Patent ID: 8374893

Claim:
A method for implementing an insurance plan for a group of people with rules to coordinate an adjudication of a submitted claim corresponding to the plan, the plan including a people model and a benefit model linked by a plurality of policies, the method comprising the steps of: assigning a first predefined inheritance of global attributes pertaining to people between at least two coupled people elements representing people within the people model, wherein the people model having the at least two coupled people elements is a people hierarchal tree representing the group of people under the insurance plan, and wherein the people hierarchal tree has a payor level, a group level, a member level and an individual level; assigning a second predefined inheritance of global attributes pertaining to benefits between at least two coupled benefit elements representing rules within the benefit model, wherein the benefit model having the at least two coupled benefit elements is a benefit hierarchal tree representing benefits under the insurance plan; interconnecting a selected people element of the people model and a selected benefit element of the benefit model by assigning a local rule for at least one local attribute for administering the insurance plan; resolving conflicts in administering the insurance plan, by a computer processor, through overrides, wherein overrides comprise applying the local rule based upon determining that one of the global attributes conflicts with the local rule; and wherein overriding of the global attributes with the local attributes for the selected elements provides a customized rule set for adjudication of the submitted claim.