Health Plan Management Method and Apparatus

A process for calculating member-specific out-of-pocket expenses, at a health exchange system managing the member's health plan, for a predetermined medical service or procedure available from multiple medical service providers comprising:

• receiving at the health exchange system a selection by the member of the predetermined medical service or procedure;
• calculating at the health exchange system a raw cost for performing the selected predetermined medical service or procedure for each of the multiple medical service providers;
• determining by the health exchange system whether the member has received their life time maximum benefits under the member's health plan;
• if it is determined by the health exchange system that the member has received their life time maximum benefits under the member's health plan, evaluating each of the calculated raw costs for the predetermined medical service or procedure as a qualified medical expense under the member's health plan, wherein the evaluating includes determining the availability of funds in the member's health spending account or the member's reimbursement account applicable to each of the calculated raw cost;
• if funds are available, normalizing by the health exchange system, each of the calculated raw costs to account for the available funds, wherein each of the normalized calculated raw costs is the calculated member-specific out-of-pocket expense for receiving the predetermined medical service or procedure from each of the multiple medical providers;
• and
• presenting, by the health exchange system, each of the calculated member-specific out-of-pocket expenses for each of the multiple medical providers.

A process for facilitating selection by a member of a health plan a medical service provider from multiple medical service providers for providing a predetermined medical service or procedure via a health exchange system for managing the member's health plan, comprising:

• receiving at the health exchange system a selection by the member of the predetermined medical service or procedure;
• calculating a member-specific out-of-pocket expense, at the health exchange system, for receiving the predetermined medical service or procedure from each of the multiple medical service providers, wherein calculating the member-specific out-of-pocket expense includes determining each of the following:
• a raw cost for performing the selected predetermined medical service or procedure for each of the multiple medical service providers;
• whether the member has received their life time maximum benefits under the member's health plan;
• and the availability of funds in the member's health spending account or the member's reimbursement account;
• and
• presenting, by the health exchange system, each of the calculated member-specific out-of-pocket expenses for each of the multiple medical providers.