“Method and System for Enrolling in Health Insurance” in Patent Application Approval Process (USPTO 20240029167): True Health Connect LLC

2024 FEB 08 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A patent application by the inventors Batista, Amari (Pembroke Pines, FL, US); Roche, Amanda (Miami, FL, US), filed on March 30, 2023, was made available online on January 25, 2024, according to news reporting originating from Washington, D.C., by NewsRx correspondents.

This patent application is assigned to True Health Connect LLC (Pembroke Pines, Florida, United States).

The following quote was obtained by the news editors from the background information supplied by the inventors: “

“Field of the Invention

“The invention relates to methods for enrolling applicants in insurance policies, and more particularly, health insurance policies.

“Description of the Related Art

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“Insurance Terminology

“Health insurance is sold through a hierarchy of entities. The following is an explanation of some commonly used terms in the insurance industry. Four acronyms are used to describe insurance marketing agents (IMAs) that independent insurance agents can partner with to do business: FMO, IMO, MGA, and GA. The hierarchy of the groups is insurance carriers>FMO (Field Marketing Organization)>IMO (Independent Marketing Organization)>MGA (Managing General Agent)>GA (general agent).

“A field marketing organization (FMO) is basically the same as an independent marketing organization (IMO). FMOs are typically top-level organizations that are licensed to sell health insurance products in most, if not all, states. They work with hundreds to thousands of agents and multiple big-name and small-name carriers across the U.S. Almost all of an FMO’s contracts are direct with carriers, and FMOs are usually able to offer agents contracts that provide higher than street-level commissions. In general, FMOs also offer agents a lot of other perks they cannot get elsewhere.

“While FMOs focus on health insurance products, they may also offer contracting for life insurance products or other types of ancillary insurance coverage. Agents who work with an FMO may have production requirements they have to meet to maintain their commission levels. It’s also worth noting that agents who partner with an FMO and later wish to leave the organization will have to get a release from the FMO.

“An independent marketing organization (IMO) is basically the same as an FMO. Some agents believe FMOs tend to focus more on health insurance products while IMOs tend to focus on life insurance products, but this isn’t always true. IMOs are sometimes a little smaller than FMOs and may not be able to pay agents as much in commission as some FMOs.

“Like FMOs, IMOs tend to be licensed to sell multiple carrier products in multiple states. They work with hundreds to thousands of agents, and usually offer those agents valuable training and support.

“Managing general agents (MGAs) may partner with FMOs and/or IMGs, though typically as a downline of those top-of-hierarchy organizations. They also have their own downline agents, who they help with their businesses. MGAs earn more commission than a general agent, but less than an FMO/IMO. They oftentimes are required to reach and maintain certain production requirements to keep their status as an MGA. These requirements can vary from one FMO or IMO to another, and even from one carrier to another.

“The MGA term is more widely recognized with life insurance agencies. Some MGAs may call themselves brokerage general agencies (BGAs), which is also a common term on the life side of business. Sometimes, MGA/BGA can be a top-level contract. In fact, the MGA/BGA contract is the top contract offered by life insurance carriers.

“Good MGAs/BGAs will provide their downline agents training and support, even as much as an FMO/IMO/NMO.

“General agents (GAs) may contract under an FMO, IMO, NMO, or MGA. This contract typically allows them to have their own sub-agents and likely has production requirements an agent needs to meet to maintain their status as a GA.

“Like good MGAs, good GAs will provide their agents with some training and support, but likely not on the same level as an FMO/IMO. Again, this is simply because they don’t have as many resources as the larger organizations (i.e., time, money, staff members, etc.).

“A healthcare consumer (“consumer”) is a person who utilizes healthcare services and who purchases healthcare insurance to cover costs of the healthcare services. Consumer is a term that can include the policy holder and additional beneficiaries. Before a consumer purchases a health insurance policy, an IMA will refer to a consumer as a lead or potential customer. After purchasing the health insurance policy, the IMA will refer to the consumer as a customer or client.

“Actors and entities in the insurance and health insurance marketplace (agents, agencies, carriers, consumers/beneficiaries) cannot presently engage on a mobile application to complete the enrollment process in a simple and integrated platform. Furthermore, there are challenges such as efficiency, quality lead-generation, churn, retention, and Telecommunications Consumer Protections (TCP) issues, which increase costs for all parties (and ultimately consumers), decrease consumer satisfaction, increase insurer risk, and decrease agent cash flow.

“Method for Enrolling Consumers

“A typical method for enrolling customers in health insurance policies occurs as follows. A (sales) lead generation firm (hereinafter, “firm” or “LGF”)) hosts an event (i.e., a meeting, party, social event) for consumers. For example, the firm could host an event for residents in a retirement community. At the event, the firm requests the customers to provide their customer information (e.g., name, telephone number, email address, mailing address, and social media handle) and to give their consent to be contacted by an insurance agent. Following the event, the firm sells the customer information to an insurance agent.

“In an alternate method, the firm hosts and markets a website promoting health insurance coverage. Potential customers seeking insurance coverage submit their contact information and possibly health information (e.g., age and medical history). Next, the firm sells the customer information to insurance agents and insurers for the highest price. It is important to note that the firm itself is typically not qualified to sell the insurance itself.

“In either case, the firm sells the lead based on the highest price, which is not necessarily the best coverage or price for the customer. The insurance agent contacts the potential customer and solicits the customer. During the solicitation, the insurance agent collects health information from the potential customer. In the same conversation, the insurance agent provides the potential customer with any required consumer protection information. Next, the insurance agent provides the customer information and the health information to an insurer (i.e., underwriter). The insurer replies to the insurance agent with an appropriate health insurance policy and an annual price. In turn, the insurance agent provides the potential customer with the terms of the insurance policy and a premium (i.e., price). If the customer accepts, the insurance agent enrolls the potential customer in the policy and arranges a payment schedule that includes a downpayment followed by monthly payments to be paid by the potential customer to the insurer. The insurer rebates the insurance agent with a portion of the premium. The rebate to the insurance agent may pass through IMAs before reaching the insurance agent. The insurance agent is paid a commission on the premium even if the premium is being paid in installments. If the customer cancels the policy, the insurance agent returns a prorated commission upstream.

“This process has many shortcomings. The following are examples.

“The firm sells a given lead to an insurance agents based on the highest price. The winning insurance agent may not be affiliated with an insurer that can offer the best policy for the potential customer.

“The firm only agrees to sell the lead exclusively for ninety days. After ninety days, the firm will resell the lead to a second insurance agent, even if the first agent already converted the lead to a customer. The second insurance agent will offer a different policy at a different price. If the customer accepts the second offer, the customer will cancel the first policy. When the insured cancels the first policy, the insurer requests a charge back from the first agent for the portion of the policy that the insured canceled. This process exposes the insured to repeated sales calls, which lower the customer’s satisfaction. In addition, the process unexpectedly reduces the cash flow of the insurance agent.

“To protect consumers from unethical insurance agents, the government has passed consumer protection laws. The consumer protection laws provide civil penalties for violations. Attorneys who represent customers/insureds win penalties from insurers when the insurer or insurance agent violate the law. To protect themselves, insurers and insurance agents provide the required notice and disclaimers that are required by the law to the customers/insureds. The insurance agent and insurer note the customer’s consent to the disclaimers. Later, when the customer consults with an attorney, the customer may not remember that they had been given the necessary disclaimer. If litigation for violation of the consumer protection law ensues, the insurance agent, who acted within the requirements of the consumer protection law, only has the weak, self-serving evidence of their own notes as a defense.

“Healthcare Insurance Software Platforms’

There is additional background information. Please visit full patent to read further.”

In addition to the background information obtained for this patent application, NewsRx journalists also obtained the inventors’ summary information for this patent application: “An object of the invention is to provide a method for enrolling in insurance, a kiosk for enrolling in insurance, and a computer software product for enrolling in health insurance that overcomes the disadvantages of the devices and methods of this general type and of the prior art.

“The method according to the invention can be used by customers seeing individual and/or group insurance coverage.

“With the foregoing and other objects in view there is provided, in accordance with the invention, a downloadable software application for self-service enrollment for insurance, and particularly for health insurance. The software application includes a method with the following steps. A consumer/beneficiary engages with an agent, agency, or carrier of the consumer/beneficiary’s choosing. The consumer/beneficiary engages the agent, agency, or carrier with the consumer/beneficiary’s own mobile device (e.g., smartphone or portable computer). An alternative to the consumer/beneficiary’s own mobile device is for the consumer/beneficiary to use a shared public kiosk to contact the agent, agency, or carrier. A second alternative to the consumer/beneficiary’s own mobile device is for the consumer/beneficiary to use a software application on a smart television or run on a home personal computer.

“The platform can include a method for arranging an appointment at a later time with a remote agent.

“An object of the invention is to provide a fast, easy, and convenient insurance enrollment process.

“An object of the invention is to provide an enrollment platform that operates twenty-four hours per day while requiring a minimal amount of staffing.

“A further object of the invention is to provide a platform for enrolling in insurance that enables the following processes:

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“Comparing coverage options;

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“Making an in-home appointment;

“Sending a scope of appointment;

“Visiting virtually via video with a tele agent;

“Accessing the platform on a kiosk or downloadable application (i.e., “App”); and

“Providing a FAQ knowledge center.

“The invention encompasses a kiosk. The kiosk provides a terminal for accessing a platform for enrolling in an insurance policy. The kiosk can include blood pressure monitor for measuring a customer’s blood pressure. The blood pressure reads blood pressure of the customer and transmits the blood pressure to the terminal. The terminal provides the blood pressure of the patient in order to qualify the customer for a particular policy,

“The kiosk can include additional devices for collecting data on the customer to qualify the customer for a given insurance policy.

“The kiosk can include a speaker, a microphone, and a camera connected to the terminal. The speaker, the microphone, and the camera can be used to form a voice or video conference with an agent. The agent can be remote from the kiosk. The agent can enroll the customer in an insurance plan based on information given by the customer during the teleconference. The agent can provide the customer with a set of insurance policies based on the information given by the customer and then the customer can select a particular policy from the set.

“The invention includes downloadable software that can access the online enrollment platform. Applications for smartphones, tablets, personal computers, and set-top boxes can be provided.

“The platform provides a set of agents to the customer. The agents can provide personal criteria about themselves: for example, age, gender, and language preference, cultural affinity, agent rating, location, and availability. The customer can select a particular agent from the set of agents based on the criteria.

“An object of the invention is to reduce churn and to increase customer retention. To prevent a customer from being bombarded by multiple agencies, a customer will be asked to join the Do Not Call List during the enrollment process. If the customer choses, the platform will submit the customer’s number for addition to the Do Not Call List.

“In accordance with the objects of the invention, a method for offering health insurance to a consumer includes the following steps. The first step is providing a database of independent insurance agents. The database includes an identity field for storing a unique identity for each of the independent insurance agents. The database includes a criterion field for storing a criterion describing each of the independent insurance agents. Accordingly, a first record has a first unique identifier identifying the first independent agent stored in an identity field of the first record and a first criterion describing the first independent agent stored in a criterion field of the first record. The database further includes a second record associated with a second independent agent. The second record having a second unique identifier identifying the second independent agent stored in an identity filed of the second record and a second criterion describing the second independent agent stored in a criterion field of the second record. The next step is receiving an inquiry for health insurance from a consumer on a computer (typically a server). The computer being connected to the database. The next step is transmitting the first criterion and the second criterion from the computer to a downloadable software application of the consumer over a network (typically, the Internet). The next step is receiving an agent selection from the consumer. The agent selection is made by the consumer and depends on a selection of one of the first criterion and the second criterion by the consumer. The next step is connecting, to the consumer, a selected agent. The next step is transmitting an offer for health insurance to the consumer from the selected agent. The selected agent can send multiple, different offers to the consumer that can be provided from different underwriters.

“In accordance with the objects of the invention, after the customer selects an independent insurance agent, the independent insurance agent can transmit a compliance document to the consumer and require the consumer to read, acknowledge, and accept the compliance agreement. The compliance agreement can be stored by the independent insurance agent.

“In accordance with the objects of the invention, a method offers health insurance to a consumer. The first step is transmitting a downloadable software package of an independent insurance agent to a consumer of healthcare. The consumer installs the downloadable software package on the customer’s smart device such as a computer, smartphone, tablet, or smart television. The next step is receiving an inquiry for health insurance for the consumer from the downloadable software package with a computer of the independent insurance agent. The next step is transmitting an offer for a health insurance policy from said computer of the independent insurance agent to said downloadable software package.

“In accordance with the objects of the invention, a system offers health insurance to a consumer. The system can include a kiosk. The kiosk includes a computer, a medical instrument, and a network interface controller. The input device is connected to the computer for receiving input from the consumer. The display is connected to the computer and is used for displaying output from the consumer. The medical instrument is for measuring health data of the consumer. Examples of medical instruments include a sphygmomanometer and a scale for measuring a patient’s weight. The network interface controller connects the computer to a network and transmits the input and the health data to an independent insurance agent via the network.

“Although the invention is illustrated and described herein as embodied in a method for enrolling in insurance, a kiosk for enrolling in insurance, and a computer software product for enrolling in health insurance, the invention should not be limited to the details shown in those embodiments because various modifications and structural changes may be made without departing from the spirit of the invention while remaining within the scope and range of equivalents of the claims.

“The construction and method of operation of the invention and additional objects and advantages of the invention is best understood from the following description of specific embodiments when read in connection with the accompanying examples.”

The claims supplied by the inventors are:

“1. A method for offering health insurance to a consumer, which comprises: providing a database of independent insurance agents, said database including an identity field for storing a unique identity for each of the independent insurance agents and a criterion field for storing a criterion describing each of the independent insurance agents, a first record associated with a first independent agent, the first record having a first unique identifier identifying the first independent agent stored in an identity field of said first record and a first criterion describing the first independent agent stored in a criterion field of the first record, and a second record associated with a second independent agent, the second record having a second unique identifier identifying the second independent agent stored in an identity filed of said second record and a second criterion describing the second independent agent stored in a criterion field of said second record; receiving an inquiry for health insurance from a consumer on a computer, said computer being connected to said database; transmitting said first criterion and said second criterion from said computer to the consumer over a network; receiving an agent selection from the consumer, said agent selection depending on a selection of one of said first criterion and said second criterion by the consumer; connecting, to the consumer, a selected agent, the selected agent being one of said first independent agent and said second independent agent based on said agent selection; and transmitting an offer for health insurance to the consumer from the selected agent.

“2. The method according to claim 1, which further comprises: transmitting a further offer for health insurance to the consumer from the selected agent; and receiving a policy selection of one of said offer and said further offer from the consumer.

“3. The method according to claim 2, wherein: said offer for health insurance is from a first underwriter; and said further offer for health insurance is from a second underwriter.

“4. The method according to claim 1, which further comprises the selected agent submitting a telephone number of the consumer to a do not call list.

“5. The method according to claim 1, which further comprises: transmitting a compliance confirmation request from the selected agent to the consumer; and receiving a compliance confirmation replying to the compliance confirmation request from the consumer.

“6. A method for offering health insurance to a consumer, which comprises: transmitting a downloadable software package of an independent insurance agent to a consumer of healthcare; receiving an inquiry for health insurance for the consumer from said downloadable software package with a computer of the independent insurance agent; and transmitting an offer for a health insurance policy from said computer of the independent insurance agent to said downloadable software package.

“7. The method according to claim 6, which further comprises: providing a database of independent insurance agents, said database including an identity field for storing a unique identity for each of the independent insurance agents and a criterion field for storing a criterion describing each of the independent insurance agents, a first record associated with a first independent agent, the first record having a first unique identifier identifying the first independent agent stored in an identity field of said first record and a first criterion describing the first independent agent stored in a criterion field of the first record, and a second record associated with a second independent agent, the second record having a second unique identifier identifying the second independent agent stored in an identity filed of said second record and a second criterion describing the second independent agent stored in a criterion field of said second record; transmitting said first criterion and said second criterion from said computer to the consumer over a network; receiving an agent selection from the consumer, said agent selection depending on a selection of one of said first criterion and said second criterion by the consumer; and connecting, to the consumer, a selected agent, the selected agent being one of said first independent agent and said second independent agent based on said agent selection.

“8. The method according to claim 7, which further comprises: transmitting a further offer for health insurance to the consumer from the selected agent; and receiving a policy selection of one of said offer and said further offer from the consumer.

“9. The method according to claim 8, wherein: said offer for health insurance is from a first underwriter; and said further offer for health insurance is from a second underwriter.

“10. The method according to claim 6, which further comprises the independent insurance agent submitting a telephone number of the consumer to a do not call list.

“11. The method according to claim 7, which further comprises: transmitting a compliance confirmation request from the selected agent to the consumer; and receiving a compliance confirmation replying to the compliance confirmation request from the consumer.

“12. A system for offering health insurance to a consumer, comprising: a kiosk for requesting healthcare insurance, said kiosk including a computer, an input device being connected to said computer for receiving input from the consumer, a display being connected to said computer for displaying output from the consumer, a medical instrument for measuring health data of the consumer, and a network interface controller for connecting to a network and transmitting the input and the health data to an independent insurance agent.

“13. The system according to claim 12, further comprising: a terminal of an independent insurance agent including a computer, a network interface controller for connected said computer to the network; and said computer receiving the health data from said kiosk.

“14. The system according to claim 12, wherein said input device is a keyboard.

“15. The system according to claim 12, wherein said display shows video sent from the independent insurance agent.

“16. The system according to claim 12, wherein said kiosk includes a camera for recording video of the consumer.

“17. The system according to claim 12, wherein said medical instrument is a sphygmomanometer for measuring blood pressure of the consumer.”

URL and more information on this patent application, see: Batista, Amari; Roche, Amanda. Method and System for Enrolling in Health Insurance. U.S. Patent Application Number 20240029167, filed March 30, 2023 and posted January 25, 2024. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(20240029167)&db=US-PGPUB&type=ids

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