FORM 2
THE PATENTS ACT, 1970
(39 of 1970)
&
THE PATENTS RULES, 2003
COMPLETE SPECIFICATION
(See section 10, rule 13)
“PARAMETRIC DRAW-DOWN SYSTEM FOR RISKS
SHARING OF CRITICAL ILLNESS RISK AND
CORRESPONDING METHOD THEREOF”
SWISS REINSURANCE COMPANY LTD. of Mythenquai
50/60, 8022 Zürich, Switzerland;
The following specification particularly describes the invention and the manner in
which it is to be performed.
2
Parametric Draw-Down System For Risk Sharing of Critical Illness Risks And
Corresponding Method Thereof
Field of the Invention
The present invention relates to critical illness insurance systems for
5 providing risk sharing of critical illness risks of a variable number of risk exposure
components by providing a dynamic self-sufficient risk protection for the risk exposure
components by means of the critical illness insurance system. In particular, the invention
relates to automated event-driven systems triggering on the patient dataflow pathway.
Background of the Invention
10 These days, there is significant risk exposure related to many aspects in life
and non-life sectors. Risk exposed units as any kinds of objects, individuals, corporate
bodies and/or legal entities, necessarily are confronted with many forms of active and
passive risk management to hedge and protect against the risk of certain losses and
events. In the prior art, one way to address such risk of loss is based on transferring and
15 pooling the risk of loss from a plurality of risk exposed entities to a dedicated pooling
entity. In essence, this can be executed by effectively allocating the risk of loss to this
pooling unit or entity by pooling resources of associated units, which are exposed to a
certain risk. In case, that one of the units is hit by an event occurrencing related to a
transferred risk, the pooling entity directly intercepts the loss or damage caused by the
20 event by transferring resources from the pooled resources to the affected unit. Pooling of
resources can be achieved by exchanging predefined amounts of resources with the
resource-pooling system; e.g. payments or premiums to be paid, for the transfer of the
risk. This means that predefined amounts of resources are exchanged for the other unit
assuming the risk of loss.
25 For living individuals, a special kind of risk is based on the risk of loss of life
and related possible losses; i.e., losses that occur as a consequence of the death of that
individual. Such risks are traditionally handled by so-called life insurance systems. To
administer a loss for benefits provided by a life insurance policy, a substantial amount of
information must be collected and managed by the pooling entity in order to allow risk-
30 transfer. Appropriate documentation must be identified, captured and analyzed, such as
3
death certificates or medical provider verification of condition or service in the cases of
health/supplementary health. One important problem arises by the fact that life
insurance methods are triggered by the death of the unit, which risk is transferred.
However, often problems arise for an individual before then, in that financial resources
5 were threatened by losses occurring prior to death as a consequence of the events leading
to death. This is mostly the case when the individual suffers from potentially terminal
disease, like malignant cancer, which may inevitably lead to the death of the individual.
Typically, the patient is confronted with increasing costs for medical treatment or other
related costs as travel expenses or additional heating costs, but also by the decreasing
10 ability to earn the money needed to fulfill their monthly financial needs. This may lead to
the necessity of having to make many sacrifices; e.g. taking children out of private
schools, selling their house and filling for bankruptcy. All these financial concerns
contrariwise impacted on their health. Recovery is delayed, and stress additionally
aggravates the anyway poor health.
15 As a solution, resource-pooling systems were developed that cover such “critical
illnesses”, where the resource-pooling unit operated by the insurer provides a lump sum
cash payment if the risk-exposed unit, which is, seen from the prespective of the insurer
the policyholder, is diagnosed with one of the critical illnesses listed in a defined table of
transferred risk. The operation of the resource-pooling system may also be structured to
20 pay out regular income, and the payouts may also benefit the policyholder undergoing a
surgical procedure, for example, having a heart bypass operation. Typically, such systems
require the risk-exposed unit to survive a minimum number of days (the so-called
survival period) from when the illness was first diagnosed. The survival period can vary;
however, 14 days is the most commonly used survival period used. In the Australian
25 market, survival periods are set between 8 – 14 days. However, systems as e.g. systems
accosiated with indemnity based on accelerated payment (e.g. related to specific life
insurance products) and stand alone products, are also known. The terms, as defined for
the risk transfer, typically contain specific predefined triggers or rules to be applied that
provide the basis for the determination of when a diagnosis of a critical illness is
30 considered valid. Terms for survival periods may also define parameters providing that
the diagnosis need to be made by a physician who specializes in the treatment of that
illness or condition or name specific tests, e.g. ECG changes in case of a myocardial
infarctions, that confirm the diagnosis. In many markets, the trigger parameters for many
of the diseases and conditions have become standardized; thus typically resource-pooling
4
systems would use the same definition (cf. stand alone products and accelerated critical
illness systems). The standardization of the critical illness definitions serves many
purposes, including better clarity of coverage for the risk-exposed units and greater
comparability of terms and conditions for risk transfers among different resource-pooling
5 systems. Such terms and conditions are often defined in the policy covering the risk
transfer. For example, in the UK the Association of British Insurers (ABI) has issued a
Statement of Best Practice, which includes a number of standard definitions for common
critical illnesses. The prior art also provides for alternative methods of critical illness risk
transfer, other than the lump sum cash payment method. These critical illness insurance
10 systems can directly pay health providers (as e.g. "tiers payant" systems) for the treatment
costs involving critical and life-threatening illnesses that are covered by the
policyholder’s insurance policy, including fees for specialists and procedures at a select
group of high-ranking hospitals up to a certain amount per course of treatment as set out
in the policy, but also transfer the payment to the customer.
15 In the prior art, critical illnesses are typicallycovered by critical illness risk transfer; these
are heart attack, cancer, stroke and coronary artery by-pass surgery. Examples of other
conditions that might be covered include: Alzheimer's disease, blindness, deafness,
kidney failure, major organ transplant, multiple sclerosis, HIV/AIDS contracted by blood
transfusion or during an operation, Parkinson's disease, paralysis of limb, terminal
20 illness. One of the problems of the risk transfer system as provided by the prior art lies in
the fact that the incidence of a condition may vary (i.e. in- or decrease) over time, and that
diagnosis and treatment may improve over time, that the financial need to cover some
illnesses deemed critical a decade ago is no longer considered necessary today. Likewise,
some of the conditions covered today may no longer need to be covered a decade or so
25 from now. It is very difficult to adapt the prior art systems to such changing conditions.
What is clear is the fact that the financial hardship at the time of diagnosis and afterwards
increases during the course of treatment, which seldom can be meet by the present
systems. Furthermore, operating the systems of the prior art requires a high level of
human resources, because these systems cannot be adequately automated. Therefore, a
30 large quantity of the pooled resources are used by the resource-pooling system itself to
administer the risk transfer, which makes the risk transfer expensive for the risk-exposed
unit. Finally, another problem comes from the fact that, due to the medical progress,
many patients no longer die but can survive for many years after undergoing treatment
for a heart attack, stroke and cancer. Due to the long survival period, such individuals,
5
who were struck already once by a critical illness, continue to be exposed to the risk of a
second or consequential occurrence of a critical illness. In fact, the risk typically does not
decrease, since the health of these patients is already weakened by the first incidence of a
critical illness. Since critical illnesses are traditionally meant to lead to death, the risk
5 involving such individuals, who may be affected by a second or even morecritical
illnesses is no longer covered by the resource-pooling system. Therefore, although the
patient survived his first bout with a critical illness, he may, at least financially, not
survive the second time.
In the state of the art, US 8 452 620 B1 discloses a system for determining a parametric
10 index value of the risk arising from aggregate litigation activity, which risk is correlated
with the financial exposures of the insureds' exposed to such claims, and of the insurers
who provide coverage. The parametric index determined from a set of parameters that
define the type, scope, timing of litigation activity for the index, as well as details how the
index values are determined from the underlying litigation exposure. Further, US
15 2002194099 A1 discloses a for managing a proxy asset vehicle and the means to
implement the proxy assets by defining the proxy assets set, distributing, managing, and
maintaining a plurality of proxy assets shares, linked to account activity in accordance
with pre-determined criteria.
Summary of the Invention
20 It is an object of the invention to provide a system and method for risk
sharing of critical illness risks of a variable number of risk exposure components by
providing a dynamic self-sufficient risk protection for the risk exposure components by
means of the critical illness insurance system. The critical illness insurance system,
realized as a automated resource-pooling system shall be completely automated and self-
25 adaptable/self-maintaining by its technical means and shall provide the technical risk
transfer basis, which can be used by service providers in the risk transfer or insurance
technology for risk transfer related to critical illness risks (CI). A further object of the
invention provides for a way to technically capture, handle and automate complex
related operations of the insurance industry related to critical illness risk transfer.
30 Another object is to synchronize and adjust such operations based on technical means. In
contrast to the standard approach, the resource-pooling system shall create a
reproducible operation with the desired, technically based, repetitious accuracy based on
6
technical means, process flow and process control/operation.
According to the present invention, these objects are achieved particularly
through the features of the independent claims. In addition, further advantageous
embodiments follow from the dependent claims and the related description.
5 According to the present invention, the above-mentioned objects for risk
sharing of critical illness risks of a variable number of risk exposure components are
achieved, particularly, by providing a dynamic self-sufficient risk protection for the risk
exposure components by means of the resource-pooling system, wherein the risk
exposure components are connected to the resource-pooling system by means of a
10 plurality of payment-receiving modules configured to receive and store payments from
the risk exposure components for the pooling of their risks and resources, and wherein
the resource-pooling system comprises an event-driven core engine comprising critical
illness triggers triggering in a patient dataflow pathway to provide risk protection for a
specific risk exposure component based on received and stored payments from the risk
15 exposure components, in that the total risk of the pooled risk exposure components
comprises a critical illness risk contribution of each pooled risk exposure components
associated to risk exposure in relation to a diagnosis of a critical illness, wherein the
critical illness is comprised in a predefined searchable table of critical illnesses and
wherein critical illness losses occur as a consequence to the first diagnosis of risk
20 exposure components with one of the searchable critical illnesses, in that in case of a
triggering of an occurrence of a critical illness in the patient data flow pathway of a risk
exposure component, a corresponding trigger-flag is set by means of the resource-pooling
system and a parametric draw-down transfer of payments is assigned to this
corresponding trigger-flag, wherein a loss associated with the critical illness is distinctly
25 covered by the resource pooling system based on the respective trigger-flag and based on
the received and stored payment parameters from risk exposure components by the
parametric draw-down transfer from the resource-pooling system to the risk exposure
component and in that a first parametric payment is transferred by triggering the
occurrence of the critical illness, a second parametric payment is transferred by a
30 triggering of an acute treatment phase, and a third parametric payment is transferred by
a triggering of a recovery phase linked to terminal prognosis data. The critical illness
triggers can for example comprise a trigger for triggering the occurrence of measuring
parameters indicating heart attack and/or cancer and/or stroke and/or coronary artery
7
by-pass surgery in the patient data flow pathway. Further, the critical illness triggers can
e.g. comprise a trigger for triggering the occurrence of measuring parameters indicating
Alzheimer's disease, blindness, deafness, kidney failure, major organ transplant, multiple
sclerosis, HIV/AIDS contracted by blood transfusion or during an operation, Parkinson's
5 disease, paralysis of limb, terminal illness on the patient dataflow pathway. As an
embodiment variant, it can be provided that the first parametric payment, for example
can technically be implemented in that it only is transferred by the triggering of the
occurrence of measuring parameters indicating the critical illness of malignant cancer
and/or a smaller incidence for ductal carcinoma in situ (DCIS) and/or early prostate
10 carcinoma. Further, the acute treatment phase parameters indicating surgery and/or
chemotherapy and/or radiotherapy and/or reconstructive surgery can be triggered on
the patient data flow pathway by means of a critical illness trigger by the core engine. As
an embodiment variant, it is provided that the second parametric payment only is
transferred due to the triggering of acute treatment phase parameters indicating surgery
15 and/or chemotherapy and/or radiotherapy and/or reconstructive surgery. The recovery
phase parameters associated with terminal prognosis data can e.g. be triggered in a
patient data flow pathway by means of a critical illness trigger of the core engine. As a
further embodiment variant, the third parametric payment is only transferred by the
triggering of the recovery phase parameters and/or terminal prognosis parameters. As a
20 further variant, the critical illness data of the patient dataflow pathway of the risk
exposure component can e.g. additionally be transferred to an automated employee
assistance system (EAP: Employee Assistance Program) providing automated support to
the risk exposure component. Alternatively or in addition, the critical illness data of the
patient dataflow pathway of the risk exposure component can e.g. be transferred to an
25 alert system of an Change Advisory Board (CAB) to activate automated or at least semiautomated,
CAB actions. It can also be advantageously that the patient dataflow pathway
is e.g. monitored by the resource-pooling system by capturing patient-measuring
parameters of the patient data flow pathway at least periodically and/or within
predefined time frames or periods. Finally, the patient data flow pathway can e.g. be
30 dynamically monitored by the resource-pooling system in that it triggers patientmeasuring
parameters of the patient dataflow pathway transmitted from associated
measuring systems. The invention has, inter alia, the advantage that the system provides
the technical means to meet customer needs related to the financial hardships at the time
of the diagnosis of a critical illness, which will become more acute as the treatment
35 progresses. Therefore, cancer fears and the related consequences that are suffered by
8
many people can be met with the automated resource-pooling system according to the
invention. The system has, furthermore, the advantage that smaller payments than in
traditional critical illness systems are sufficient to allow for a safe operation of the system.
The operational aspects of the system are transparent for operators as well as covered risk
5 units, since payment is transferred in response to certain triggers on the cancer patient’s
information pathways. The system is able to provide an adaptable survival period e.g. 14,
21 or 28 days, to be confirmed or defined by the risk transfer. The system is further able
to provide the technical implementation of an automated system that is based on a
drawdown payment operation or a predefined payment operation. The system also
10 provides the technical means, which can support different underwriting options, such as
(i) underwritten with a set of questions, (ii) in/out underwriting, (iii) inclusion or
exclusion of Pre-Existing Condition Exclusion (PECE) and/or a Related Conditions
Exclusion with the associated problems of risk transfer. PECE-problems are based on the
fact that resource-pooling systems are often required by an employer to create safety
15 provisions, if there is a diagnosis of a critical illness in an employee, in order to provide a
lump sum benefit for an employee (or the employee’s spouse or children, if comprised in
the risk transfer), who is diagnosed with one of the defined medical conditions or
undergoes one of the listed surgical procedures. However, many systems fail to take over
risk transfers if the individual suffered from the insured condition, before the risk
20 transfer was activated (this is known as the Pre-Existing Condition Exclusion), or because
the individual suffered from a condition that led to a claim under the insured illness – for
example, it was known that an individual suffered from high blood pressure before the
risk transfer being activated, and suffered a stroke after the risk transfer had been
activated. Another advantage of the system is based on the fact that payments are directly
25 transferred to the risk transfer unit or the consumer/client. Therefore, the system is able
to enhance critical illness insurance offerings by independent financial advisers (IFA).
IFAs are persons who give impartial advice to clients on financial matters and who are
not employed by any financial institution, although commissions for the sale of products
may be received. Especially the IFA service is made completely cost-transparent to the
30 consumer. However, it is also clear to a man skilled in the art, that the system can
comprise additional trigger levels, i.e. more that the three herein exemplarily disclosed
trigger levels.
In an embodiment variant, the above-mentioned objects for risk sharing of
critical illness risks of a variable number of risk exposure components are achieved,
9
particularly, by providing a dynamic self-sufficient risk protection for the risk exposure
components by means of the critical illness insurance system based on a resource-pooling
system, in that risk-related component data are processed by an assembly module of the
resource-pooling system and the likelihood of said risk exposure is provided by means of
5 the assembly module for one or a plurality of the pooled risk exposure components based
on the risk-related component data, wherein the risk exposure components are connected
to the resource-pooling system by means of a plurality of payment receiving modules,
and payment data are received and stored by means of a payment data store from the risk
exposure components for the pooling of their risks, and wherein the resource-pooling
10 system triggers a patient dataflow pathway by means of critical illness triggers of an
event-driven core engine in order to provide risk protection for a specific risk exposure
component based on received and stored payments from the risk exposure components,
in that a first risk contribution of each pooled risk exposure components related to a first
diagnosis of a critical illness is associated with risk exposure of each pooled risk exposure
15 component, and the total risk of the pooled risk exposure components is determined by
means of the resource-pooling system, wherein the critical illness is comprised in a
predefined searchable table of critical illnesses, and wherein critical illness losses occur as
a consequence of the first diagnosis of risk exposure components due to any one of the
searchable critical illnesses, in that a first risk contribution of each of the pooled risk
20 exposure components related to a second and/or successional risk contribution diagnosis
of a critical illness is associated with risk exposure of each pooled risk exposure
component, and the total risk of the pooled risk exposure components is determined by
means of the resource-pooling system, wherein the critical illness is comprised in the
predefined searchable table of critical illnesses, and wherein critical illness losses occur as
25 a consequence of the second and/or successional diagnosis of risk exposure components
due to any one of the searchable critical illnesses, in that, in case an occurrence of a first or
second or successional critical illness on the patient data flow pathway of a risk exposure
component is triggered, a corresponding trigger-flag is set by means of the resourcepooling
system and a parametric draw-down transfer of payments is assigned to this
30 corresponding trigger-flag, wherein a loss associated with the first or second or
successional critical illness is distinctly covered by the resource-pooling system based on
the respective trigger-flag and based on the received and stored payment parameters
from risk exposure components by the parametric draw-down transfer from the resourcepooling
system to the risk exposure component, and in that a first parametric payment is
35 transferred by the triggering of the occurrence of the critical illness, a second parametric
10
payment is transferred by the triggering of an acute treatment phase, and a third
parametric payment is transferred by the triggering ofan recovery phase associated with
terminal prognosis data. This embodiment variant has the additional advantage, that it
provides further the capability of triggering multiple occerence of critical illnesses and of
5 trasfering can covering such risk by the system.
In one embodiment variant, the receiving and preconditioned storage of
payments from risk exposure components for the pooling of their risks is dynamically
determined based on total risk and/or the likelihood of the risk exposure of the pooled
risk exposure components. This embodiment variant has, inter alia, the advantage that
10 the operation of the resource-pooling system can be dynamically adapted to changing
conditions of the pooled risk, as, for example, changing demographic conditions or
changing age distributions or the like of the pooled risk components. A further advantage
is that the system needs no manual adaption, when it is operated in different
environments, places or countries, because the size of the payments of the risk exposure
15 components is directly related to the totally pooled risk.
In another embodiment variant, the number of pooled risk exposure
components is dynamically adapted, by means of the resource-pooling system, to a range
where non-covariant occurring risks covered by the resource-pooling system affect only a
relatively small proportion of the total pooled risk exposure components at a given time.
20 This variant has, inter alia, the advantage that the operational and financial stability of
the system can be improved.
In a further embodiment variant, the critical illness triggers are dynamically
adapted by means of an operating module based on time-correlated incidence data for a
critical illness condition and/or diagnosis or treatment conditions indicating
25 improvements in diagnosis or treatment. This variant has, inter alia, the advantage that
improvements in diagnosis or treatment can be dynamically captured by the system and
dynamically affect the overall operation of the system based on the total risk of the
pooled risk exposure components.
In yet another embodiment variant, the first, second and third parametric
30 payment are leveled by a predefined total payment sum determined at least based on the
risk-related component data and/or on the likelihood of the risk exposure for one or a
11
plurality of the pooled risk exposure components based on the risk-related component
data, and wherein the first parametric payment that is transferred is up to 30% of said
total payment sum, and the second parametric payment that is transferred is up to 50% of
said total payment sum, and the third parametric payment that is transferred is up to the
5 left over part given by said total payment sum, minus the actual first parametric payment
and the second parametric payment. The predefined total payments can e.g. be leveled to
any appropriate lump sum, such as, for example, $50,000 up to $500,000, or any other
sum related to the total transferred risk and the amount of the periodic payments of the
risk exposure component. As embodiment variant of the realization of the system, the
10 critical illness trigger e.g. can comprise multi-dimensional trigger channels, wherein each
of said trigger-flags is assigned to a first dimension trigger channel, comprising a first
trigger-level triggering occurrence parameters of the critical illness, a second trigger-level
triggering acute treatment phase parameters, and a third trigger-level triggering recovery
phase parameters associated with terminal prognosis data, and each of said trigger-flags
15 is assigned to at least a second or higher dimension trigger channel, and comprises
additional trigger-stages based on the first, second and/or third trigger-level of the first
dimension trigger channel. As a further variant, the critical illness trigger can also
comprise multi-dimensional trigger channels, wherein each of said trigger-flags is
assigned to a first dimension of a trigger channels comprising a first trigger-level relative
20 to triggering occurrence parameters of the critical illness, a second trigger-level relative to
triggering acute treatment phase parameters, and a third trigger-level relative to
triggering recovery phase parameters associated with terminal prognosis data, and each
of said trigger-flags is assigned to a second dimension of trigger channels comprising a
first trigger-level triggering on a first stage of progression-measuring parameters of the
25 occurred critical illness, and one or more higher trigger-levels triggering on higher stages
of progression-measuring parameters of the occurred critical illness. This variant, inter
alia, has the advantage that the draw-down payments or the payments of predefined
amounts, which depend on the first, second or third trigger level, i.e. the different stages
of triggers, allow for an adapted payment of the total sum that is dependent on the stage
30 of the critical illness, as triggered by the system.
In one embodiment variant, a periodic payment transfer from the risk
exposure components to the resource pooling system via a plurality of payment receiving
modules is requested by means of a monitoring module of the resource-pooling system,
wherein the risk transfer or protection for the risk exposure components is interrupted by
12
the monitoring module when the periodic transfer is no longer detectable by means of the
monitoring module. As a variant, the request for periodic payment transfer can be
interrupted automatically or waived by means of the monitoring module, when the
occurrence of indicators for critical illness is triggered in the patient data flow pathway of
5 a risk exposure component. These embodiment variants have, inter alia, the advantage
that the system allows for a further automation of the monitoring operation, especially of
its operation with regard to the pooled resources.
In a further embodiment variant, an independent verification critical illness
trigger of the resource pooling system is activated in cases of a triggering of the
10 occurrence of indicators for critical illness in the patient data flow pathway of a risk
exposure component by means of the critical illness trigger and wherein the independent
verification critical illness trigger additionally is triggering for the occurrence of
indicators regarding critical illness in an alternative patient data flow pathway with
independent measuring parameters from the primary patient data flow pathway in order
15 to verify the occurrence of the critical illness at the risk exposure component. As a
variant, the parametric draw-down transfer of payments is only assigned to the
corresponding trigger-flag, if the occurrence of the critical illness at the risk exposure
component is verified by the independent verification critical illness trigger. These
embodiment variants have, inter alia, the advantage that the operational and financial
20 stability of the system can thus be improved. In addition, the system is rendered less
vulnerably relative to fraud and counterfeit.
In addition to the system, as described above, and the corresponding
method, the present invention also relates to a computer program product that includes
computer program code means for controlling one or more processors of the control
25 system in such a manner that the control system performs the proposed method; and it
relates, in particular, to a computer program product that includes a computer-readable
medium containing therein the computer program code means for the processors.
Brief Description of the Drawings
The present invention will be explained in more detail, by way of example,
30 with reference to the drawings in which:
13
Figure 1 shows a block diagram illustrating schematically an exemplary
parametric, event-driven critical illness insurance system based on a resource-pooling
system 1 according to the invention for risk sharing of critical illness risks of a variable
number of risk exposure components 21, 22, 23 by providing a dynamic self-sufficient
5 risk protection for the risk exposure components 21, 22, 23. The resource-pooling system
1 comprises an assembly module 5 to process risk- related component data 211, 221, 231
and to provide the likelihood 212, 222, 232 of said risk exposure for one or a plurality of
the pooled risk exposure components 21, 22, 23, wherein the risk exposure components
21, 22, 23 are connected to the resource-pooling system 1 by means of a plurality of
10 payment receiving modules 4 that are configured to receive and store 6 payments 214,
224, 234 from the risk exposure components 21, 22, 23 for the pooling of their risks, and
wherein the resource-pooling system 1 comprises an event-driven core engine 3 that
comprises critical illness triggers 31, 32, 33, which trigger a patient data flow pathway
213, 223, 233 to provide risk protection for a specific risk exposure component 21, 22, 23.
15 The patient data flow pathway 213, 223, 233 is monitored by the resource-pooling system
1 in that patient measuring parameters of the patient data flow pathway 213, 223, 233 are
captured, wherein the patient data flow pathway 213, 223, 233 is dynamically monitored
and triggered for patient measuring parameters of the patient data flow pathway 213,
223, 233, which is transmitted from associated measuring systems.
20 Figure 2 shows a block diagram illustrating schematically exemplary trigger
stages of the resource-pooling system, wherein reference number 1001 is assigned to the
triggering of the critical illness, for example the malignant cancer. Reference number 1002
designates the triggering of the treatment phase, such as, for example, surgery,
chemotherapy, radiotherapy or medications of drugs etc. Reference number 1003
25 designates the triggering of the recovery phase or the triggering of the terminal illness
and/or the aftercare phase. Finally, reference number 1004 designates the triggering of
additional support services. Reference number 1004 gives an example of additional
trigger stages to the critical illness triggers 31, 32, 33 of the core engine module 3.
Figure 3 shows a diagram illustrating schematically an exemplary payment
30 drawdown as it can be provided by the resource pooling system 1 in case of triggering
critical illness at a risk exposure component.
14
Figure 4 shows a block diagram illustrating schematically an exemplary
parameterization of the risk exposure for critical illness of the risk exposure components
21, 22, 23. The reference numeral 520 gives the total transferred risk of a specific risk
exposure component 21, 22, 23 comprising at least a first risk contribution 511, 521, 531
5 for a first occurrence of a critical illness. Further, it comprises a second risk contribution
512, 522, 532 related to a second occurrence of a critical illness. It also can comprise third
513, 523, 533 and subsequent 51i, 52i, 53i risk contributions thereafter; i.e., "i" herein
denotes the i-th risk distribution.
Detailed Description of the Preferred Embodiments
10 Figure 1 illustrates, schematically, an architecture for a possible
implementation of an embodiment of the parametric, event-driven resource-pooling
system 1 for risk sharing of critical illness risks. In Figure 1, reference numeral 1 refers to
the resource-pooling system for risk sharing of the risk exposure components 21, 22, 23…
The resource-pooling system 1 provides a dynamic self-sufficient risk protection and
15 corresponding risk protection structure for a variable number of risk exposure
components 21, 22, 23, i.e.; persons or individuals, by its means. The system 1 includes at
least one processor and associated memory modules. The system 1 can also include one
or more display units and operating elements, such as a keyboard, and/or graphical
pointing devices as a computer mouse. The resource-pooling system 1 is a technical
20 device comprising electronic means that can be used by service providers in the field of
risk transfer or insurance technology for risk transfer related to critical illness risks (CI).
The invention seeks to technically capture, handle and automate complex related
operations of the insurance industry. An other aspect is to synchronize and adjust such
operations based on technical means. In contrast to the standard approach, the resource-
25 pooling system also achieves an reproducible operations with the desired technical,
repetitious accuracy because it is completely based on technical means, process flow and
process control/operation.
The resource-pooling system 1 comprises an assembly module 5 to process
risk related component data 211, 221, 231 and to provide the likelihood 212, 222, 232 of
30 said risk exposure for one or a plurality of the pooled risk exposure components 21, 22,
23, etc. based on the risk-related component data 211, 221, 231.The resource-pooling
system 1 can be implemented as a technical platform, which is developed and
15
implemented to provide critical illness risk transfer through a plurality of (but at least
one) payment receiving module 4. The risk exposure components 21, 22, 23, etc. are
connected to the resource-pooling system 1 by means of the plurality of payment
receiving modules 4 configured to receive and store payments 214, 224, 234 from the risk
5 exposure components 21, 22, 23,…. for the pooling of their risks in a payment data store 6.
The storage of the payments can be implemented by transferring and storing componentspecific
payment parameters. The payment amount can be dynamically determined by
means of the resource-pooling system 1 based on total risk of the overall pooled risk
exposure components 21, 22, 23. For the pooling of the resources, the resource-pooling
10 system 1 can comprise a monitoring module 8 requesting a periodic payment transfer
from the risk exposure components 21, 22, 23, etc. to the resource-pooling system 1 by
means of the plurality of payment receiving modules 2, wherein the risk protection for
the risk exposure components 21, 22, 23,.... is interrupted by the monitoring module 8,
when the periodic transfer is no longer detectable by means of the monitoring module 8.
15 In one embodiment variant, the request for periodic payment transfers is automatically
interrupted or waived by means of the monitoring module 8, if the occurrence 1001 of
indicators for critical illness 71, 72, 73 is triggered 31 in the patient data flow pathway of a
risk exposure component 21, 22, 23,...
As also illustrated schematically in Figure 1, the resource-pooling system 1
20 includes a data storing module for capturing the risk-related component data and
multiple functional modules; e.g., namely the payment receiving modules 4, the core
engine 3 with the triggers 31, 32, 33, the assembly module 5 or the operating module 30.
The functional modules can be implemented at least partly as programmed software
modules stored on a computer readable medium, connected as fixed or removable to the
25 processor(s) of system 1 or to associated automated systems. One skilled in the art
understands, however, that the functional modules can also be implemented fully by
means of hardware components, units and/or appropriately implemented modules. As
illustrated in Figure 1, system 1 can be connected via a network, such as a
telecommunications network, to the payment receiving module 4. The network can
30 include a wired or wireless network; e.g., the Internet, a GSM network (Global System for
Mobile Communication), an UMTS network (Universal Mobile Telecommunications
System) and/or a WLAN (Wireless Local Region Network), and/or dedicated point-topoint
communication lines. In any case, the technical electronic money schemes for the
present system comprises adequate technical, organizational and procedural safeguard
16
means in order to prevent, contain and detect threats to the security of the scheme,
particularly the threat of counterfeits. The resource-pooling system 1 comprises further
all necessary technical means for electronic money transfer and association e.g. initiated
by one or more associated payment receiving modules 4 over an electronic network. The
5 monetary parameters can be based on all possible electronic and transferable means as
e.g. e-currency, e-money, electronic cash, electronic currency, digital money, digital cash,
digital currency, or cyber currency etc., which can only be exchanged electronically. The
payment data store 6 provides the means for associating and storing monetary
parameters associated with a single of the pooled risk exposure components 21, 22, 23.
10 The present invention can involve the use of the mentioned network, such as e.g.
computer networks or telecommunication networks, and/or the internet and digital
stored value systems. Electronic funds transfer (EFT), direct deposit, digital gold currency
and virtual currency are further examples of electronic money. Also, the transfer can
involve technologies, such as financial cryptography and technologies enabling the same.
15 For the transaction of the monetary parameters, it is preferable that hard electronic
currency is used without the technical possibilities for disputing or reversing any charges.
The resource-pooling system 1 supports, for example, non-reversible transactions. The
advantage of this arrangement is that the operating costs of the electronic currency
system are greatly reduced by not having to resolve payment disputes. However, this
20 way, it is also possible for electronic currency transactions to clear instantly, making the
funds available immediately to the system 1. This means that using hard electronic
currency is more akin to a cash transaction. However, also conceivable is the use of soft
electronic currency, such as currency that allows for the reversal of payments, for
example having a "clearing time" of 72 hours, or the like. The way of the electronic
25 monetary parameter exchange applies to all connected systems and modules related to
the resource-pooling system 1 of the present invention, such as e.g. the payment receiving
module 4. The monetary parameter transfer to the resource-pooling system 1 can be
initiated by a payment-receiving module 4 or on request of the resource-pooling system
1.
30 The resource-pooling system 1 comprises an event-driven core engine 3
comprising critical illness triggers 31, 32, 33 for triggering component-specific measuring
parameters in the patient data flow pathway 213, 223, 233 of the assigned risk exposure
components 21, 22, 23, …. The patient data flow pathway 213, 223, 233 can e.g. be
monitored by the resource-pooling system 1, capturing patient-related measuring
17
parameters of the patient data flow pathway 213, 223, 233 at least periodically and/or
within predefined time periods. The patient data flow pathway 213, 223, 233 can, for
example, also be dynamically monitored by the resource-pooling system 1, by triggering
patient-measuring parameters of the patient data flow pathway 213, 223, 233 transmitted
5 from associated measuring systems. Triggering the patient data flow pathway 213, 223,
233, which comprises dynamically recorded measuring parameters of the concerned risk
exposure components 21, 22, 23, …., the system 1 is able to detect the occurrence of a
critical illness and dynamically monitor the different stages during the progress of the
critical illness in order to provide appropriately adapted and gradated risk protection for
10 a specific risk exposure component 21, 22, 23, …. Such a risk protection structure is based
on received and stored payments 214, 224, 234 from the related risk exposure component
21, 22, 23, …. and/or related to the total risk of the resource-pooling system ,1 based on
the overall transferred critical illness risks of all pooled risk exposure components 21, 22,
23, ….
15 Figure 2 shows a block diagram with possible trigger stages, wherein
reference number 1001 is assigned to the triggering of the critical illness, for example
cancer; reference number 1002 designates the triggering of the treatment phase, such as,
for example, surgery, chemotherapy, radiotherapy or the administration of medication,
etc.; reference number 1003 designates the triggering of the recovery phase or the
20 triggering of the terminal illness and/or the aftercare phase.; and reference number 1004
designates the triggering of additional support services. Reference number 1004 gives an
example of additional trigger stages to the critical illness triggers 31, 32, 33 of the core
engine module 3. The critical illness triggers 31, 32, 33 can e.g. comprise a trigger 31 for
triggering the occurrence 1001 of the measuring parameters, indicating a heart attack
25 and/or cancer and/or a stroke and/or coronary artery by-pass surgery in the patient
data flow pathway 213, 223, 233. Further, the critical illness triggers 31, 32, 33 can
comprise a trigger 31 for triggering the occurrence 1001 of measuring parameters
indicating Alzheimer's disease, blindness, deafness, kidney failure, major organ
transplant, multiple sclerosis, HIV/AIDS contracted by blood transfusion or during an
30 operation, Parkinson's disease, paralysis of limb, terminal illness in the patient data flow
pathway 213, 223, 233. The majority of cases of occurrences of critical illness are typically
related to heart attack, stroke and cancer, as can be expected. The average age of
individual 21, 22, 23, at which a critical illness can be detected in the patient data flow
pathway 213, 223, 233, is ± 41 years; however, this depends on the development of
18
diagnostic and other medical means. These statistics are common for all countries where
statistics are maintained. However, it is of great concern to observe the increasing
number of critical illness occurrences – particularly regarding cancer cases. In most
countries, this observed increase is more than 50%, and in some even 80%. Earlier
5 diagnosis due to better diagnostic equipment may be partially responsible for these
figuress. Therefore, to ensure proper operation of the resource-pooling system 1, the
definitions of the stored trigger parameters 71, 72, 73 of critical illness in the trigger table
7 can be dynamically adapted based on a monitoring of changing risks in the risk
exposure components 21, 22, 23. In particular, the trigger parameters 71, 72, 73 can be
10 region-specific, country-specific and/or specific of the total pooled risk, adapted or
changed. New critical illnesses 71, 72, 73 can be added, while others can be deleted from
the triggerable list of critical illnesses by the resource-pooling system, owing to better
treatments or other changed environmental conditions. In one embodied variant, the
critical illness triggers 31, 32, 33 can be dynamically adapted by means of an operating
15 module 30, based on time-correlated incidence dates of a critical illness condition and/or
diagnosis or treatment conditions indicating improvements in diagnosis or treatment.
In addition to the adaptation of the triggers 31, 32, 33, the amount of
requested payments from the risk exposure components 21, 22, 23 can be accordingly
adjusted by the resource-pooling system 1.Therefore the receiving and preconditioned
20 storage 6 of payments 214, 224, 234 from risk exposure components 21, 22, 23, ... for the
pooling of their risks can be determined dynamically, based on total risk 50 and/or the
likelihood of the risk exposure of the pooled risk exposure components 21, 22, 23, ... To
improve operational and functional security of the resource- pooling system 1 even
further, the number of pooled risk exposure components 21, 22, 23, ... can be dynamically
25 adapted by means of the resource-pooling system 1 to a range where non-covariant,
occurring risks covered by the resource-pooling system 1 affect only a relatively small
proportion of the totally pooled risk exposure components 21, 22, 23, ... at a given time.
The total risk 50 of the pooled risk exposure components 21, 22, 23, ...
comprises a first risk contribution 511, 521, 531 of each pooled risk exposure component
30 21, 22, 23, ... that is associated with risk exposure in relation to a first diagnosis of a
critical illness. The triggering parameters 71, 72, 73 of the covered critical illnesses is
comprised and stored in a predefined searchable table 7, such as e.g. an appropriately
structured hash table, of critical illnesses 71, 72, 73, respectively critical illness parameters
19
71, 72, 73. The critical illness losses occur as a consequence to the first diagnosis of risk
exposure components 21, 22, 23, ... with regard to one of the searchable critical illnesses;
i.e., the possible need of a risk exposure components 21, 22, 23, ... to be covered by the
pooled resources of the resource-pooling system 1 is linked to the risk of the occurrence
5 of a critical illness requiring complex medical treatment and handling.
The total risk 50 of the pooled risk exposure components 21, 22, 23,…
comprises at least a second risk contribution 512,522,523 and/or third or additional
successional risk contributions 513/521/…51i/52i/53i; i.e., up to the i-th risk
contribution, associated with risk exposure in relation to a second and/or successional
10 critical illness(es). The critical illnesses 71, 72, 73 for triggering the second risk
contribution 512, 522, 523 and/or third or additional successional risk contributions
513/521/…51i/52i/53i are the same as for the first risk contribution and comprised in the
predefined searchable table 7 of critical illness parameters 71, 72, 73.
Figure 4 shows a block diagram with an exemplary parameterization of the
15 risk exposure for critical illness of the risk exposure components 21, 22, 23. The reference
numeral 520 gives the total transferred risk of a specific risk exposure component 21, 22,
23 comprising at least a first risk contribution 511, 521, 531 for a first occurrence of a
critical illness. Further comprised is a second risk contribution 512, 522, 532 related to a
second occurrence of a critical illness. Also comprised can be a third 513, 523, 533 and
20 subsequent 51i,52i,53i risk contribution; i.e., "i" denotes the i-th risk distribution.
In case of triggering an occurrence of a first or second or successional critical
illness 71,72,73 on the patient dataflow pathway 213,223,233 of a risk exposure
component 21, 22, 23, i.e. if a triggering of an occurrence of a first or second or
successional critical illness 71, 72, 73 goes into effect in the patient data flow pathway 213,
25 223, 233, a corresponding trigger-flag is set by means of the resource-pooling system 1
and a parametric draw-down or predefined transfer of payments is assigned to this
corresponding trigger-flag. A loss associated with the first or second or successional
critical illness(es) 71, 72, 73 is distinctly covered by the resource-pooling system 1, based
on the respective trigger-flag and based on the received and stored payment parameters
30 214, 224, 234 from risk exposure components 21, 22, 23 by the parametric draw-down or
predefined transfer from the resource-pooling system 1 to the risk exposure component
21, 22, 23,etc. The payment receiving module 4 can, as an input device, comprise one or
20
more data processing units, displays and other operating elements, such as a keyboard
and/or a computer mouse or another pointing device. As mentioned previously, the
receiving operation of the payments with regard to the risk exposure components 21, 22,
23 is monitored based on the stored component-specific payment parameters in the
5 payment data store 6. The different components of the resource-pooling system 1, such as
e.g. the payment receiving module 4 with the core engine 3 and the assembly module 5
can be connected via a network for signal transmission. The network can comprise, e.g., a
telecommunications network, such as a wired or wireless network, e.g., the internet, a
GSM network (Global System for Mobile Communications), an UMTS network
10 (Universal Mobile Telecommunications System) and/or a WLAN (Wireless Local Area
Network), a Public Switched Telephone Network (PSTN) and/or dedicated point-topoint
communication lines. The payment receiving module 4 and/or core engine 3 and
the assembly module 5 can also comprise a plurality of interfaces for connecting to the
telecommunications network adhering to the transmission standard or protocol. As an
15 embodied variant, the payment receiving module 4 can also be implemented as an
external device relative to the resource-pooling system 1, which provides the risk transfer
service via the network for signal transmission, e.g. by a secured data transmission line.
A first parametric payment 211 is transferred by triggering the occurrence
1001 of the critical illness 71, 72, 73 by means of the critical illness trigger 31 of the core
20 engine 3, thus triggering the measuring parameters of the specific risk exposure
component 21, 22, 23 in the related patient data flow pathway 213, 223, 233.The core
engine 3, analogously to the resource-pooling system 1 and the other components of the
system, is implemented based on underlying electronic components, steering codes and
interacting interface devices, such as e.g. appropriate signal generation modules or other
25 modules interacting electronically by means of appropriate signal generation between the
different modules, devices, or the like. For example, the first parametric payment can be
transferred by triggering 31 the occurrence 1001 of measuring parameters indicating the
critical illness 71, 72, 73 of malignant cancer and/or smaller incidence of ductal carcinoma
in situ (DCIS) and/or early prostate carcinoma.
30 A second parametric payment 212 is transferred by triggering measuring
parameters in the patient data flow pathway 213, 223, 233 indicating the initiation of an
acute treatment phase 1002 by means of the critical illness trigger 32 of the core engine 3.
For example, acute treatment phase parameters 1002 indicating surgery and/or
21
chemotherapy and/or radiotherapy and/or reconstructive surgery can be triggered in
patient data flow pathway 213, 223, 233 by means of a critical illness trigger 32 of the core
engine 3. For example, the second parametric payment can only be transferred by
triggering 32 acute treatment phase parameters 1002, indicating surgery and/or
5 chemotherapy and/or radiotherapy and/or reconstructive surgery. Finally a third
parametric payment 213 is transferred by triggering measuring parameters in the patient
data flow pathway 213, 223, 233 indicating the initiation of a recovery phase 1003 linked
to terminal prognosis data by means of the critical illness trigger 33 by the core engine 3.
For example, recovery phase parameters 1003 linked to or associated with terminal
10 prognosis data are triggered in patient data flow pathway 213, 223, 233 by means of a
critical illness trigger 33 by the core engine 3. As a variant, the third parametric payment
is only transferrable by triggering 33 recovery phase parameters and/or terminal
prognosis parameters 1003.
Therefore, if triggering 1001 takes effect, an occurrence of a first critical
15 illness 71, 72, 73 in the patient dataflow pathway 213, 223, 233 of a risk exposure
component 21, 22, 23, any associated loss is covered by the resource-pooling system 1
based on the received and stored payments 214, 224, 234 from risk exposure components
21, 22, 23 by transferring a parametric diagnosis payment 2001 from the resource-pooling
system 1 to the risk exposure component 21, 22, 23, etc.; if triggering 1002 takes effect, an
20 occurrence of an acute treatment phase in the patient data flow pathway 213, 223, 233 of
an associated loss is covered by the resource-pooling system 1 based on the received and
stored payments 214, 224, 234 from risk exposure components 21, 22, 23 by transferring a
parametric treatment phase payment 2002 from the resource-pooling system 1 to the risk
exposure component 21, 22, 23, etc,; and if triggering 1003 takes effect, an occurrence of
25 arecovery phase linked to terminal prognosis data in the patient data flow pathway and
associated loss is covered by the resource-pooling system based on the received and
stored payments 214, 224, 234 from risk exposure components 21, 22, 23 by transferring a
parametric recovery phase payment 2003 from the resource-pooling system 1 to the risk
exposure component 21, 22, 23, etc. The first, second and third parametric payments can,
30 for example, be leveled by a predefined total payment sum determined at least based on
the risk-related component data 211, 221, 231 and/or the likelihood of the risk exposure
for one or a plurality of the pooled risk exposure components 21, 22, 23, etc., based on the
risk-related component data 211, 221, 231, wherein the first parametric payment is
transferred up to 30% of said total payment sum, and the second parametric payment is
22
transferred up to 50% of said total payment sum, and the third parametric payment is
transferred up to the residual part given by said total payment sum minus the actual first
parametric payment and the second parametric payment. Such an exemplary payment
draw-down as it can be provided by the resource-pooling system 1 in the event of a
5 triggering of a critical illness at a risk exposure component is shown in the diagram of
Figure 3.
As a further technical variant, the critical illness triggers 31, 32, 33 comprise
multi-dimensional trigger channels. Each of said trigger-flags is assigned to a first
dimension trigger channel comprising a first trigger-level triggering 31 on occurrence
10 parameter 1001 of the critical illness 71, 72, 73, a second trigger-level triggering 32 on
acute treatment phase parameter 1002, and a third trigger-level triggering 33 on recovery
phase parameter 1003 linked to or associated with terminal prognosis data; and each of
said trigger-flags is assigned to at least a second or higher dimension trigger channel and
comprises additional trigger-stages based on the first, second and/or third trigger-levels
15 of the first dimension trigger channel. The critical illness trigger 31, 32, 33 can e.g.
comprise multi-dimensional trigger channels, wherein each of said trigger-flags is
assigned to a first dimension of a trigger channel comprising a first trigger-level
triggering 31 on occurrence parameter 1001 of the critical illness 71, 72, 73, a second
trigger-level triggering 32 on acute treatment phase parameter 1002, and a third trigger-
20 level triggering 33 on recovery phase parameter 1003 linked to terminal prognosis data,
and each of said trigger-flags is assigned to a second dimension of a trigger channel
comprising a first trigger-level triggering 31 on a first stage of progression-measuring
parameters of the occurrance 1001 with regard to critical illness 71, 72, 73, and one or
more higher trigger-levels triggering 32, 33,…. in higher stages of progression-measuring
25 parameters of the occurred critical illness 71, 72, 73.
In addition, the resource-pooling system 1 can be realized such that it
transfers critical illness data in the patient data flow pathway 213, 223, 233 of the related
risk exposure component 21, 22, 23, etc., after triggering the occurrence of a critical illness
71, 72, 73, to an automated employee assistance system (EAP: Employee Assistance
30 Program) providing automated support to the risk exposure component 21, 22, 23, etc.
Analogously, by triggering the occurrence of a critical illness 71, 72, 73 by means of the
critical illness trigger 31 by the core engine 3, critical illness data in the patient data flow
pathway 213, 223, 233 of the related risk exposure component 21, 22, 23, etc. can be
23
transferred to an alert system of an Change Advisory Board (CAB) to activate automated
or at least semi-automated CAB actions.
Finally, in a further specified embodied variant, an independent verification
critical illness trigger of the resource-pooling system 1 can be activated in the event of a
5 triggering of the occurrence 1001 of indicators for critical illness 71, 72, 73 in the patient
data flow pathway 213, 223, 233 of a risk exposure component 21, 22, 23, etc. by means of
the critical illness trigger 31, and wherein the independent verification critical illness
trigger additionally is triggering with regard tothe occurrence 1001 indicators for critical
illness 71, 72, 73 in an alternative patient data flow pathway 215, 225, 235 with
10 independent measuring parameters from the primary patient data flow pathway 213, 223,
233 to verify the occurrence 1001 of the critical illness 71, 72, 73 at the risk exposure
component 21, 22, 23, etc, As a variant, the parametric draw-down or predefined transfer
of payments is only assigned to the corresponding trigger-flag, if the occurrence 1001 of
the critical illness 71, 72, 73 at the risk exposure component 21, 22, 23, etc. is verified by
15 the independent verification critical illness trigger.
24
References
1 Resource-pooling system / Critical illness insurance system
21, 22, 23 Risk exposure component
211, 221, 231 Risk-related component data
5 212, 222, 232 Likelihood of risk exposure of the pooled risk
exposure components
213, 223, 233 Patient dataflow pathway
214, 224, 234 Stored payment parameters
215, 225, 235 Alternative patient dataflow pathway
10 3 Core engine
30 Operating module
31, 32, 33 Critical illness triggers
4 Payment receiving modules
5 Assembly module
15 50 Total Risk
511, 521, 531 First risk contribution
512, 522, 532 Second risk contribution
513, 523, 533 Third risk contribution
51i, 52i, 53i i-th risk contribution
20 6 Payment data store
7 Trigger table with critical illness parameter
71, 72, 73 Critical illness parameters
8 Monitoring module
1001 Diagnosis phase of the critical illness
25 1002 Treatment phase (surgery, chemotherapy/radiotherapy/medication)
1003 Recovery phase and/or terminal illness phase and/or aftercare phase
1004 Additional support services
2001, 2002, 2003 Parametric payment transfers from the system 1 to the risk
exposure units 21, 22, 23
30
25
Claims
1. A parametric, event-driven critical illness insurance system based on a
resource-pooling system (1) for risk sharing of critical illness risks of a variable number of
risk exposure components (21, 22, 23, …) by providing a dynamic self-sufficient risk
5 protection for the risk exposure components (21, 22, 23, …) by means of the resourcepooling
system (1), wherein the risk exposure components (21, 22, 23, …) are connected to
the resource-pooling system (1) by means of a plurality of payment-receiving modules (4)
configured to receive and store (6) payments (214, 224, 234) from the risk exposure
components (21, 22, 23, …) by means of a payment data store (6) for the pooling of their
10 risks and resources, wherein the payments (214, 224, 234) are stored based on componentspecific
payment parameters by means of electronic money transfer by payment receiving
modules 4 over an electronic network, and wherein the resource-pooling system (1)
comprises an event-driven core engine (3) comprising critical illness triggers (31, 32, 33)
triggering in a patient dataflow pathway (213, 223, 233) to provide risk protection for a
15 specific risk exposure component (21, 22, 23, …) based on received and stored payments
(214, 224, 234) from the risk exposure components (21, 22, 23, …), characterized
in that the total risk (50) of the pooled risk exposure components (21, 22, 23,
…) comprises a critical illness risk contribution (511, 521, 531) of each pooled risk
exposure components (21, 22, 23,…) associated to risk exposure in relation to a diagnosis
20 of a critical illness, wherein the critical illness (71, 72, 73) is comprised in a predefined
searchable table (7) of critical illnesses (71, 72, 73) and wherein critical illness losses occur
as a consequence to the diagnosis of risk exposure components (21, 22, 23, …) with one of
the searchable critical illnesses,
in that the resource-pooling system (1) comprises an assembly module (5) to
25 process risk-related component data (211, 221, 231) and to provide the likelihood (212,
222, 232) of said risk exposure for one or a plurality of the pooled risk exposure
components (21, 22, 23, …) based on the risk-related component data (211, 221, 231), and
wherein the receiving and preconditioned storage (6) of payments (214, 224, 234) from
risk exposure components (21, 22, 23, …) for the pooling of their risks is dynamically
30 determinable based on total risk (50) and/or the likelihood of the risk exposure of the
pooled risk exposure components (21, 22, 23, …),
26
in that the patient dataflow pathway (213, 223, 233) is dynamically
monitored by the resource-pooling system (1) by a triggering of patient measuring
parameters of the patient dataflow pathway (213, 223, 233) transmitted from associated
measuring systems, or by capturing patient measuring parameter of the patient dataflow
5 pathway (213, 223, 233) at least periodically and/or within predefined time frames,
in that in case of a triggering of an occurrence of a critical illness (71, 72, 73)
in the patient data flow pathway (213, 223, 233) of a risk exposure component (21, 22, 23),
a corresponding trigger-flag is set by means of the resource-pooling system (1) and a
parametric draw-down transfer of payments is assigned to this corresponding trigger-
10 flag, wherein a loss associated with the critical illness (71, 72, 73) is distinctly covered by
the resource pooling system (1) based on the respective trigger-flag and based on the
received and stored payment parameters (214, 224, 234) from risk exposure components
(21, 22, 23) by the parametric draw-down transfer from the resource-pooling system (1) to
the risk exposure component (21, 22, 23, …), and
15 in that a first parametric payment (211) is transferred by triggering (31) the
occurrence (1001) of the critical illness (71, 72, 73), a second parametric payment (212) is
transferred by a triggering (32) of an acute treatment phase (1002), and a third parametric
payment (213) is transferred by a triggering (33) of a recovery phase (1003) linked to
terminal prognosis data.
20 2. The system (1) according to claim 1, wherein the critical illness triggers
(31, 32, 33) comprise a trigger (31) for triggering the occurrence of measuring parameters
indicating a heart attack and/or cancer and/or a stroke and/or coronary artery by-pass
surgery in the patient dataflow pathway (213, 223, 233).
3. The system (1) according to claim 2, wherein the critical illness triggers
25 (31, 32, 33) further comprise a trigger (31) for triggering the occurrence of measuring
parameters indicating Alzheimer's disease, blindness, deafness, kidney failure, major
organ transplant, multiple sclerosis, HIV/AIDS contracted by blood transfusion or
during an operation, Parkinson's disease, paralysis of limb, terminal illness in the patient
dataflow pathway (213, 223, 233).
27
4. A parametric, event-driven critical illness insurance system based on a
resource-pooling system (1) for risk sharing of critical illness risks of a variable number of
risk exposure components (21, 22, 23, …) by providing a dynamic self-sufficient risk
protection for the risk exposure components (21, 22, 23, …) by means of the resource-
5 pooling system (1), wherein the risk exposure components (21, 22, 23, …) are connected to
the resource-pooling system (1) by means of a plurality of payment-receiving modules (4)
configured to receive and store (6) payments (214, 224, 234) from the risk exposure
components (21, 22, 23, …) by means of a payment data store (6) for the pooling of their
risks and resources, wherein the payments (214, 224, 234) are stored based on component-
10 specific payment parameters by means of electronic money transfer by payment receiving
modules 4 over an electronic network, and wherein the resource-pooling system (1)
comprises an event-driven core engine (3) comprising critical illness triggers (31, 32, 33)
triggering in a patient dataflow pathway (213, 223, 233) to provide risk protection for a
specific risk exposure component (21, 22, 23, …) based on received and stored payments
15 (214, 224, 234) from the risk exposure components (21, 22, 23, …), characterized
in that the total risk (50) of the pooled risk exposure components (21, 22, 23,
…) comprises a first risk contribution (511, 521, 531) of each pooled risk exposure
components (21, 22, 23,…) associated to risk exposure in relation to a first diagnosis of a
critical illness, wherein the critical illness (71, 72, 73) is comprised in a predefined
20 searchable table (7) of critical illnesses (71, 72, 73) and wherein critical illness losses occur
as a consequence to the first diagnosis of risk exposure components (21, 22, 23, …) with
one of the searchable critical illnesses,
in that the total risk (50) of the pooled risk exposure components (21, 22, 23,
…) comprises at least a second and/or successional risk contributions (512/522/…,
25 513/521/…) associated to risk exposure in relation to a second and/or successional
critical illnesses, wherein the critical illnesses (71, 72, 73) are comprised in the predefined
searchable table (7) of critical illness parameters (71, 72, 73), and wherein a critical illness
loss losses occurs as a consequence to the second and/or successional diagnosis of risk
exposure components (21, 22, 23, …) with one of the searchable critical illnesses,
30 in that the resource-pooling system (1) comprises an assembly module (5) to
process risk-related component data (211, 221, 231) and to provide the likelihood (212,
222, 232) of said risk exposure for one or a plurality of the pooled risk exposure
28
components (21, 22, 23, …) based on the risk-related component data (211, 221, 231), and
wherein the receiving and preconditioned storage (6) of payments (214, 224, 234) from
risk exposure components (21, 22, 23, …) for the pooling of their risks is dynamically
determinable based on total risk (50) and/or the likelihood of the risk exposure of the
5 pooled risk exposure components (21, 22, 23, …),
in that the patient dataflow pathway (213, 223, 233) is dynamically
monitored by the resource-pooling system (1) by a triggering of patient measuring
parameters of the patient dataflow pathway (213, 223, 233) transmitted from associated
measuring systems, or by capturing patient measuring parameter of the patient dataflow
10 pathway (213, 223, 233) at least periodically and/or within predefined time frames,
in that in case of a triggering of an occurrence of a first or second or
successional critical illness (71, 72, 73) in the patient data flow pathway (213, 223, 233) of a
risk exposure component (21, 22, 23), a corresponding trigger-flag is set by means of the
resource-pooling system (1) and a parametric draw-down transfer of payments is
15 assigned to this corresponding trigger-flag, wherein a loss associated with the first or
second or successional critical illness(es) (71, 72, 73) is distinctly covered by the resource
pooling system (1) based on the respective trigger-flag and based on the received and
stored payment parameters (214, 224, 234) from risk exposure components (21, 22, 23) by
the parametric draw-down transfer from the resource-pooling system (1) to the risk
20 exposure component (21, 22, 23, …), and
in that a first parametric payment (211) is transferred by triggering (31) the
occurrence (1001) of the critical illness (71, 72, 73), a second parametric payment (212) is
transferred by a triggering (32) of an acute treatment phase (1002), and a third parametric
payment (213) is transferred by a triggering (33) of a recovery phase (1003) linked to
25 terminal prognosis data.
5. The system (1) according to claim 4, wherein the critical illness triggers
(31, 32, 33) comprise a trigger (31) for triggering the occurrence of measuring parameters
indicating a heart attack and/or cancer and/or a stroke and/or coronary artery by-pass
surgery in the patient dataflow pathway (213, 223, 233).
29
6. The system (1) according to claim 5, wherein the critical illness triggers
(31, 32, 33) further comprise a trigger (31) for triggering the occurrence of measuring
parameters indicating Alzheimer's disease, blindness, deafness, kidney failure, major
organ transplant, multiple sclerosis, HIV/AIDS contracted by blood transfusion or
5 during an operation, Parkinson's disease, paralysis of limb, terminal illness in the patient
dataflow pathway (213, 223, 233).
7. The system (1) according to one of the claims 5 to 6, wherein the receiving
and preconditioned storage (6) of payments (214, 224, 234) from risk exposure
components (21, 22, 23, …) for the pooling of their risks is dynamically determinable
10 based on total risk (50) and/or the likelihood of the risk exposure of the pooled risk
exposure components (21, 22, 23, …).
8. The system (1) according to one of the claims 4 to 7, wherein the number
of pooled risk exposure components (21, 22, 23, …) is dynamically adaptable by means of
the resource-pooling system (1) to a range where non-covariant occurring risks covered
15 by the resource-pooling system (1) affect only a relatively small proportion of the totally
pooled risk exposure components (21, 22, 23, …) at a given time.
9. The system (1) according to one of the claims 4 to 8, wherein the critical
illness triggers (31, 32, 33) are dynamically adapted by means of an operating module (30)
based on time-correlated incidence data for a critical illness conditions and/or diagnosis
20 or treatment conditions indicating improvements in diagnosis or treatment.
10. The system (1) according to one of the claims 4 to 9, wherein the first
parametric payment only is transferred by a triggering (31) of the occurrence (1001) of
measuring parameters indicating the critical illness (71, 72, 73) of malignant cancer
and/or a smaller amount incidence of ductal carcinoma in situ (DCIS) and/or early
25 prostate carcinoma.
11. The system (1) according to one of the claims 4 to 9, wherein the critical
illness triggers further comprise triggers triggering (32) acute treatment phase parameters
(1002) indicating surgery and/or chemotherapy and/or radiotherapy and/or
reconstructive surgery in the patient dataflow pathway (213, 223, 233).
30
12. The system (1) according to claim 11, wherein the second parametric
payment only is transferred by triggering (32) acute treatment phase parameters (1002)
indicating surgery and/or chemotherapy and/or radiotherapy and/or reconstructive
surgery.
5 13. The system (1) according to one of the claims 4 to 12, wherein the critical
illness triggers (31,32,33) further comprise triggers (33) triggering recovery phase
parameters (1003) associated with or linked to terminal prognosis data in patient
dataflow pathway (213, 223, 233).
14. The system (1) according to claim 13, wherein the third parametric
10 payment is only transferred by a triggering (33) of recovery phase parameters and/or
terminal prognosis parameters (1003).
15. The system (1) according to one of the claims 4 to 14, wherein the first,
second and third parametric payments are leveled by a predefined total payments sum
determined at least based on the risk-related components data (211, 221, 231) and/or on
15 the likelihood of the risk exposure for one or a plurality of the pooled risk exposure
components (21, 22, 23, …) based on the risk related components data 211, 221, 231 and
wherein the first parametric payment is transferred up to 30% of said total payments sum
and the second parametric payment is transferred up to 50% of said total payments sum
and the third parametric payment is transferred up to the residual part given by said total
20 payment sum minus the actual first parametric payment and the second parametric
payment.
16. The system (1) according to one of the claims 4 to 15, wherein the critical
illness trigger (31,32,33) comprises multi-dimensional trigger channels, wherein each of
said trigger-flags is assigned to a first dimension trigger channel comprising a first
25 trigger-level triggering (31) upon an occurrence parameter (1001) of the critical illness (71,
72, 73), a second trigger-level triggering (32) upon an acute treatment phase parameter
(1002), and a third trigger-level triggering (33) upon a recovery phase parameters (1003)
liked to terminal prognosis data, and each of said trigger-flags is assigned to at least a
second or higher dimension trigger channel comprises additional trigger-stages based on
30 the first, second and/or third trigger-levels of the first dimension trigger channel.
31
17. The system (1) according to claim 16, wherein the critical illness trigger
(31,32,33) comprises multi-dimensional trigger channels, wherein each of said triggerflags
is assigned to a first dimension of trigger channel comprising a first trigger-level
triggering (31) upon an occurrence parameter (1001) of the critical illness (71, 72, 73), a
5 second trigger-level triggering (32) upon an acute treatment phase parameters (1002), and
a third trigger-level triggering (33) upon a recovery phase parameters (1003) linked to
terminal prognosis data, and each of said trigger-flags is assigned to a second dimension
of trigger channel comprising a first trigger-level triggering (31) upon a first stage of
progression measuring parameters of the occurred (1001) critical illness (71,72,73) and
10 one or more higher trigger-levels triggering (32,33,…) upon higher stages of progression
measuring parameters of the occurred critical illness (71, 72, 73).
18. The system (1) according to one of the claims 4 to 17, wherein the
resource-pooling system (1) comprises a monitoring module (8) requesting a periodic
payment transfer from the risk exposure components (21, 22, 23, …) to the resource-
15 pooling system (1) by means of a plurality of payment receiving modules (2), wherein the
risk protection for the risk exposure components (21, 22, 23, …) is interrupted by the
monitoring module (8) when the periodic transfer is no longer detectable by means of the
monitoring module (8).
19. The system (1) according to claim 18, wherein the request for periodic
20 payment transfer is interrupted or waived by the monitoring module (8) when the
occurrence (1001) of indicators for critical illness (71,72,73) is triggered (31) in a patient
data flow pathway of a risk exposure component (21, 22, 23, …).
20. The system (1) according to one of the claims 4 to 19, wherein the
resource-pooling system (1) comprises an independent verification critical illness trigger,
25 which is activated in the event of a triggering of the occurrence (1001) of indicators for
critical illness in the patient dataflow pathway (213, 223, 233) of a risk exposure
component (21, 22, 23, …) by means of the critical illness trigger (31) and which
additionally, is a triggering for the occurrence (1001) of indicators for critical illness (71,
72, 73) in an alternative patient dataflow pathway (215, 225, 235) with independent
30 measuring parameters from the primary patient data flow pathway (213, 223, 233) to
verify the occurrence of the critical illness (71,72,73) at the risk exposure component (21,
22, 23, …).
32
21. The system (1) according to claim 20, wherein the parametric draw-down
transfer of payments is only assigned to the corresponding trigger-flag, if the occurrence
(1001) of the critical illness (71,72,73) at the risk exposure component (21, 22, 23, …) is
verified by the independent verification critical illness trigger.
5 22. The system (1) according to one of the claims 4 to 21, wherein critical
illness data of the patient dataflow pathway (213, 223, 233) of the risk exposure
component (21, 22, 23, …) are transferred to an automated employee assistance system
(EAP: Employee Assistance Program) providing automated support to the risk exposure
component (21, 22, 23, …).
10 23. An method for risk sharing of critical illness risks of a variable number of
risk exposure components (21, 22, 23, …) by providing a dynamic self-sufficient risk
protection for the risk exposure components (21, 22, 23, …) by means of a resourcepooling
system (1), wherein the risk exposure components (21, 22, 23, …) are connected to
the resource-pooling system (1) by means of a plurality of payment receiving modules (4)
15 and payment data (214, 224, 234) are received and stored by means of a payment data
store (6) from the risk exposure components (21, 22, 23, …) for the pooling of their risks,
wherein the payments (214, 224, 234) are stored based on component-specific payment
parameters by means of electronic money transfer by payment receiving modules 4 over
an electronic network, and wherein the resource-pooling system (1) triggers a patient
20 dataflow pathway (213, 223, 233) by means of critical illness triggers (31, 32, 33) of an
event-driven core engine (3) in order to provide risk protection for a specific risk
exposure component (21, 22, 23, …) based on received and stored payments (214, 224,
234) from the risk exposure components (21, 22, 23, …), characterized
in that a first risk contribution (511, 521, 531) of each pooled risk exposure
25 components (21, 22, 23,…) related to a first diagnosis of a critical illness (71,72,73) is
associated with risk exposure of each pooled risk exposure components (21, 22, 23,…) and
the total risk (50) of the pooled risk exposure components (21, 22, 23, …) by means of the
resource-pooling system (1), wherein the critical illness (71, 72, 73) is comprised in a
predefined searchable table (7) of critical illnesses (71, 72, 73) and wherein critical illness
30 losses occur as a consequence to the first diagnosis of risk exposure components (21, 22,
23, …) with one of the searchable critical illnesses,
33
in that a second and/or successional risk contribution (511, 521, 531) of each
pooled risk exposure component (21, 22, 23,…) related to a second and/or successional
risk contributions (512/522/…, 513/521/…) diagnosis of a critical illness (71,72,73) is
associated to risk exposure of each pooled risk exposure component (21, 22, 23,…) and
5 the total risk (50) of the pooled risk exposure components (21, 22, 23, …) by means of the
resource-pooling system (1), wherein the critical illness (71,72,73) is comprised in the
predefined searchable table (7) of critical illnesses (71, 72, 73) and wherein critical illness
losses occur as a consequence of the second and/or successional diagnosis of risk
exposure components (21, 22, 23, …) with one of the searchable critical illnesses,
10 in that risk-related component data (211, 221, 231) are processed by an
assembly module (5) of the resource-pooling system (1) and the likelihood (212, 222, 232)
of said risk exposure is provided by means of the assembly module (5) for one or a
plurality of the pooled risk exposure components (21, 22, 23, …) based on the risk-related
component data (211, 221, 231), and wherein the receiving and preconditioned storage (6)
15 of payments (214, 224, 234) from risk exposure components (21, 22, 23, …) for the pooling
of their risks is dynamically determined based on total risk (50) and/or the likelihood of
the risk exposure of the pooled risk exposure components (21, 22, 23, …),
in that the patient dataflow pathway (213, 223, 233) is dynamically
monitored by the resource-pooling system (1) by triggering of patient measuring
20 parameters of the patient dataflow pathway (213, 223, 233) transmitted from associated
measuring systems or by capturing patient measuring parameter of the patient data flow
pathway (213, 223, 233) at least periodically and/or within predefined time frames,
in that, in case of a triggering of an occurrence of a first or second or
successional critical illness (71, 72, 73) in the patient data flow pathway (213, 223, 233) of a
25 risk exposure component (21, 22, 23) a corresponding trigger-flag is set by means of the
resource-pooling system (1) and a parametric draw-down transfer of payments is
assigned to this corresponding trigger-flag, wherein a loss associated to the first or
second or successional critical illness (71, 72, 73) is distinctly covered by the resourcepooling
system (1) based on the respective trigger-flag and based on the received and
30 stored payment parameters (214, 224, 234) from risk exposure components (21, 22, 23) by
the parametric draw-down transfer from the resource-pooling system (1) to the risk
exposure component (21, 22, 23, …), and
34
in that a first parametric payment (211) is transferred by a triggering (31) of
an occurrence (1001) of the critical illness (71, 72, 73), a second parametric payment (212)
is transferred by a triggering (32) of an acute treatment phase (1002), and a third
parametric payment (213) is transferred by a triggering (33) of an recovery phase (1003)
5 linked to terminal prognosis data.
24. The method according to claim 23, wherein the occurrence (1001) of
measuring parameters indicating a heart attack and/or cancer and/or a stroke and/or
coronary artery by-pass surgery are triggered in the patient dataflow pathway (213, 223,
233) by means of a critical illness trigger (31) of the core engine (3).
10 25. The method according to claim 23 to 24, wherein the occurrence (1001) of
measuring parameters indicating Alzheimer's disease, blindness, deafness, kidney failure,
major organ transplant, multiple sclerosis, HIV/AIDS contracted by blood transfusion or
during an operation, Parkinson's disease, paralysis of limb, terminal illness are triggered
in the patient dataflow pathway (213, 223, 233) by means of a critical illness trigger (31) of
15 the core engine (3).
26. The method according to one of the claims 23 to 25, wherein the receiving
and preconditioned storage (6) of payments (214, 224, 234) from risk exposure
components (21, 22, 23, …) for the pooling of their risks is dynamically determined based
on total risk (50) and/or the likelihood of the risk exposure of the pooled risk exposure
20 components (21, 22, 23, …).
27. The method according to one of the claims 23 to 26, wherein the number
of pooled risk exposure components (21, 22, 23, …) is dynamically adapted by means of
the resource-pooling system (1) to a range where non-covariant occurring risks covered
by the resource-pooling system (1) affect only a relatively small proportion of the totally
25 pooled risk exposure components (21, 22, 23, …) at a given time.
28. The method according to one of the claims 23 to 25, wherein the critical
illness triggers (31, 32, 33) are dynamically adapted by means of an operating module (30)
based on time-correlated incidence data for critical illness conditions and/or diagnosis or
treatment conditions indicating improvements in diagnosis or treatment.
35
29. The method according to one of the claims 23 to 28, wherein the first
parametric payment is only transferred by a triggering (31) of an occurrence (1001) of
measuring parameters indicating the critical illness (71, 72, 73) of malignant cancer
and/or smaller incidence of ductal carcinoma in situ (DCIS) and/or early prostate
5 carcinoma.
30. The method according to one of the claims 23 to 29, wherein acute
treatment phase parameters (1002) indicating surgery and/or chemotherapy and/or
radiotherapy and/or reconstructive surgery is/are triggered in the patient dataflow
pathway (213, 223, 233) by means of a critical illness trigger (32) of the core engine (3).
10 31. The method according to claim 30, wherein the second parametric
payment is only transferred by a triggering (32) of acute treatment phase parameters
(1002) indicating surgery and/or chemotherapy and/or radiotherapy and/or
reconstructive surgery.
32. The method according to one of the claims 23 to 31, wherein recovery
15 phase parameters (1003) linked to terminal prognosis data are triggered in a patient data
flow pathway (213, 223, 233) by means of a critical illness trigger (33) of the core engine
(3).
33. The method according to claim 32, wherein the third parametric payment
is only transferred by a triggering (33) of a recovery phase parameter and/or terminal
20 prognosis parameter (1003).
34. The method according to one of the claims 23 to 33, wherein the first,
second and third parametric payments are leveled by a predefined total payments sum
determined at least based on the risk-related component data (211, 221, 231) and/or on
the likelihood of the risk exposure for one or a plurality of the pooled risk exposure
25 components (21, 22, 23, …) based on the risk-related component data 211, 221, 231), and
wherein the first parametric payment is transferred up to 30% of said total payment sum
and the second parametric payment is transferred up to 50% of said total payment sum
and the third parametric payment is transferred up to the residual part given by said total
payment sum minus the actual first parametric payment and the second parametric
30 payment.
36
35. The method according to one of the claims 23 to 34, wherein the critical
illness trigger (31,32,33) comprises multi-dimensional trigger channels, wherein each of
said trigger-flags is assigned to a first dimension trigger channel comprising a first
trigger-level triggering (31) upon an occurrence parameter (1001) of the critical illness
5 (71,72,73), a second trigger-level triggering (32) upon an acute treatment phase parameter
(1002), and a third trigger-level triggering (33) upon a recovery phase parameter (1003)
linked to terminal prognosis data, and each of said trigger-flags is assigned to at least a
second or higher-dimension trigger channel and comprises additional trigger-stages
based on the first, second and/or third trigger-levels of the first dimension trigger
10 channel.
36. The method according to claim 35, wherein the critical illness trigger
(31,32,33) comprises multi-dimensional trigger channels, wherein each of said triggerflags
is assigned to a first dimension of trigger channel comprising a first trigger-level
triggering (31) upon an occurrence parameter (1001) of the critical illness (71, 72, 73), a
15 second trigger-level triggering (32) upon an acute treatment phase parameter (1002), and
a third trigger-level triggering (33) upon a recovery phase parameter (1003) linked to
terminal prognosis data, and each of said trigger-flags is assigned to a second dimension
of trigger channel comprising a first trigger-level triggering (31) on a first stage of
progression measuring parameters of the occurred (1001) critical illness (71,72,73) and
20 one or more higher trigger-levels triggering (32,33,…) upon higher stages of progression
measuring parameters of the occurred critical illness (71, 72, 73).
37. The method according to one of the claims 23 to 36, wherein the periodic
payment transfer from the risk exposure components (21, 22, 23, …) to the resourcepooling
system (1) via a plurality of payment receiving modules (2) is requested by
25 means of a monitoring module (8) of the resource-pooling system (1), wherein the risk
transfer or protection for the risk exposure components (21, 22, 23, …) is interrupted by
the monitoring module (8) when the periodic transfer is no longer detectable by means of
the monitoring module (8).
38. The method according to claim 37, wherein the request for periodic
30 payment transfer is interrupted or waived by means of the monitoring module (8) when
the occurrence (1001) of indicators for critical illness (71,72,73) is triggered (31) on patient
dataflow pathway of a risk exposure component (21, 22, 23, …).
37
39. The method according to one of the claims 23 to 38, wherein an
independent verification critical illness trigger of the resource-pooling system (1) is
activated in case of triggering the occurrence (1001) of indicators for critical illness (71, 72,
73) in a patient dataflow pathway (213, 223, 233) of a risk exposure component (21, 22, 23,
5 …) by means of the critical illness trigger (31) and wherein the independent verification
critical illness trigger is, additionally a triggering for an occurrence (1001) of indicators of
critical illness (71, 72, 73) in an alternative patient data flow pathway (215, 225, 235) with
independent measuring parameters from the primary patient dataflow pathway (213,
223, 233) to verify the occurrence (1001) of the critical illness (71,72,73) at the risk
10 exposure component (21, 22, 23, …).
40. The method according to claim 39, wherein the parametric draw-down
transfer of payments is only assigned to the corresponding trigger-flag, if the occurrence
(1001) of the critical illness (71,72,73) at the risk exposure component (21, 22, 23, …) is
verified by the independent verification critical illness trigger.
15 41. The method according to one of the claims 23 to 40, wherein critical
illness data of the patient dataflow pathway (213, 223, 233) of the risk exposure
component (21, 22, 23, …) are transferred to an automated employee assistance system
(EAP: Employee Assistance Program) providing automated support to the risk exposure
component (21, 22, 23, …).
20
25
38
Abstract
Proposed are a parametric, event-driven critical illness insurance system
based on a resource-pooling system (1) and method for risk sharing of critical illness risks
of a variable number of risk exposure components (21, 22, 23) by providing a dynamic
5 self-sufficient risk protection for the risk exposure components (21, 22, 23) by means of
the resource-pooling system (1). The resource-pooling system (1) comprises an assembly
module (5) to process risk-related component data (211,221,231) and to provide the
likelihood (212, 222, 232) of said risk exposure for one or a plurality of the pooled risk
exposure components (21, 22, 23, …) based on the risk-related component data (211, 221,
10 231). The risk exposure components (21,22,23) are connected to the resource-pooling
system (1) for the pooling of their risks and resources, and wherein the resource-pooling
system (1) comprises an event-driven core-engine (3) with critical illness triggers (31, 32,
33) triggering in a patient dataflow pathway (213,223,233) to provide risk protection for a
specific risk exposure component (21,22,23). The operation of the resource pooling system
15 (1) is supported by a parametric draw-down risk-cover which can additionally be related
to multiple occurrences of critical illness parameters 71,72,73 triggered in the related
patient data flow pathway (213, 223, 233).