Enrollment & EOI
Every enrollment matched to the plan, and every amount above guaranteed issue held for EOI review.
Why it matters
Elections arrive as 834 files, spreadsheets and portal exports; amounts above guaranteed issue slip through without EOI, and premium is taken on cover nobody approved.
How the solution handles it
Agents read each enrollment, check eligibility and every elected amount against guaranteed-issue limits, and hold amounts above the limit. EOI answers and medical evidence are summarised with sources. A medical underwriter approves or declines every EOI.
How an election moves
Five agents read elections, check eligibility and guaranteed-issue limits and summarise the evidence; a medical underwriter approves or declines every EOI.
What it reads, and what it hands back.
What goes in
- Enrollment files (834, Excel, portal)
- EOI forms and health questions
- Plan guaranteed-issue limits by class
- Attending physician statements
What comes out
- Clean enrollment with flags
- EOI file ready for review
- Pended amounts list
- Approval and decline letter drafts
Who uses it
The difference, in numbers.
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
“Target” = design goal, measured in the live solution · by-hand time from an 8-hour working day · agents = the live solution’s configuration
5 specialist agents. One person decides.
More in this division.
Every broker RFP and census becomes a clean, quote-ready case the same day, every gap flagged.
Disability ClaimsEvery disability claim built, cited and decided well inside the 45-day ERISA clock.
Plan Document CheckEvery certificate, SPD and amendment checked against the signed policy before an employee reads it.
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We’ll show Enrollment & EOI running on your own documents.