Predictika · Group benefits plan design for small businesses: eligibility, benefit options and minimums

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

An AI sales agent puts together a small-business group benefits plan: the size of the group, how many employees will enrol, the employer's share, life cover and the optional disability, health, dental, health spending account and critical illness benefits. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the published SunAdvantage plan rules and returns a verdict, every reason and the figures it computed.

Scope: SunAdvantage group benefits plans for 3 to 49 employees: eligibility, participation, life, disability, extended health, dental, health spending account and critical illness options. See everything this validator covers

This validator models plans under one product, the SunAdvantage small-business group benefits plan (3 to 49 employees), not just the scenarios shown below.

  • Who qualifies — groups of 3 to 49 employees, more than one year in business, an employer share of at least 50 percent of the plan cost (25 percent in Quebec), at least 3 employees ready to take part in each benefit, and employee participation of at least 75 percent (100 percent in Quebec).
  • Life cover — $25,000 to $500,000, earnings multiples of 1 to 5 or a flat amount up to $300,000, spouse life from $5,000 to $20,000 in $5,000 units, and the amount available without evidence by group size ($50,000 for 3 to 4 employees up to $200,000 for 35 to 49). The quote states that limit and it is compared with the guide's figure for the group size.
  • Disability — the offered benefit formulas (50 to 80 percent, with 70 to 80 percent on a taxable-only basis), the $1,300 weekly short-term and $10,000 monthly long-term maximums, long-term waiting periods of 90, 105, 120 or 180 days, the $2,500 long-term amount without evidence, and fewer than 50 percent related employees.
  • Health, dental, health spending account and critical illness — extended health (mandatory in Quebec) with its paramedical and deductible options, dental options that need 5, 10 or 20 insured employees, a health spending account (15 participants, health and dental in the plan, at least $300 credit per employee), and critical illness (mandatory for all employees, voluntary top-up from 25 employees, $100,000 combined).
  • Approvals — coverage above the amounts available without evidence, graded long-term disability formulas and optional life for qualifying groups go to a person.

Any SunAdvantage plan within these rules is in scope — not only the scenarios pictured here. Not covered: prices (the guide publishes no rates, so this validator produces no price build-up or line-item quote), plans for 50 or more employees (a different Sun Life product), the employee assistance program, travel assistance, dental maximums and coinsurance, other health and dental details, regional or underwriting terms.

The AI sales agentBuilds the group benefits plan from the conversation and says it is ready.
Predictika validatorChecks every rule at once and returns the verdict, each finding, 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
Limits that depend on the size of the groupOnly with workarounds
The amount of life cover available without evidence, the critical illness limit and the voluntary top-up all change with the number of employees, so each needs a table of its own and a rule that reads the headcount.		The group size travels with the plan; the limits are computed from it on every call and the stated figure is compared with the computed one.
Minimums that depend on how many employees take partOnly with care
Major dental, orthodontics and the health spending account each need a minimum number of insured employees; a rule per option is possible, but every new option needs its own.		Headcount and enrolment are in one request; every option is checked against them together.
Different rules for QuebecOnly with care
The employer share, the participation rate and the extended health requirement all change for Quebec groups, which usually means a second set of rules kept in step with the first.		The province is one input; the participation rate, employer share and extended health requirement are computed from it.
Benefit formulas that depend on a tax basisOnly with workarounds
The 70 to 80 percent disability formulas are offered only on a taxable-only basis, so the percentage and the tax basis must be checked together across two lines.		The percentage and the tax basis are checked together with every other rule in one pass.
Every problem returned in one answerOnly with workarounds
Rules tend to fire as a step is saved or the order is submitted, 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.

    
1The group has 2 employees; SunAdvantage is for groups of 3 to 49 employees.
2Only 2 employees are ready to participate; each benefit needs at least 3.
3The group has 50 employees; SunAdvantage is for groups of 3 to 49 employees.
4The business has operated for 12 months; SunAdvantage asks for more than one year in business.
5The employer pays 49 percent of the plan cost; the minimum is 50 percent.
614 of 20 eligible employees would participate; the minimum participation rate is 75 percent.
79 of 10 eligible employees would participate; the minimum participation rate is 100 percent.
8Extended health care is mandatory in Quebec and the plan does not include it.
9The life amount is $24,999; basic life is available from $25,000 to $500,000.
10The life amount of $500,000 is above the $125,000 available without evidence for this group size; a person should confirm the evidence of insurability.
11The life amount is $500,001; basic life is available from $25,000 to $500,000.
12The life amount of $500,001 is above the $125,000 available without evidence for this group size; a person should confirm the evidence of insurability.
13A flat life amount of $300,001 is above the $300,000 flat maximum.
14The life amount of $300,001 is above the $125,000 available without evidence for this group size; a person should confirm the evidence of insurability.
15The life amount is 6 times earnings; the multiples offered are 1, 2, 3, 4 or 5.
16Spouse life of $12,000 is not offered; spouse life is $5,000 to $20,000 in $5,000 units.
17Short-term disability formulas of 70, 75 and 80 percent are offered on a taxable-only basis, which this plan does not use.
18The short-term disability benefit is $1,301 a week; the maximum is $1,300 a week.
19A long-term disability waiting period of 100 days is not offered; the waiting periods are 90, 105, 120 or 180 days.
20The long-term disability benefit is $10,001 a month; the maximum is $10,000 a month.
21The long-term disability benefit of $10,001 a month is above the $2,500 available without evidence; a person should confirm the evidence of insurability.
22The long-term disability benefit of $2,501 a month is above the $2,500 available without evidence; a person should confirm the evidence of insurability.
23Graded long-term disability formulas are available on request; a person should confirm the formula with Sun Life.
2450 percent of the employees are related or share a household; disability cover needs fewer than 50 percent.
25Optional life and optional accidental death cover are available to qualifying groups; a person should confirm the group qualifies.
26The paramedical annual maximum is $199; the maximums offered run from $200 to $750.
27The health deductibles of $30 single and $0 family are not offered; single is $0, $25, $50 or $100 and family is $0, $25, $50, $100 or $200.
28Major dental needs at least 5 insured employees; the quote has 4.
29Dependent orthodontics needs at least 10 insured employees; the quote has 9.
30Adult orthodontics needs at least 20 insured employees; the quote has 19.
31Major, dependent orthodontic or adult orthodontic dental is quoted without the basic dental plan.
32A health spending account needs at least 15 active employees participating; the quote has 14.
33A health spending account needs both extended health and dental benefits in the plan.
34The health spending account credit is $299 per employee a year; the minimum is $300.
35Critical illness insurance is mandatory for all employees; the quote does not cover all of them.
36A voluntary critical illness top-up is offered to groups of 25 to 49 employees; this group has 24.
37Mandatory plus voluntary critical illness of $100,001 is above the $100,000 combined maximum.
38The mandatory critical illness amount of $25,001 is above the $25,000 available without evidence for this group size; a person should confirm the evidence of insurability.
39The quote states a life maximum without evidence of $75,000; for this group size the guide gives $125,000.
40The quote states a life maximum without evidence of $150,000; for this group size the guide gives $125,000.
41The quote states a life maximum without evidence of $200,000; for this group size the guide gives $125,000.
42The life amount of $200,000 is above the $125,000 available without evidence for this group size; a person should confirm the evidence of insurability.
43The short-term disability benefit of 65 percent of earnings is not offered; the offered formulas are 50, 55, 60, 66.7, 67, 70, 75 and 80 percent.
44The long-term disability benefit of 65 percent of earnings is not offered; the offered formulas are 50, 55, 60, 66.7, 67, 70, 75 and 80 percent.
45Long-term disability formulas of 70, 75 and 80 percent are offered on a taxable-only basis, which this plan does not use.

  

  

    
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. Disability cover: A 20-employee group with short-term and long-term disability that breaks several limits

    
The agent's request. Please quote a SunAdvantage group benefits plan for a business with 20 employees, 18 of them ready to take part, in business for 60 months, with the employer paying 60 percent of the cost. Life cover is 3 times earnings, up to $150,000, with spouse life of $15,000. It also includes extended health, dental, short-term disability at 75 percent of earnings, $1,500 a week and long-term disability at 60 percent of earnings, $12,000 a month, with a 60-day waiting period. 60 percent of the employees are related. The quote states a life maximum without evidence of $150,000. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Too many related employees for disability. 60 percent of the employees are related or share a household; disability cover needs fewer than 50 percent.
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  • 70 to 80 percent formula needs taxable-only benefit. Short-term disability formulas of 70, 75 and 80 percent are offered on a taxable-only basis, which this plan does not use.
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  • Weekly benefit above 1,300. The short-term disability benefit is $1,500 a week; the maximum is $1,300 a week.
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  • Monthly benefit above 10,000. The long-term disability benefit is $12,000 a month; the maximum is $10,000 a month.
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  • Long-term disability waiting period not offered. A long-term disability waiting period of 60 days is not offered; the waiting periods are 90, 105, 120 or 180 days.
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  • Long-term disability above 2,500 without evidence. The long-term disability benefit of $12,000 a month is above the $2,500 available without evidence; a person should confirm the evidence of insurability.
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2. Disability cover: The agent resubmits after fixing the errors

    
The agent's request. Please quote a SunAdvantage group benefits plan for a business with 20 employees, 18 of them ready to take part, in business for 60 months, with the employer paying 60 percent of the cost. Life cover is 3 times earnings, up to $150,000, with spouse life of $15,000. It also includes extended health, dental, short-term disability at 75 percent of earnings, $1,300 a week and long-term disability at 60 percent of earnings, $10,000 a month, with a 60-day waiting period. 60 percent of the employees are related. The quote states a life maximum without evidence of $150,000. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Too many related employees for disability. 60 percent of the employees are related or share a household; disability cover needs fewer than 50 percent.
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  • Long-term disability waiting period not offered. A long-term disability waiting period of 60 days is not offered; the waiting periods are 90, 105, 120 or 180 days.
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  • Long-term disability above 2,500 without evidence. The long-term disability benefit of $10,000 a month is above the $2,500 available without evidence; a person should confirm the evidence of insurability.
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3. Disability cover: The agent resubmits after fixing the errors

    
The agent's request. Please quote a SunAdvantage group benefits plan for a business with 20 employees, 18 of them ready to take part, in business for 60 months, with the employer paying 60 percent of the cost. Life cover is 3 times earnings, up to $150,000, with spouse life of $15,000. It also includes extended health, dental, short-term disability at 75 percent of earnings, $1,300 a week and long-term disability at 60 percent of earnings, $2,500 a month, with a 90-day waiting period. 20 percent of the employees are related. The quote states a life maximum without evidence of $150,000. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Plan summary. Group of 20 employees; life without evidence up to $150,000; minimum participation 75 percent, employer share at least 50 percent.
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4. Participation and life cover: A 12-employee group with 7 taking part, a 40 percent employer share and life above the amount available without evidence

    
The agent's request. Please quote a SunAdvantage group benefits plan for a business with 12 employees, 7 of them ready to take part, in business for 48 months, with the employer paying 40 percent of the cost. Life cover is 3 times earnings, up to $150,000, with spouse life of $10,000. It also includes extended health, dental and major dental. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Employer share too low. The employer pays 40 percent of the plan cost; the minimum is 50 percent.
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  • Participation too low. 7 of 12 eligible employees would participate; the minimum participation rate is 75 percent.
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  • Life above the amount without evidence. The life amount of $150,000 is above the $125,000 available without evidence for this group size; a person should confirm the evidence of insurability.
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5. Participation and life cover: The agent resubmits after fixing the errors

    
The agent's request. Please quote a SunAdvantage group benefits plan for a business with 12 employees, 10 of them ready to take part, in business for 48 months, with the employer paying 50 percent of the cost. Life cover is 3 times earnings, up to $125,000, with spouse life of $10,000. It also includes extended health, dental and major dental. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Plan summary. Group of 12 employees; life without evidence up to $125,000; minimum participation 75 percent, employer share at least 50 percent.
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6. Dental, spending account and critical illness: A 14-employee group with adult orthodontics, a health spending account and critical illness

    
The agent's request. Please quote a SunAdvantage group benefits plan for a business with 14 employees, 12 of them ready to take part, in business for 30 months, with the employer paying 50 percent of the cost. Life cover is a flat $100,000, with spouse life of $10,000. It also includes extended health, dental, major dental, dependent orthodontics, adult orthodontics, a health spending account with a $250 credit per employee and critical illness of $25,000 plus a voluntary top-up of $20,000 for some employees. The quote states a life maximum without evidence of $125,000. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Adult orthodontics needs 20 insured. Adult orthodontics needs at least 20 insured employees; the quote has 12.
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  • Health spending account needs 15 participants. A health spending account needs at least 15 active employees participating; the quote has 12.
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  • Health spending account credit below 300. The health spending account credit is $250 per employee a year; the minimum is $300.
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  • Critical illness is mandatory for all employees. Critical illness insurance is mandatory for all employees; the quote does not cover all of them.
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  • Voluntary critical illness needs 25 employees. A voluntary critical illness top-up is offered to groups of 25 to 49 employees; this group has 14.
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7. Dental, spending account and critical illness: The agent resubmits after fixing the errors

    
The agent's request. Please quote a SunAdvantage group benefits plan for a business with 30 employees, 27 of them ready to take part, in business for 30 months, with the employer paying 50 percent of the cost. Life cover is a flat $150,000, with spouse life of $10,000. It also includes extended health, dental, major dental, dependent orthodontics, adult orthodontics, a health spending account with a $300 credit per employee and critical illness of $30,000 plus a voluntary top-up of $20,000. The quote states a life maximum without evidence of $175,000. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Plan summary. Group of 30 employees; life without evidence up to $175,000; minimum participation 75 percent, employer share at least 50 percent.
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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 puts together a small-business group benefits plan: the size of the group, how many employees will enrol, the employer's share, and more. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the published SunAdvantage plan rules and returns a verdict, every reason and the figures it computed.
    2. 
      
  2. I will start with the first request by the agent.
    3. 
      
  3. The agent says. Please quote a SunAdvantage group benefits plan for a business with 20 employees, 18 of them ready to take part. Life cover is 3 times earnings, up to $150,000, with spouse life of $15,000. The rest of the request is on screen. The quote states a life maximum without evidence of $150,000.
    4. 
      
  4. Before it goes out, the agent calls the validator.
    5. 
      
  5. Blocked, with five findings and one approval, all in one answer. 60 percent of the employees are related or share a household; disability cover needs fewer than 50 percent. Short-term disability formulas of 70, 75 and 80 percent are offered on a taxable-only basis, which this plan does not use. The short-term disability benefit is $1,500 a week; the maximum is $1,300 a week. The other two are on screen.
    6. 
      
  6. The validator returned five 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.
    7. 
      
  7. What this shows: for minimums that depend on how many employees take part, a rules-based CPQ is error-prone for this.
    8. 
      
  8. Now the agent resubmits.
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  9. The corrected request. It changes the short-term disability to 75 percent, $1,300 a week, taxable only and the long-term disability to 60 percent, $10,000 a month, 60-day wait.
    10. 
      
  10. It calls the validator again.
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  11. Still blocked, with two findings and one approval, all in one answer. 60 percent of the employees are related or share a household; disability cover needs fewer than 50 percent. A long-term disability waiting period of 60 days is not offered; the waiting periods are 90, 105, 120 or 180 days.
    12. 
      
  12. Three findings cleared; still blocked on too many related employees for disability and long-term disability waiting period not offered.
    13. 
      
  13. The agent resubmits once more.
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  14. The revised request. It changes the long-term disability to 60 percent, $2,500 a month, 90-day wait and the related employees to 20 percent.
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  15. It calls the validator once more.
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  16. This time the validator clears it.
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  17. All three earlier findings are cleared, and the validator's total, $150,000, matches the quote.
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  18. Six problems caught in one call, fixed in two passes, and a clean quote. That is the value of Predictika's validator: catching mistakes before they reach the customer.
    19.