a health exchange Riskshare© method comprising;
 providing interface components capable of confirming the establishment of an agreement to share risks from members of an insurance pool amongst two or more service providers; 
 providing computer components for calculating a range of medical loss ratios (MLR's) for each said service provider, and recommending a range of suitable premiums based on said MRL's; 
 providing computer components for collecting data and evaluating the performance of one or more of each said insurance members over a period of time against said established MLR's; and 
 providing computer components for calculating one or more of; individual company MLR and/or combined companies MLR to assess financial obligations or rewards for each said service provider based on their performance against said MLRs. 
 
     
     
         6 . the method of  claim 5  wherein;
 a pre-agreed adjusted experience factor is used in the assessment of financial rewards or obligations.