Predictika · Group benefits quotes

An AI sales agent's Aflac group benefits quote, checked before it goes out

An AI sales agent prepares an enrollment quote for an employer's Aflac group voluntary benefits: Group Accident Insurance, Group Critical Illness Insurance and Group Hospital Indemnity Insurance. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the plan levels and enrollment rules and returns a verdict, every reason, a line-item premium quote and the figures it computed.

Scope: Aflac group voluntary benefits for one employer: Group Accident Insurance (Low and Mid plans), Group Critical Illness Insurance ($5,000 to $50,000) and Group Hospital Indemnity Insurance (Low and Mid plans), priced by family tier. See everything this validator covers

This validator models enrollment quotes for these three Aflac group products, not just the scenarios shown below. Premiums on this page are illustrative: Aflac group rates are state-filed and specific to each employer, so the totals are not Aflac rates.

  • Plans and tiers — Group Accident and Group Hospital Indemnity in the Low or Mid plan, Group Critical Illness at $5,000, $10,000, $20,000, $30,000, $40,000 or $50,000, each priced for employee only, employee and spouse, employee and child(ren), or family.
  • Enrollment and underwriting — eligible versus enrolled employees and the participation a group plan needs, critical illness above $30,000 needing the simplified health questions, the state, and the group's average age band.
  • Pricing and approvals — a line-item premium for every plan and tier, employer-paid shares, large groups and older groups with a high critical illness amount that a person should approve, and the stated premium compared with the computed one.

Any enrollment quote for these three products is in scope — not only the scenarios pictured here. Not covered: Aflac individual policies, cancer, disability, dental, vision and life plans, riders, claims, taxes and state filing details. Several rules and all premiums are modeled from comparable group products rather than published by Aflac; see the fine print at the end of the page.

The AI sales agentBuilds the benefits quote from the conversation and says it is ready.
Predictika validatorChecks every rule at once and returns the verdict, each finding, the line-item premium quote and the computed figures.

7 scenarios in 3 groups · each group runs from the agent’s first attempt to the outcome · click one to switch

What the agent proposes

The AI sales agent says

Illustrative agent statement. The validator receives the structured request below.

Proposing agent: AI sales agent (scripted)

Before sending, the agent must call Recorded run

Predictika validator


      

        
        
        
      

      
Waiting for the call.

      
    

  

  
  

    
Where rules-based CPQ gets it wrong
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Our assessment of what a typical rules-based CPQ (product rules, price rules and validation rules, as in Salesforce CPQ) does with the same cases. It is a judgment about effort and reliability, not a claim that nothing can be built.

    
What the validator caughtTypical rules-based CPQPredictika
Participation that must reach a minimum before a group plan is offeredOnly with care
A rule that compares enrolled and eligible counts; the counts are free-entry fields, so it only works if someone keeps them in step.		Enrolled and eligible employees are in the request and compared on every call.
A critical illness amount above $30,000 that needs health questionsOnly with care
A condition on one option that depends on an answer elsewhere; easy to miss when a new amount is added.		Amount, health questions and state are checked together.
A state limit on one coverage amountOnly with workarounds
State rules multiply the product rules; each state needs its own variant or a lookup that someone must maintain.		The state is one more input to the same check, whatever order the choices arrive in.
Premiums that change with family tier and the group's average ageOnly with care
Rate tables by plan, tier and age band are a large set of price rules; a stated total is a free-entry field that nothing forces to match them.		The stated premium travels with the quote and is compared with the computed premium on every call.
Every problem returned in one answerOnly with workarounds
Rules tend to fire as the quote is saved or a step is completed, so a rep often fixes one error and meets the next.		All findings come back together, whatever order the choices arrived in.

  

  

    
What this validator catches: findings from its test cases
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Every rule is checked on every call, in any order the choices arrive; one problem never hides another. Blocking findings stop the quote; approval findings need a person to sign off; everything else is computed.

    
1Critical illness above $30,000 needs the simplified health questions answered; none are on the order.
2The critical illness amount is not one of the offered levels ($5,000, $10,000, $20,000, $30,000, $40,000 or $50,000).
3Critical illness above $30,000 is not offered in New York.
4No accident, critical illness or hospital indemnity coverage is selected.
5The quote has 0 eligible employees; it needs at least 1.
680 employees are enrolled but only 0 are eligible.
780 employees are enrolled out of 321 eligible; a group plan needs at least 10 enrolled and 25 percent of the eligible employees.
8The employer pays 50 percent of the premium; employer-paid coverage is no longer purely voluntary and a person should confirm the plan design.
9An employer share of 101 percent is outside 0 to 100 percent.
10A group of 500 eligible employees should be reviewed by a group underwriter.
11Critical illness of $40,000 or more for a group with an average age of 60 or over needs an underwriter to confirm.
12The quote states a monthly premium of $5,700.36; the modeled rates give $5,705.36.

  

  

    
Scenarios and results
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The recorded result of the validator for each scenario on this page: the request the AI agent sent, the verdict, and every finding, in the order they appear above.

    
1. Manufacturer, 450 eligible employees: Accident, hospital indemnity and $40,000 critical illness for 450 eligible employees in New York

    
The agent's request. Please quote Group Accident Insurance (Mid plan), Group Hospital Indemnity Insurance (Mid plan) and Group Critical Illness Insurance at $40,000 for 450 eligible employees in New York (average age 50s), with 190 employees enrolled (100 employee only, 30 employee and spouse, 25 employee and child(ren), 35 family). The employer will pay 20 percent of the premium. The quote states a monthly premium of $25,173.90. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Critical illness needs health questions. Critical illness above $30,000 needs the simplified health questions answered; none are on the order.
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  • Critical illness above $30,000 in New York. Critical illness above $30,000 is not offered in New York.
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  • Stated total does not match. The quote states a monthly premium of $25,173.90; the modeled rates give $30,426.70.
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  • Employer-paid share. The employer pays 20 percent of the premium; employer-paid coverage is no longer purely voluntary and a person should confirm the plan design.
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2. Manufacturer, 450 eligible employees: The agent resubmits after fixing the errors

    
The agent's request. Please quote Group Accident Insurance (Mid plan), Group Hospital Indemnity Insurance (Mid plan) and Group Critical Illness Insurance at $30,000 for 450 eligible employees in New York (average age 50s), with 190 employees enrolled (100 employee only, 30 employee and spouse, 25 employee and child(ren), 35 family). The employer will pay 20 percent of the premium. The quote states a monthly premium of $25,173.90. It is ready to send.

    
Verdict: Needs approval.

    
    
      
  • Employer-paid share. The employer pays 20 percent of the premium; employer-paid coverage is no longer purely voluntary and a person should confirm the plan design.
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  • Order summary. 190 employees enrolled of 450 eligible, monthly premium $25,173.90 at illustrative rates.
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3. Manufacturer, 450 eligible employees: The agent resubmits after fixing the errors

    
The agent's request. Please quote Group Accident Insurance (Mid plan), Group Hospital Indemnity Insurance (Mid plan) and Group Critical Illness Insurance at $30,000 for 450 eligible employees in New York (average age 50s), with 190 employees enrolled (100 employee only, 30 employee and spouse, 25 employee and child(ren), 35 family). The quote states a monthly premium of $25,173.90. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Order summary. 190 employees enrolled of 450 eligible, monthly premium $25,173.90 at illustrative rates.
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4. Distribution company, 150 eligible employees: Accident, hospital indemnity and critical illness for 150 eligible employees

    
The agent's request. Please quote Group Accident Insurance (Low plan), Group Hospital Indemnity Insurance (Low plan) and Group Critical Illness Insurance at $15,000 for 150 eligible employees in Georgia (average age 40s), with 160 employees enrolled (80 employee only, 25 employee and spouse, 20 employee and child(ren), 35 family). The quote states a monthly premium of $6,101.90. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • More enrolled than eligible. 160 employees are enrolled but only 150 are eligible.
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  • Critical illness amount not offered. The critical illness amount is not one of the offered levels ($5,000, $10,000, $20,000, $30,000, $40,000 or $50,000).
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  • Stated total does not match. The quote states a monthly premium of $6,101.90; the modeled rates give $9,452.70.
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5. Distribution company, 150 eligible employees: The agent resubmits after fixing the errors

    
The agent's request. Please quote Group Accident Insurance (Low plan), Group Hospital Indemnity Insurance (Low plan) and Group Critical Illness Insurance at $10,000 for 150 eligible employees in Georgia (average age 40s), with 120 employees enrolled (60 employee only, 20 employee and spouse, 15 employee and child(ren), 25 family). The quote states a monthly premium of $6,101.90. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Order summary. 120 employees enrolled of 150 eligible, monthly premium $6,101.90 at illustrative rates.
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6. School district, average age 60 and over: Accident and $40,000 critical illness for 240 eligible employees

    
The agent's request. Please quote Group Accident Insurance (Mid plan) and Group Critical Illness Insurance at $40,000 for 240 eligible employees in Florida (average age 60 and over), with 115 employees enrolled (70 employee only, 15 employee and spouse, 10 employee and child(ren), 20 family). The quote states a monthly premium of $18,435.40. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Critical illness needs health questions. Critical illness above $30,000 needs the simplified health questions answered; none are on the order.
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  • Stated total does not match. The quote states a monthly premium of $18,435.40; the modeled rates give $23,947.70.
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  • Older group with a high critical illness amount. Critical illness of $40,000 or more for a group with an average age of 60 or over needs an underwriter to confirm.
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7. School district, average age 60 and over: The agent resubmits after fixing the errors

    
The agent's request. Please quote Group Accident Insurance (Mid plan) and Group Critical Illness Insurance at $30,000 for 240 eligible employees in Florida (average age 60 and over), with 115 employees enrolled (70 employee only, 15 employee and spouse, 10 employee and child(ren), 20 family). The quote states a monthly premium of $18,435.40. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Order summary. 115 employees enrolled of 240 eligible, monthly premium $18,435.40 at illustrative rates.
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Narration transcript
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The text of the narrated walkthrough, step by step.

    
    
      
  1. Welcome to a demo of Predictika's Validator. An AI sales agent prepares an enrollment quote for an employer's Aflac group voluntary benefits: Group Accident Insurance, Group Critical Illness Insurance and Group Hospital Indemnity Insurance. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the plan levels and enrollment rules and returns a verdict, every reason, a line-item premium quote and the figures it computed.
    2. 
      
  2. I will start with the first request by the agent.
    3. 
      
  3. The agent says. Please quote Group Accident Insurance (Mid plan), Group Hospital Indemnity Insurance (Mid plan) and Group Critical Illness Insurance at $40,000 for 450 eligible employees in New York (average age 50s). The employer will pay 20 percent of the premium. The rest of the request is on screen. The quote states a monthly premium of $25,173.90.
    4. 
      
  4. Before it goes out, the agent calls the validator.
    5. 
      
  5. Blocked, with three findings and one approval, all in one answer. Critical illness above $30,000 needs the simplified health questions answered; none are on the order. Critical illness above $30,000 is not offered in New York. The quote states a monthly premium of $25,173.90; the modeled rates give $30,426.70.
    6. 
      
  6. The validator returned three blocking findings and one approval in one answer. A check that reads one field at a time would pass most of this; it shows only when the choices in the quote are checked against each other and against the stated total.
    7. 
      
  7. What this shows: for a critical illness amount above $30,000 that needs health questions, a rules-based CPQ is error-prone for this.
    8. 
      
  8. Now the agent resubmits.
    9. 
      
  9. The corrected request. It changes the Group Critical Illness amount to $30,000.
    10. 
      
  10. It calls the validator again.
    11. 
      
  11. Not blocked, but held for a person.
    12. 
      
  12. The validator also returns the line-item quote. It starts with Aflac Group Accident Insurance and Aflac Group Hospital Indemnity Insurance; the other ten lines are on screen.
    13. 
      
  13. The three blocking findings are cleared; one approval remains for a person: employer-paid share.
    14. 
      
  14. The agent resubmits once more.
    15. 
      
  15. The revised request. It removes the employer share of premium.
    16. 
      
  16. It calls the validator once more.
    17. 
      
  17. This time the validator clears it.
    18. 
      
  18. The validator also returns the line-item quote. It starts with Aflac Group Accident Insurance and Aflac Group Hospital Indemnity Insurance; the other ten lines are on screen.
    19. 
      
  19. The earlier finding is cleared, and the validator's total, $25,173.90, matches the quote.
    20. 
      
  20. Four problems caught in one call, fixed in two passes, and a clean $25,173.90 quote. That is the value of Predictika's validator: catching mistakes before they reach the customer. Now you can try the other scenarios yourself.
    21.