The Future of Health Insurance is Built on Verifiable Claims

Claims processing is a slow, manual, and adversarial process of verifying provider credentials, patient eligibility, and service validity. This creates ~$30B in annual administrative waste and 30-45 day payment cycles.

• Fraudulent claims cost the US system ~$100B annually.
• Manual data entry leads to a ~20% error rate in submissions.

Protocols like Ethereum Attestation Service (EAS) and Veramo enable issuers (medical boards, insurers) to issue tamper-proof credentials for licenses and network participation.

• Providers hold self-sovereign credentials, eliminating manual verification.
• Payers can programmatically check credential status and revocation in ~500ms.
• Interoperability is achieved via W3C standards, not proprietary APIs.

Using zk-SNARKs (via Aztec, RISC Zero), a patient can prove they are eligible for a specific treatment without revealing their full medical history or identity to the insurer.

• Privacy-Preserving: Insurer sees only the proof of eligibility, not the underlying data.
• Automated Compliance: Proofs can encode HIPAA and policy rules directly into logic.
• Reduces Friction: Eliminates invasive pre-authorization questionnaires.

Protocols like Chainlink Functions and API3 allow smart contracts to securely fetch off-chain data (e.g., real-time drug formularies, CMS fee schedules) to automate claim adjudication logic.

• Deterministic Pricing: Claim payment amount is calculated on-chain using verified external data.
• Automated Settlement: Triggers instant payment via stablecoins or traditional rails upon proof verification.
• Transparent Audit Trail: Every decision and data point is immutably recorded.

Patient health records and insurance history are locked in proprietary systems from Epic, Cigna, or UnitedHealth. This creates friction for switching jobs, insurers, or providers.

• Patient data is not an asset they control.
• Prior authorization must be re-done from scratch with every new provider.

Decentralized identity protocols (Spruce ID, Disco) enable patients to aggregate verifiable claims from various sources into a personal data vault, controlled by private keys.

• Patient-Centric: Individuals grant granular, time-bound access to insurers or providers.
• Portable DIDs: A Decentralized Identifier (DID) travels with the patient across insurers.
• Composable History: Enables seamless prior authorization and continuity of care.

Manual claims adjudication and fraud detection consume ~25-30% of every premium dollar. The process is slow, opaque, and creates adversarial relationships between payers and providers.\n- Key Benefit 1: Automate adjudication with on-chain logic, slashing admin costs by ~50%.\n- Key Benefit 2: Create a single source of truth, reducing disputes and accelerating payments from 45 days to near-instant.

Treat a health insurance claim like an ERC-1155 or ERC-3525 token. Its state (submitted, approved, paid, appealed) is immutable and its logic (coverage rules, provider network) is executable code.\n- Key Benefit 1: Enables composability with DeFi (e.g., instant provider financing via Aave) and new products.\n- Key Benefit 2: Creates a verifiable audit trail, making fraud systemic and detectable, not just probabilistic.

The winning infrastructure layer will bridge off-chain medical data (EHRs, lab results) to on-chain logic without exposing sensitive PHI. This requires ZK-proof oracles like RISC Zero and decentralized identity stacks.\n- Key Benefit 1: Providers prove claim validity (e.g., "procedure was performed") without leaking patient data.\n- Key Benefit 2: Creates unbreakable network effects; the oracle/zkVM that secures the most premium becomes the industry standard.

Today's actuarial models are black boxes. On-chain claims data allows for transparent, real-time risk assessment. This enables peer-to-peer coverage pools, derivative markets for catastrophic risk, and dynamic premium pricing.\n- Key Benefit 1: Unlocks capital efficiency by allowing reinsurers and DAOs to underwrite specific risk tranches.\n- Key Benefit 2: Shifts competition from scale to data quality, rewarding protocols with the cleanest, most verifiable claims ledger.

The most painful, manual process in insurance—determining primary vs. secondary payer when a patient has multiple plans—is a perfect smart contract. Rules are deterministic; execution is not.\n- Key Benefit 1: Smart contracts can auto-adjudicate multi-payer claims, recovering billions in erroneous payments.\n- Key Benefit 2: Serves as a trojan horse; once a payer uses the system for subrogation, migrating core claims becomes inevitable.

HIPAA and state insurance regulators are drowning in paper. A public, permissioned blockchain with ZK-proofs provides continuous, real-time compliance. The protocol itself is the audit.\n- Key Benefit 1: Reduces compliance overhead by ~70% by making regulatory reporting a read function, not a quarterly project.\n- Key Benefit 2: Creates a regulatory moat; once a protocol is certified, it becomes the de facto standard for new market entrants.