AI Critical Illness Plan Enrollment Agent

How Cassidy automates this using AI

Step 1: Trigger on enrollment event

The Workflow activates when an employee enters a new-hire window, open enrollment period, or qualifying life event pulling their eligibility data from your HRIS and benefits platform.

Step 2: Deliver personalized education

Cassidy generates tailored critical illness plan explainers from your Knowledge Base, factoring in the employee's medical plan selections, income, and risk profile. The Agent answers questions conversationally and models per-pay deductions using your carrier's age-banded and tobacco rates.

Step 3: Validate elections in real time

As the employee selects coverage amounts for themselves, spouse, or dependents, Cassidy checks class eligibility, waiting periods, GI limits, and late-entrant rules preventing invalid elections before they reach your carrier.

Step 4: Route EOI when required

If an election exceeds Guaranteed Issue thresholds or the employee is a late entrant, Cassidy triggers the Evidence of Insurability workflow collecting health questionnaires, capturing consent, and routing to underwriting while keeping only GI-eligible amounts active.

Step 5: Generate and transmit 834 files

Cassidy builds X12 834 Benefit Enrollment and Maintenance transactions mapped to each carrier's companion guide populating INS, HD, AMT, and DTP segments with correct coverage amounts, effective dates, and maintenance reason codes then transmits via AS2 or SFTP.

Step 6: Process acknowledgments and fix rejects

The Workflow ingests TA1, 999, and 824 responses, automatically flagging syntax errors or business-edit failures. Cassidy corrects common issues like plan code mismatches or invalid maintenance reasons and requeues transactions without manual intervention.

Step 7: Sync payroll deductions

Once coverage is confirmed, Cassidy generates payroll change files with post-tax deduction codes, start dates aligned to coverage effective dates, and handles retroactive adjustments or proration as needed.

Step 8: Maintain throughout the year

Cassidy processes mid-year QLEs, attained-age rate changes, and termination events including portability election capture keeping your HRIS, carrier, and payroll systems in sync with automated reconciliation and variance reporting.