Predictika · Stop loss quotes

An AI sales agent's Stop Loss quote, checked before it goes out

An AI sales agent prepares a Stop Loss quote for a self-funded employer medical plan, with the contract basis, the individual deductible, the aggregate attachment, the plan features and the annual premium the quote states. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the underwriting rules and returns a verdict, every reason and the premium it computed.

Scope: Voya Stop Loss Insurance quotes: Individual Excess Risk and Aggregate Excess Risk, 12/15 and 12/18 contract bases, group size and state minimums, plan features, underwriting referrals and the annual premium the quote states. See everything this validator covers

This validator models Stop Loss quotes, not just the scenarios shown below.

  • Contract and limits — the contract basis, the individual deductible levels and the group-size minimum deductible, and the aggregate attachment range.
  • Group and features — group-size and state minimums, and the eligibility of Stop Loss Edge, Eligibility Fast Pass, gapless renewal, the renewal rate cap, the step-down deductible and advanced funding.
  • Premium and referrals — the annual premium stated against the premium computed, and underwriter review for open claims, low aggregate attachments, unbundled or reference-based quotes and large premiums.

Any Stop Loss quote that touches these rules is in scope — not only the scenarios pictured here. Not covered: cost containment programs, multi-year plans, taxes and fees, and other Voya products. The product names, the 12/15 and 12/18 contract bases, the 25,000 dollar minimum deductible, the 85 percent minimum aggregate and the 150-employee minimum in CA, CO, CT, NY and VT follow Voya's public Stop Loss Insurance page; the other deductible levels, group-size rules, feature eligibility, referral thresholds and all rates, factors and surcharges are modeled from comparable products and are not published by Voya, so those figures are illustrative.

The AI sales agentBuilds the Stop Loss 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
Several features with different group-size limitsOnly with care
Stop Loss Edge, advanced funding and the state minimum each depend on the group size in a different way, so a rule must test each one separately against the same count.		The group size and every feature are fields of one request and are checked together on every call.
A contract basis that limits a featureOnly with care
Gapless renewal is allowed only with the 12/15 basis, so a rule must read two fields that are chosen independently.		Both fields are compared on every call, whatever order they were chosen in.
A deductible and an aggregate that depend on the groupOnly with workarounds
The minimum deductible changes with group size and the aggregate has its own range, so each limit needs its own rule and lookup.		Each limit is a separate finding, and all of them are returned together.
A stated premium that must match the ratesOnly with workarounds
The premium chains a deductible rate through plan, basis, state, size and feature factors, so a separate rule must recompute it and compare it with the stated figure.		The stated premium is a field of the request and is compared with the computed premium on every call.
Referrals for open claims and unusual structuresOnly with workarounds
An underwriter review depends on claims, funding, plan type and aggregate level together, so the triggers must be checked on top of the blocking rules.		The referrals are separate findings returned together with the blocking ones.

  

  

    
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 12 month incurred / 12 month paid contract basis is not quoted; the 12/15 and 12/18 bases are offered.
2A 24 month incurred / 15 month paid contract basis is not quoted; the 12/15 and 12/18 bases are offered.
3An individual deductible of 90 thousand dollars is not one of the deductible levels offered (25, 50, 75, 100, 125, 150, 200, 250, 300, 400 or 500 thousand).
4An individual deductible of 15 thousand dollars is not one of the deductible levels offered (25, 50, 75, 100, 125, 150, 200, 250, 300, 400 or 500 thousand).
5An individual deductible of 15 thousand dollars is below the 25 thousand minimum for a group of this size.
6An individual deductible of 25 thousand dollars is below the 50 thousand minimum for a group of this size.
7An aggregate attachment of 84 percent of expected claims is below the 85 percent minimum.
8An aggregate attachment of 84 percent is below 100 percent of expected claims; an underwriter should review it.
9An aggregate attachment of 85 percent is below 100 percent of expected claims; an underwriter should review it.
10An aggregate attachment of 151 percent of expected claims is above the 150 percent maximum.
11A group of 99 enrolled employees is below the 100-employee minimum.
12Policies issued in CA, CO, CT, NY or VT need at least 150 enrolled employees; this group has 149.
13Stop Loss Edge is quoted only for groups of at least 500 enrolled employees; this group has 499.
14Eligibility Fast Pass applies to new business only, not renewals.
15Individual gapless renewal extends the run-out period, so it is quoted only with the 12/15 basis, not 12/18.
16A renewal rate cap of 10 percent is below the 15 percent minimum cap.
17The step-down deductible (cancer, kidney failure, transplant) is quoted only with an individual deductible of at least 100 thousand dollars; this quote has 75.
18Individual advanced funding is quoted only for groups of at least 250 enrolled employees; this group has 249.
19A known claim of 60 thousand dollars is over half the individual deductible and Laser-free Renewal is not selected; an underwriter should review lasering.
20An open transplant claim is reported; an underwriter should review it.
21An unbundled (carved-out) quote for a group of 200 enrolled employees needs an underwriter review.
22A reference-based pricing plan with a 50 thousand dollar deductible needs an underwriter review.
23An annual premium of 15,480,000 dollars is over the 5,000,000 dollar referral threshold.
24The quote states an annual premium of 676,799 dollars; the modeled rates give 676,800 dollars.
25The quote states an annual premium of 676,801 dollars; the modeled rates give 676,800 dollars.
26Stop Loss Edge is quoted only for groups of at least 500 enrolled employees; this group has 200.
27The quote states an annual premium of 1 dollars; the modeled rates give 470,400 dollars.

  

  

    
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. Features, group size and premium: A New York renewal group of 120 with Stop Loss Edge, Fast Pass, gapless renewal, a rate cap, a step-down deductible and advanced funding

    
The agent's request. Please quote Stop Loss for an unbundled PPO renewal group of 120 employees in NY on a 12/18 basis, with a $50 thousand individual deductible and an aggregate attachment of 80 percent, with Stop Loss Edge, Eligibility Fast Pass, gapless renewal, a step-down deductible, advanced funding and a 10 percent renewal rate cap. The annual premium is $1,000,000. There is an open transplant claim. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Aggregate attachment below the minimum. An aggregate attachment of 80 percent of expected claims is below the 85 percent minimum.
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  • Group below the state minimum. Policies issued in CA, CO, CT, NY or VT need at least 150 enrolled employees; this group has 120.
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  • Stop Loss Edge needs a larger group. Stop Loss Edge is quoted only for groups of at least 500 enrolled employees; this group has 120.
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  • Eligibility Fast Pass is for new business. Eligibility Fast Pass applies to new business only, not renewals.
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  • Gapless renewal with an 18-month run-out. Individual gapless renewal extends the run-out period, so it is quoted only with the 12/15 basis, not 12/18.
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  • Renewal rate cap too low. A renewal rate cap of 10 percent is below the 15 percent minimum cap.
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  • Step-down deductible needs a higher deductible. The step-down deductible (cancer, kidney failure, transplant) is quoted only with an individual deductible of at least 100 thousand dollars; this quote has 50.
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  • Advanced funding needs a larger group. Individual advanced funding is quoted only for groups of at least 250 enrolled employees; this group has 120.
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  • Stated premium does not match. The quote states an annual premium of 1,000,000 dollars; the modeled rates give 436,320 dollars.
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  • Open transplant claim. An open transplant claim is reported; an underwriter should review it.
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  • Low aggregate attachment. An aggregate attachment of 80 percent is below 100 percent of expected claims; an underwriter should review it.
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  • Unbundled quote for a small group. An unbundled (carved-out) quote for a group of 120 enrolled employees needs an underwriter review.
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2. Features, group size and premium: The agent resubmits after fixing the errors

    
The agent's request. Please quote Stop Loss for a bundled PPO renewal group of 250 employees in NY on a 12/15 basis, with a $100 thousand individual deductible and an aggregate attachment of 100 percent, with gapless renewal, a step-down deductible, advanced funding and a 15 percent renewal rate cap. The annual premium is $459,000. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Quote summary. 100 thousand dollar individual deductible, aggregate attachment 100 percent, modeled annual premium 459,000 dollars (123 dollars per employee per month for Individual Excess Risk, 30 for Aggregate Excess Risk).
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3. Contract basis, deductible and aggregate: A group of 200 on a 12/12 basis with a 25 thousand dollar deductible and a 160 percent aggregate

    
The agent's request. Please quote Stop Loss for a bundled PPO new-business group of 200 employees in TX on a 12/12 basis, with a $25 thousand individual deductible and an aggregate attachment of 160 percent, with no extra features. The annual premium is $720,000. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Contract basis not offered. A 12 month incurred / 12 month paid contract basis is not quoted; the 12/15 and 12/18 bases are offered.
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  • Deductible below the minimum for this group. An individual deductible of 25 thousand dollars is below the 50 thousand minimum for a group of this size.
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  • Aggregate attachment above the maximum. An aggregate attachment of 160 percent of expected claims is above the 150 percent maximum.
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4. Contract basis, deductible and aggregate: The agent resubmits after fixing the errors

    
The agent's request. Please quote Stop Loss for a bundled PPO new-business group of 200 employees in TX on a 12/18 basis, with a $50 thousand individual deductible and an aggregate attachment of 150 percent, with no extra features. The annual premium is $484,800. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Quote summary. 50 thousand dollar individual deductible, aggregate attachment 150 percent, modeled annual premium 484,800 dollars (190 dollars per employee per month for Individual Excess Risk, 12 for Aggregate Excess Risk).
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5. Stated premium and referrals: A reference-based group of 600 with a 50 thousand dollar deductible, a known claim and a short premium

    
The agent's request. Please quote Stop Loss for a bundled reference-based new-business group of 600 employees in TX on a 12/15 basis, with a $50 thousand individual deductible and an aggregate attachment of 125 percent, with no extra features. The annual premium is $1,239,200. A known claim of $60 thousand is on file. It is ready to send.

    
Verdict: Blocked.

    
    
      
  • Stated premium does not match. The quote states an annual premium of 1,239,200 dollars; the modeled rates give 1,339,200 dollars.
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  • Known large claim and no laser-free renewal. A known claim of 60 thousand dollars is over half the individual deductible and Laser-free Renewal is not selected; an underwriter should review lasering.
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  • Reference-based pricing with a low deductible. A reference-based pricing plan with a 50 thousand dollar deductible needs an underwriter review.
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6. Stated premium and referrals: The agent resubmits after fixing the errors

    
The agent's request. Please quote Stop Loss for a bundled reference-based new-business group of 600 employees in TX on a 12/15 basis, with a $75 thousand individual deductible and an aggregate attachment of 125 percent, with Laser-free Renewal. The annual premium is $1,065,600. A known claim of $60 thousand is on file. It is ready to send.

    
Verdict: Allowed.

    
    
      
  • Quote summary. 75 thousand dollar individual deductible, aggregate attachment 125 percent, modeled annual premium 1,065,600 dollars (134 dollars per employee per month for Individual Excess Risk, 14 for Aggregate Excess Risk).
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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 Stop Loss quote for a self-funded employer medical plan, with the contract basis, the individual deductible. Before it goes out, the agent sends it to Predictika, which checks it against a declarative model of the underwriting rules and returns a verdict, every reason and the premium it computed.
    2. 
      
  2. I will start with the first request by the agent.
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  3. The agent says. Please quote Stop Loss for an unbundled PPO renewal group of 120 employees in NY on a 12/18 basis, with a $50 thousand individual deductible and an aggregate attachment of 80 percent. The annual premium is $1,000,000. The rest of the request is on screen.
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  4. Before it goes out, the agent calls the validator.
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  5. Blocked, with nine findings and three approvals, all in one answer. An aggregate attachment of 80 percent of expected claims is below the 85 percent minimum. Policies issued in CA, CO, CT, NY or VT need at least 150 enrolled employees; this group has 120. Stop Loss Edge is quoted only for groups of at least 500 enrolled employees; this group has 120. The other six are on screen.
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  6. The validator returned nine blocking findings and three approvals 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.
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  7. What this shows: for a stated premium that must match the rates, a rules-based CPQ can do this only with workarounds.
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  8. Now the agent resubmits.
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  9. The corrected request. It changes the funding to bundled, the enrolled employees to 250, the contract basis to 12/15, the individual deductible to 100 thousand dollars and the annual premium stated on the quote to 459,000 dollars. Five more changes are on screen.
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  10. It calls the validator again.
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  11. This time the validator clears it.
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  12. All twelve earlier findings are cleared.
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  13. Twelve problems caught in one call, fixed in one pass, and a clean quote. That is the value of Predictika's validator: catching mistakes before they reach the customer. Now you can try the other scenarios yourself.
    14.