Predictika · Group dental quotes

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

An AI sales agent prepares a small-group dental quote: plan, state, employee tiers, enrollment, employer contribution, orthodontia, waiting periods, rate guarantee and broker commission, in US dollars a month. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the underwriting and quoting rules, compares the monthly premium the quote states with the computed one, and returns every finding together with the premium by tier. This is an illustrative model built from public product information with illustrative rates; it is not Cigna's internal rule set.

Scope: small-group dental quotes, 2 to 99 employees (PPO and DHMO plans, funding type, orthodontia, waiting periods, rate guarantee, broker commission). See everything this validator covers

This validator models one slice of group dental underwriting: a small-group quote for a PPO or DHMO plan, with the group size, enrollment, funding, plan design, waiting periods, rate guarantee and broker commission around it. It handles any quote built from those parts, not only the scenarios shown on this page. It does not cover large groups, other lines of coverage, or other carriers.

  • Covered: group and enrollment — the 99-employee limit, minimum enrollment, census consistency, and participation by funding type (non-contributory, contributory and voluntary), net of waivers.
  • Covered: plan design — DHMO availability by state, orthodontia on plans that offer it, the voluntary-plan and adult orthodontia conditions.
  • Covered: underwriting and commercial terms — waiting-period waivers with takeover credit, the 24-month rate guarantee, broker commission limits and overrides, the tier premium with its loads, and the monthly premium the agent states.
  • Not covered — groups of 100 or more, medical and other products, and real Cigna filings and contract terms. Other areas can be added.
  • Labeled as assumptions — rates, state factors, loads and thresholds are illustrative values built from public product information, not a Cigna rate filing.
The AI sales agentBuilds the dental quote from the conversation and says it is ready.
Predictika validatorChecks every rule at once and returns the verdict, each finding, and the computed figures.

6 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
Monthly premium built from plan, state, tier mix and stacked loadsOnly with care
The premium multiplies a plan rate by a state factor, several loads that only apply in some situations, and tier units. A rule set can price each step, but every step has to be kept in step with the others.		The whole chain is computed on every call and returned as one line per tier that adds up to the monthly premium, the annual premium and the employer cost.
Participation required depends on how the plan is fundedOnly with care
The threshold is 100, 50 or 30 percent depending on the employer contribution, and it is counted net of waivers. The same enrollment passes on one funding type and fails on another.		The funding type, the waivers and the enrollment are compared on every call, and the finding states the numbers.
Plan design that depends on funding, group size and stateOnly with care
Orthodontia, adult orthodontia and the DHMO network each depend on a different combination of plan, contribution, enrollment and state.		Every combination is checked on every call, so one problem never hides another.
Waiting-period waiver that is blocked, approved or allowed depending on prior coverage and sizeOnly with workarounds
The same request is refused below 10 enrolling employees, goes to underwriting at 10 or more, and passes with 12 months of prior coverage. That is three outcomes from one request, driven by two facts.		The prior coverage and the enrollment are evaluated together and the outcome is a block, an approval request or a clear quote.
Premium that the agent states must match the computed oneOnly with workarounds
A validation rule can compare a stated figure with a calculated one only if the stated figure is a field on the quote, which it rarely is.		The stated monthly premium travels with the quote and is compared with the computed premium on every call; a mismatch is its own block.

  

  

    
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.

    
1A group of more than 99 eligible employees is blocked, because it belongs with national accounts.
2At least 2 employees must enroll, or 3 on a voluntary plan.
3The number enrolling cannot be more than the number eligible.
4Participation must reach 100 percent when the employer pays everything, 50 percent on a contributory plan and 30 percent on a voluntary plan, counted net of employees who waive for other coverage.
5The employer contribution cannot be more than 100 percent.
6The DHMO network cannot be quoted in a state where it is not offered.
7Orthodontia can only be added to a plan that offers it.
8Orthodontia on a voluntary plan needs at least 10 employees enrolling, and adult orthodontia needs at least 50 percent employer contribution.
9Waiving waiting periods without 12 months of prior coverage is blocked below 10 enrolling employees.
10At 10 or more enrolling employees the same waiver goes to underwriting for approval, with a 10 percent load.
11A 24-month rate guarantee under 25 enrolling employees needs underwriting approval, with a 3 percent load.
12A broker commission above 15 percent is blocked, and one above 10 percent needs a compensation override.
13The premium is built from the plan rate, the state factor, the voluntary, orthodontia, waiver, rate-guarantee and commission loads, and the tier units, and is returned as one line per tier.
14The monthly premium the agent states must match the computed premium to within one dollar; otherwise the quote is blocked.
15The release step is refused unless the quote is clear, or needs approval and the approval has been recorded.

  

  

    
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. Waiting-period waiver: Waiting periods waived, no prior coverage

    
The agent's request. Group dental quote for Brightfield Foods in Texas on Cigna Dental PPO Advantage 1500. 12 employees are eligible and 8 are enrolling (4 employee only, 2 employee plus spouse, 1 employee plus children, 1 family). The employer pays 50 percent of the employee-only rate. Waiting periods are waived, with no prior group coverage. The quote states a monthly premium of $572.78. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Waiting-period waiver not allowed. Waiving waiting periods without 12 months of prior coverage needs at least 10 enrolling employees; 8 enroll and prior coverage is 0 months.
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2. Waiting-period waiver: Standard waiting periods

    
The agent's request. Group dental quote for Brightfield Foods in Texas on Cigna Dental PPO Advantage 1500. 12 employees are eligible and 8 are enrolling (4 employee only, 2 employee plus spouse, 1 employee plus children, 1 family). The employer pays 50 percent of the employee-only rate. Standard waiting periods apply. The quote states a monthly premium of $520.70. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Quote summary. Monthly premium $520.70 ($6,248.40 a year); the employer pays $164.00 a month. By tier: employee only $164.00; employee + spouse $159.90; employee + child(ren) $75.85; family $120.95.
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3. Stated premium: Stated premium is low

    
The agent's request. Group dental quote for Ridgeway Logistics in Texas on Cigna Dental PPO Advantage 1500. 20 employees are eligible and 17 are enrolling (8 employee only, 3 employee plus spouse, 2 employee plus children, 4 family). The employer pays 50 percent of the employee-only rate. It includes child orthodontia. The quote states a monthly premium of $1,195.65. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Stated premium does not match. Stated monthly premium does not match: the agent stated $1,195.65 a month; the validator computes $1,299.62 a month.
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4. Stated premium: Correct premium stated

    
The agent's request. Group dental quote for Ridgeway Logistics in Texas on Cigna Dental PPO Advantage 1500. 20 employees are eligible and 17 are enrolling (8 employee only, 3 employee plus spouse, 2 employee plus children, 4 family). The employer pays 50 percent of the employee-only rate. It includes child orthodontia. The quote states a monthly premium of $1,299.62. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Quote summary. Monthly premium $1,299.62 ($15,595.44 a year); the employer pays $376.38 a month. By tier: employee only $354.24; employee + spouse $259.04; employee + child(ren) $163.84; family $522.50.
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5. Rate guarantee: 24-month rate guarantee, 14 enrolling

    
The agent's request. Group dental quote for Maple Street Veterinary in California on Cigna Dental PPO Advantage 1500. 40 employees are eligible and 14 are enrolling (8 employee only, 2 employee plus spouse, 2 employee plus children, 2 family). The plan is voluntary, with no employer contribution. A 24-month rate guarantee is requested. The quote states a monthly premium of $1,148.55. It is ready to send.

    
Verdict: Needs approval.

    
    
      
  • Rate guarantee needs underwriting. A 24-month rate guarantee for 14 enrolling employees (under 25) needs underwriting approval; a 3 percent load applies.
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  • Quote summary. Monthly premium $1,148.55 ($13,782.60 a year); the employer pays $0.00 a month. By tier: employee only $427.37; employee + spouse $208.34; employee + child(ren) $197.66; family $315.18.
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6. Rate guarantee: Standard 12-month rate guarantee

    
The agent's request. Group dental quote for Maple Street Veterinary in California on Cigna Dental PPO Advantage 1500. 40 employees are eligible and 14 are enrolling (8 employee only, 2 employee plus spouse, 2 employee plus children, 2 family). The plan is voluntary, with no employer contribution. The quote states a monthly premium of $1,115.09. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Quote summary. Monthly premium $1,115.09 ($13,381.08 a year); the employer pays $0.00 a month. By tier: employee only $414.92; employee + spouse $202.27; employee + child(ren) $191.90; family $306.00.
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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 a small-group dental quote: plan, state, employee tiers, and more. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the underwriting and quoting rules, compares the monthly premium the quote states with the computed one, and returns every finding together with the premium by tier. This is an illustrative model built from public product information with illustrative rates; it is not Cigna's internal rule set.
    2. 
      
  2. I will start with the first request by the agent.
    3. 
      
  3. The agent says. Group dental quote for Brightfield Foods in Texas on Cigna Dental PPO Advantage 1500. 12 employees are eligible and 8 are enrolling (4 employee only, 2 employee plus spouse, 1 employee plus children, 1 family). The employer pays 50 percent of the employee-only rate. The rest of the request is on screen. The quote states a monthly premium of $572.78.
    4. 
      
  4. Before it goes out, the agent calls the validator.
    5. 
      
  5. Blocked, with one finding, all in one answer. Waiving waiting periods without 12 months of prior coverage needs at least 10 enrolling employees; 8 enroll and prior coverage is 0 months.
    6. 
      
  6. The validator returned one blocking finding 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.
    7. 
      
  7. What this shows: for waiting-period waiver that is blocked, approved or allowed depending on prior coverage and size, a rules-based CPQ can do this only with workarounds.
    8. 
      
  8. Now the agent resubmits.
    9. 
      
  9. The corrected request. It changes the stated monthly premium to $520.70. It removes the waiting periods.
    10. 
      
  10. It calls the validator again.
    11. 
      
  11. This time the validator clears it.
    12. 
      
  12. The validator also returns the line-item quote. It starts with Cigna Dental PPO Advantage 1500 and Cigna Dental PPO Advantage 1500; the other two lines are on screen.
    13. 
      
  13. The earlier finding is cleared, and the validator's total, $520.70, matches the quote.
    14. 
      
  14. One problem caught in one call, fixed in one pass, and a clean $520.70 quote. That is the value of Predictika's validator: catching mistakes before they reach the customer. Now you can try the other scenarios yourself.
    15.