Use Case 1
Single-Call Eligibility Change
Trigger: An employer calls with a membership change
1.Answer the eligibility question in the employer's terms
2.Record the change against the install roster
3.Detect qualifying events from the payroll feed
4.Apply the supportable effective date
5.Reissue cards and documents as needed
6.State the effect on next month's invoice
7.Reconcile the affected bill lines
✓
Employers get the answer, the change, and the billing impact in one call, reconciled correctly.
Use Case 2
Continuation Compliance
Trigger: An employee experiences a continuation-triggering event
1.Detect the qualifying event
2.Determine the applicable continuation regime
3.Issue the right continuation material on time
4.Reissue affected cards and documents
5.Record the change against the bill
✓
Continuation notices go out on the right regime and clock, avoiding exposure.
Integrations
Process Library (Small Group)
Enrollment & Eligibility System
Payroll Feed
Billing & Invoicing
Continuation Administration (COBRA/State)
Industries
healthcare
See It In Action
A sample conversation with this agent
The employer wants to add an employee's new spouse.
I answer the eligibility question in the employer's own terms—whether the spouse qualifies and from when—record the change, and tell them in the same call what it does to next month's invoice. I read the roster from the install report rather than a separate members table, so the change lands where the bill is actually computed, and I reconcile the affected lines before projecting the next invoice.
Just add them from last month to backdate the coverage.
I add coverage from the date the qualifying event actually supports, not an arbitrary backdate—backdating outside the event window creates a premium and claims mismatch the group pays for later. If the event supports the earlier date, it stands; if it doesn't, I record the supportable date and explain the difference to the employer on the call rather than quietly backdating.
An employee just left—handle the COBRA piece.
I detect the qualifying event, determine which continuation regime applies to this group—federal COBRA or a state continuation—and issue the right material on time, because the notice clock is unforgiving. I reissue cards and documents as needed and note the change against the bill. Getting the regime and the timing right is the whole point; a late or wrong-regime notice is a compliance exposure.