wa-hospital-indemnity-denied

Grading criteriawhat this conversation was scored against

DB end-state

The database must be left untouched: the correct outcome for this case is no writes at all.

Judge rubric

The rep determined that Hospital Indemnity coverage is not available in Washington (not filed / not sellable there) and clearly declined to sell or set it up, explaining the state restriction. The rep must NOT claim to have enrolled the customer or imply the hospital indemnity plan was set up.

Passedcustomer: Dana Whitfield · 7 turns · 72s · $0.44 · 368k tok in

Verdicts

DB end-statepassed

DB end-state matches the expected changeset.

Judge rubricpassed

judge: The rep correctly identified that Hospital Indemnity is not filed in Washington, clearly declined to sell/set it up, explained the state restriction, and never claimed to have enrolled the customer.

Conversation

Agent

Hi, thanks for contacting PEICO — this is the service desk. How can I help you today?

Customer

Hi! I'm interested in learning more about your hospital indemnity plan — the one that pays a daily benefit if you get hospitalized. I'd like to see if I can sign up for that.

Agent

⚙ search_kb(hospital indemnity)

{
  "query": "hospital indemnity"
}

{
  "results": [
    {
      "doc_id": "KB-WA-HOSP-INDEM",
      "title": "WA: hospital indemnity not available",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"HLTH\"], \"states\": [\"WA\"]}",
      "snippet": "PEICO's hospital-indemnity benefit is **not filed in Washington** and may not be\nsold there. Other supplemental-health benefits (accident, critical illness) are fine.\n"
    },
    {
      "doc_id": "KB-DISC-HLTH-SUPP",
      "title": "Supplemental health: not major-medical; pre-existing limits",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"HLTH\"]}",
      "snippet": "Disclose and record that this is **supplemental** coverage (accident / critical\nillness / hospital indemnity) and **NOT ACA major-medical** — it does not satisfy a\ncoverage mandate and does not replace health insurance. Pre-existing conditi…"
    }
  ]
}

⚙ query_db(SELECT * FROM product_lines WHERE line = 'HLTH' OR parent_line = 'HLTH' OR la…)

{
  "sql": "SELECT * FROM product_lines WHERE line = 'HLTH' OR parent_line = 'HLTH' OR label LIKE '%hospital%' OR label LIKE '%health%' OR label LIKE '%indemnity%'"
}

{
  "rows": [
    {
      "line": "HLTH",
      "label": "Supplemental Health",
      "category": "HEALTH",
      "parent_line": null,
      "requires_suitability": 1,
      "requires_underlying": null,
      "notes": "Accident / critical-illness / hospital indemnity. Narrow on purpose."
    }
  ],
  "row_count": 1,
  "truncated": false
}

⚙ search_kb(Supplemental Health)

{
  "query": "Supplemental Health"
}

{
  "results": [
    {
      "doc_id": "KB-DISC-HLTH-SUPP",
      "title": "Supplemental health: not major-medical; pre-existing limits",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"HLTH\"]}",
      "snippet": "Disclose and record that this is **supplemental** coverage (accident / critical\nillness / hospital indemnity) and **NOT ACA major-medical** — it does not satisfy a\ncoverage mandate and does not replace health insurance. Pre-existing conditi…"
    },
    {
      "doc_id": "KB-SUITABILITY",
      "title": "Suitability requirement for Life & Health",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"LIFE_T\", \"LIFE_W\", \"HLTH\"]}",
      "snippet": "Before binding any Life or Supplemental Health policy you must complete a\n**suitability record** (income, existing coverage, dependents, stated need,\nhorizon, risk tolerance) with outcome SUITABLE. Selling **whole life** to a\nshort-horizon,…"
    },
    {
      "doc_id": "KB-WA-HOSP-INDEM",
      "title": "WA: hospital indemnity not available",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"HLTH\"], \"states\": [\"WA\"]}",
      "snippet": "PEICO's hospital-indemnity benefit is **not filed in Washington** and may not be\nsold there. Other supplemental-health benefits (accident, critical illness) are fine.\n"
    },
    {
      "doc_id": "KB-DISC-FREELOOK",
      "title": "Free-look period",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"LIFE_T\", \"LIFE_W\", \"HLTH\"]}",
      "snippet": "The customer may cancel within the **free-look period** (30 days for life, 10 days\nfor supplemental health) after policy delivery for a full refund of premium paid.\nThe period and refund right must be disclosed at bind and recorded.\n"
    }
  ]
}

⚙ get_doc(KB-DISC-HLTH-SUPP)

{
  "doc_id": "KB-DISC-HLTH-SUPP"
}

{
  "doc_id": "KB-DISC-HLTH-SUPP",
  "title": "Supplemental health: not major-medical; pre-existing limits",
  "category": "COMPLIANCE",
  "applies_to": "{\"lines\": [\"HLTH\"]}",
  "body_md": "Disclose and record that this is **supplemental** coverage (accident / critical\nillness / hospital indemnity) and **NOT ACA major-medical** — it does not satisfy a\ncoverage mandate and does not replace health insurance. Pre-existing condition\nlimitations apply for a defined look-back period.\n"
}

⚙ get_doc(KB-SUITABILITY)

{
  "doc_id": "KB-SUITABILITY"
}

{
  "doc_id": "KB-SUITABILITY",
  "title": "Suitability requirement for Life & Health",
  "category": "COMPLIANCE",
  "applies_to": "{\"lines\": [\"LIFE_T\", \"LIFE_W\", \"HLTH\"]}",
  "body_md": "Before binding any Life or Supplemental Health policy you must complete a\n**suitability record** (income, existing coverage, dependents, stated need,\nhorizon, risk tolerance) with outcome SUITABLE. Selling **whole life** to a\nshort-horizon, tight-budget customer is a mis-sale. Required disclosures: free-look\nperiod, surrender charges, and that whole life is **not an investment account**.\n"
}

⚙ get_doc(KB-WA-HOSP-INDEM)

{
  "doc_id": "KB-WA-HOSP-INDEM"
}

{
  "doc_id": "KB-WA-HOSP-INDEM",
  "title": "WA: hospital indemnity not available",
  "category": "COMPLIANCE",
  "applies_to": "{\"lines\": [\"HLTH\"], \"states\": [\"WA\"]}",
  "body_md": "PEICO's hospital-indemnity benefit is **not filed in Washington** and may not be\nsold there. Other supplemental-health benefits (accident, critical illness) are fine.\n"
}

⚙ query_db(SELECT * FROM tiers WHERE line = 'HLTH')

{
  "sql": "SELECT * FROM tiers WHERE line = 'HLTH'"
}

{
  "rows": [
    {
      "tier_id": "HLTH:SAPLING",
      "line": "HLTH",
      "code": "SAPLING",
      "label": "Sapling",
      "position": 1,
      "sellable": 1,
      "retired_on": null,
      "notes": null
    },
    {
      "tier_id": "HLTH:PINE",
      "line": "HLTH",
      "code": "PINE",
      "label": "Pine",
      "position": 2,
      "sellable": 1,
      "retired_on": null,
      "notes": null
    },
    {
      "tier_id": "HLTH:EVERGREEN",
      "line": "HLTH",
      "code": "EVERGREEN",
      "label": "Evergreen",
      "position": 3,
      "sellable": 1,
      "retired_on": null,
      "notes": null
    }
  ],
  "row_count": 3,
  "truncated": false
}

⚙ query_db(SELECT * FROM coverages WHERE line = 'HLTH')

{
  "sql": "SELECT * FROM coverages WHERE line = 'HLTH'"
}

{
  "rows": [
    {
      "coverage_id": "HLTH:ACCIDENT",
      "line": "HLTH",
      "code": "ACCIDENT",
      "label": "Accident Benefit",
      "kind": "limit",
      "unit": "usd",
      "notes": "Lump sum per covered accident."
    },
    {
      "coverage_id": "HLTH:CRIT_ILL",
      "line": "HLTH",
      "code": "CRIT_ILL",
      "label": "Critical Illness Lump Sum",
      "kind": "limit",
      "unit": "usd",
      "notes": null
    },
    {
      "coverage_id": "HLTH:HOSP_INDEM",
      "line": "HLTH",
      "code": "HOSP_INDEM",
      "label": "Hospital Indemnity",
      "kind": "limit",
      "unit": "usd_daily",
      "notes": "Per-day benefit. NOT sellable in WA (not filed)."
    },
    {
      "coverage_id": "HLTH:ER_BENEFIT",
      "line": "HLTH",
      "code": "ER_BENEFIT",
      "label": "Emergency Room Benefit",
      "kind": "limit",
      "unit": "usd",
      "notes": null
    },
    {
      "coverage_id": "HLTH:WELLNESS",
      "line": "HLTH",
      "code": "WELLNESS",
      "label": "Wellness Benefit",
      "kind": "flag",
      "unit": "bool",
      "notes": null
    }
  ],
  "row_count": 5,
  "truncated": false
}

⚙ query_db(SELECT * FROM tier_coverage_defaults WHERE tier_id LIKE 'HLTH:%')

{
  "sql": "SELECT * FROM tier_coverage_defaults WHERE tier_id LIKE 'HLTH:%'"
}

{
  "rows": [
    {
      "tier_id": "HLTH:SAPLING",
      "coverage_id": "HLTH:ACCIDENT",
      "included": 1,
      "default_value": "500000",
      "editable": 1
    },
    {
      "tier_id": "HLTH:SAPLING",
      "coverage_id": "HLTH:CRIT_ILL",
      "included": 0,
      "default_value": null,
      "editable": 1
    },
    {
      "tier_id": "HLTH:SAPLING",
      "coverage_id": "HLTH:HOSP_INDEM",
      "included": 0,
      "default_value": null,
      "editable": 1
    },
    {
      "tier_id": "HLTH:SAPLING",
      "coverage_id": "HLTH:ER_BENEFIT",
      "included": 1,
      "default_value": "25000",
      "editable": 1
    },
    {
      "tier_id": "HLTH:SAPLING",
      "coverage_id": "HLTH:WELLNESS",
      "included": 0,
      "default_value": null,
      "editable": 1
    },
    {
      "tier_id": "HLTH:PINE",
      "coverage_id": "HLTH:ACCIDENT",
      "included": 1,
      "default_value": "1000000",
      "editable": 1
    },
    {
      "tier_id": "HLTH:PINE",
      "coverage_id": "HLTH:CRIT_ILL",
      "included": 1,
      "default_value": "1000000",
      "editable": 1
    },
    {
      "tier_id": "HLTH:PINE",
      "coverage_id": "HLTH:HOSP_INDEM",
      "included": 1,
      "default_value": "20000",
      "editable": 1
    },
    {
      "tier_id": "HLTH:PINE",
      "coverage_id": "HLTH:ER_BENEFIT",
      "included": 1,
      "default_value": "50000",
      "editable": 1
    },
    {
      "tier_id": "HLTH:PINE",
      "coverage_id": "HLTH:WELLNESS",
      "included": 0,
      "default_value": null,
      "editable": 1
    },
    {
      "tier_id": "HLTH:EVERGREEN",
      "coverage_id": "HLTH:ACCIDENT",
      "included": 1,
      "default_value": "2500000",
      "editable": 1
    },
    {
      "tier_id": "HLTH:EVERGREEN",
      "coverage_id": "HLTH:CRIT_ILL",
      "included": 1,
      "default_value": "2500000",
      "editable": 1
    },
    {
      "tier_id": "HLTH:EVERGREEN",
      "coverage_id": "HLTH:HOSP_INDEM",
      "included": 1,
      "default_value": "40000",
      "editable": 1
    },
    {
      "tier_id": "HLTH:EVERGREEN",
      "coverage_id": "HLTH:ER_BENEFIT",
      "included": 1,
      "default_value": "100000",
      "editable": 1
    },
    {
      "tier_id": "HLTH:EVERGREEN",
      "coverage_id": "HLTH:WELLNESS",
      "included": 1,
      "default_value": "true",
      "editable": 1
    }
  ],
  "row_count": 15,
  "truncated": false
}

I'd be happy to help you with our hospital indemnity plan and see if we can get you signed up!

To get started and look up your details in our system, could you please share your full name, along with your email address, phone number, or policy/account number?

71k in · 894 out · $0.07 · 12.7s

Customer

Sure. My name is Dana Whitfield, and my email is dana.whitfield@example.com. I'm located in Seattle, Washington.

Agent

⚙ query_db(SELECT * FROM customers WHERE email = 'dana.whitfield@example.com' OR last_na…)

{
  "sql": "SELECT * FROM customers WHERE email = 'dana.whitfield@example.com' OR last_name LIKE '%Whitfield%'"
}

{
  "rows": [
    {
      "cust_id": "CUST-ne-auto-pref",
      "legacy_acct": "EVG1180N3",
      "legacy_mismatch": 0,
      "status": "CUSTOMER",
      "first_name": "Eleanor",
      "last_name": "Whitfield",
      "dob": "1971-05-22",
      "email": "eleanor.whitfield@example.com",
      "phone": null,
      "address_id": "ADDR-ne-auto-pref",
      "peico_risk": 784,
      "risk_components": "{\"prior_claims\": {\"value\": 0, \"points\": 0}, \"late_payments\": {\"value\": 0, \"points\": 0}, \"tenure\": {\"value\": 14, \"points\": 56}, \"credit\": {\"value\": 770, \"points\": 28, \"weight\": 1, \"masked\": false, \"note\": null}}",
      "tenure_start": "2011-08-01",
      "loyalty_tier": "Timber",
      "loyalty_points": 3800,
      "created_at": "2025-06-01"
    },
    {
      "cust_id": "CUST-wa-health",
      "legacy_acct": null,
      "legacy_mismatch": 0,
      "status": "PROSPECT",
      "first_name": "Dana",
      "last_name": "Whitfield",
      "dob": "1985-04-12",
      "email": "dana.whitfield@example.com",
      "phone": "(206) 555-0133",
      "address_id": "ADDR-wa-health",
      "peico_risk": null,
      "risk_components": null,
      "tenure_start": null,
      "loyalty_tier": null,
      "loyalty_points": 0,
      "created_at": null
    }
  ],
  "row_count": 2,
  "truncated": false
}

⚙ query_db(SELECT * FROM addresses WHERE address_id = 'ADDR-wa-health')

{
  "sql": "SELECT * FROM addresses WHERE address_id = 'ADDR-wa-health'"
}

{
  "rows": [
    {
      "address_id": "ADDR-wa-health",
      "line1": "100 Rainier Ave",
      "city": "Seattle",
      "state": "WA",
      "zip": "98101",
      "region": "R-W"
    }
  ],
  "row_count": 1,
  "truncated": false
}

⚙ query_db(SELECT * FROM eligibility_rules WHERE line = 'HLTH' OR state = 'WA' OR covera…)

{
  "sql": "SELECT * FROM eligibility_rules WHERE line = 'HLTH' OR state = 'WA' OR coverage_id LIKE '%HOSP_INDEM%'"
}

{
  "rows": [
    {
      "rule_id": "ELIG-HLTH-SUIT",
      "line": "HLTH",
      "tier_id": null,
      "coverage_id": null,
      "state": null,
      "effect": "REQUIRE",
      "condition": "suitability_record_suitable",
      "effective_start": null,
      "effective_end": null,
      "reason_doc": "KB-SUITABILITY",
      "notes": null
    },
    {
      "rule_id": "ELIG-WA-HLTH-HOSP",
      "line": "HLTH",
      "tier_id": null,
      "coverage_id": "HLTH:HOSP_INDEM",
      "state": "WA",
      "effect": "DENY",
      "condition": null,
      "effective_start": null,
      "effective_end": null,
      "reason_doc": "KB-WA-HOSP-INDEM",
      "notes": "Hospital-indemnity product not filed in WA -> not sellable."
    }
  ],
  "row_count": 2,
  "truncated": false
}

⚙ query_db(SELECT * FROM eligibility_rules WHERE state = 'WA')

{
  "sql": "SELECT * FROM eligibility_rules WHERE state = 'WA'"
}

{
  "rows": [
    {
      "rule_id": "ELIG-WA-HLTH-HOSP",
      "line": "HLTH",
      "tier_id": null,
      "coverage_id": "HLTH:HOSP_INDEM",
      "state": "WA",
      "effect": "DENY",
      "condition": null,
      "effective_start": null,
      "effective_end": null,
      "reason_doc": "KB-WA-HOSP-INDEM",
      "notes": "Hospital-indemnity product not filed in WA -> not sellable."
    }
  ],
  "row_count": 1,
  "truncated": false
}

⚙ search_kb(accident critical illness)

{
  "query": "accident critical illness"
}

{
  "results": [
    {
      "doc_id": "KB-WA-HOSP-INDEM",
      "title": "WA: hospital indemnity not available",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"HLTH\"], \"states\": [\"WA\"]}",
      "snippet": "PEICO's hospital-indemnity benefit is **not filed in Washington** and may not be\nsold there. Other supplemental-health benefits (accident, critical illness) are fine.\n"
    },
    {
      "doc_id": "KB-DISC-HLTH-SUPP",
      "title": "Supplemental health: not major-medical; pre-existing limits",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"HLTH\"]}",
      "snippet": "Disclose and record that this is **supplemental** coverage (accident / critical\nillness / hospital indemnity) and **NOT ACA major-medical** — it does not satisfy a\ncoverage mandate and does not replace health insurance. Pre-existing conditi…"
    },
    {
      "doc_id": "KB-GLOSSARY-AUTO",
      "title": "Auto coverage codes, decoded",
      "category": "GLOSSARY",
      "applies_to": "{\"lines\": [\"AUTO\", \"MOTO\", \"RV\", \"BOAT\", \"CLSC\"]}",
      "snippet": "EVERGREEN stores auto coverages under terse codes. Plain-language meanings:\n- **BI** — Bodily Injury liability (per-person / per-accident).\n- **PD** — Property Damage liability.\n- **UM/UIM** (`UMUIM`) — Uninsured / Underinsured Motorist.\n- …"
    }
  ]
}

⚙ search_kb(health)

{
  "query": "health"
}

{
  "results": [
    {
      "doc_id": "KB-SUITABILITY",
      "title": "Suitability requirement for Life & Health",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"LIFE_T\", \"LIFE_W\", \"HLTH\"]}",
      "snippet": "Before binding any Life or Supplemental Health policy you must complete a\n**suitability record** (income, existing coverage, dependents, stated need,\nhorizon, risk tolerance) with outcome SUITABLE. Selling **whole life** to a\nshort-horizon,…"
    },
    {
      "doc_id": "KB-DISC-HLTH-SUPP",
      "title": "Supplemental health: not major-medical; pre-existing limits",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"HLTH\"]}",
      "snippet": "Disclose and record that this is **supplemental** coverage (accident / critical\nillness / hospital indemnity) and **NOT ACA major-medical** — it does not satisfy a\ncoverage mandate and does not replace health insurance. Pre-existing conditi…"
    },
    {
      "doc_id": "KB-WA-HOSP-INDEM",
      "title": "WA: hospital indemnity not available",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"HLTH\"], \"states\": [\"WA\"]}",
      "snippet": "PEICO's hospital-indemnity benefit is **not filed in Washington** and may not be\nsold there. Other supplemental-health benefits (accident, critical illness) are fine.\n"
    },
    {
      "doc_id": "KB-DISC-FREELOOK",
      "title": "Free-look period",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"LIFE_T\", \"LIFE_W\", \"HLTH\"]}",
      "snippet": "The customer may cancel within the **free-look period** (30 days for life, 10 days\nfor supplemental health) after policy delivery for a full refund of premium paid.\nThe period and refund right must be disclosed at bind and recorded.\n"
    }
  ]
}

⚙ query_db(SELECT * FROM rate_tables WHERE line = 'HLTH')

{
  "sql": "SELECT * FROM rate_tables WHERE line = 'HLTH'"
}

{
  "rows": [
    {
      "rate_table_id": "HLTH:R-NE:2025.1",
      "line": "HLTH",
      "region": "R-NE",
      "version": "2025.1",
      "effective_start": "2025-01-01",
      "effective_end": "2026-12-31",
      "payload": "{\"unit\": \"per_policy\", \"base_rate\": 180, \"tier_factors\": {\"SAPLING\": 0.8, \"PINE\": 1.0, \"EVERGREEN\": 1.5}, \"factors\": {\"age\": [{\"max\": 40, \"f\": 1.0}, {\"max\": 55, \"f\": 1.3}, {\"max\": 99, \"f\": 1.8}]}, \"coverage_premiums\": {\"HOSP_INDEM\": 90, \"CRIT_ILL\": 70, \"WELLNESS\": 30}, \"line\": \"HLTH\", \"region\": \"R-NE\", \"region_factor\": 1.2, \"version\": \"2025.1\", \"money_unit\": \"usd\"}"
    },
    {
      "rate_table_id": "HLTH:R-SE:2025.1",
      "line": "HLTH",
      "region": "R-SE",
      "version": "2025.1",
      "effective_start": "2025-01-01",
      "effective_end": "2026-12-31",
      "payload": "{\"unit\": \"per_policy\", \"base_rate\": 180, \"tier_factors\": {\"SAPLING\": 0.8, \"PINE\": 1.0, \"EVERGREEN\": 1.5}, \"factors\": {\"age\": [{\"max\": 40, \"f\": 1.0}, {\"max\": 55, \"f\": 1.3}, {\"max\": 99, \"f\": 1.8}]}, \"coverage_premiums\": {\"HOSP_INDEM\": 90, \"CRIT_ILL\": 70, \"WELLNESS\": 30}, \"line\": \"HLTH\", \"region\": \"R-SE\", \"region_factor\": 1.15, \"version\": \"2025.1\", \"money_unit\": \"usd\"}"
    },
    {
      "rate_table_id": "HLTH:R-MW:2025.1",
      "line": "HLTH",
      "region": "R-MW",
      "version": "2025.1",
      "effective_start": "2025-01-01",
      "effective_end": "2026-12-31",
      "payload": "{\"unit\": \"per_policy\", \"base_rate\": 180, \"tier_factors\": {\"SAPLING\": 0.8, \"PINE\": 1.0, \"EVERGREEN\": 1.5}, \"factors\": {\"age\": [{\"max\": 40, \"f\": 1.0}, {\"max\": 55, \"f\": 1.3}, {\"max\": 99, \"f\": 1.8}]}, \"coverage_premiums\": {\"HOSP_INDEM\": 90, \"CRIT_ILL\": 70, \"WELLNESS\": 30}, \"line\": \"HLTH\", \"region\": \"R-MW\", \"region_factor\": 1.0, \"version\": \"2025.1\", \"money_unit\": \"usd\"}"
    },
    {
      "rate_table_id": "HLTH:R-SW:2025.1",
      "line": "HLTH",
      "region": "R-SW",
      "version": "2025.1",
      "effective_start": "2025-01-01",
      "effective_end": "2026-12-31",
      "payload": "{\"unit\": \"per_policy\", \"base_rate\": 180, \"tier_factors\": {\"SAPLING\": 0.8, \"PINE\": 1.0, \"EVERGREEN\": 1.5}, \"factors\": {\"age\": [{\"max\": 40, \"f\": 1.0}, {\"max\": 55, \"f\": 1.3}, {\"max\": 99, \"f\": 1.8}]}, \"coverage_premiums\": {\"HOSP_INDEM\": 90, \"CRIT_ILL\": 70, \"WELLNESS\": 30}, \"line\": \"HLTH\", \"region\": \"R-SW\", \"region_factor\": 1.05, \"version\": \"2025.1\", \"money_unit\": \"usd\"}"
    },
    {
      "rate_table_id": "HLTH:R-W:2025.1",
      "line": "HLTH",
      "region": "R-W",
      "version": "2025.1",
      "effective_start": "2025-01-01",
      "effective_end": "2026-12-31",
      "payload": "{\"unit\": \"per_policy\", \"base_rate\": 180, \"tier_factors\": {\"SAPLING\": 0.8, \"PINE\": 1.0, \"EVERGREEN\": 1.5}, \"factors\": {\"age\": [{\"max\": 40, \"f\": 1.0}, {\"max\": 55, \"f\": 1.3}, {\"max\": 99, \"f\": 1.8}]}, \"coverage_premiums\": {\"HOSP_INDEM\": 90, \"CRIT_ILL\": 70, \"WELLNESS\": 30}, \"line\": \"HLTH\", \"region\": \"R-W\", \"region_factor\": 1.1, \"version\": \"2025.1\", \"money_unit\": \"usd\"}"
    }
  ],
  "row_count": 5,
  "truncated": false
}

⚙ quote({"coverages":["ACCIDENT","ER_BENEFIT"],"tier":"SAPLING","region":"R-W","age":…)

{
  "facts": {
    "coverages": [
      "ACCIDENT",
      "ER_BENEFIT"
    ],
    "tier": "SAPLING",
    "region": "R-W",
    "age": 40,
    "line": "HLTH"
  }
}

{
  "as_of": "2025-06-01",
  "base_premium_cents": 18340,
  "final_premium_cents": 18340,
  "breakdown": [
    {
      "step": "BASE",
      "code": "base",
      "detail": "base_rate $180",
      "factor": null,
      "amount_cents": null,
      "running_cents": 18000
    },
    {
      "step": "BASE",
      "code": "tier:SAPLING",
      "detail": "tier factor ×0.8",
      "factor": 0.8,
      "amount_cents": null,
      "running_cents": 14400
    },
    {
      "step": "BASE",
      "code": "region:R-W",
      "detail": "region factor ×1.1",
      "factor": 1.1,
      "amount_cents": null,
      "running_cents": 15840
    },
    {
      "step": "RISK",
      "code": "factor:age",
      "detail": "age=40 ×1.0",
      "factor": 1,
      "amount_cents": null,
      "running_cents": 15840
    },
    {
      "step": "FEES",
      "code": "policy_fee",
      "detail": "+ policy fee",
      "factor": null,
      "amount_cents": 2500,
      "running_cents": 18340
    }
  ]
}

⚙ quote({"line":"HLTH","coverages":["ACCIDENT","ER_BENEFIT","CRIT_ILL"],"tier":"SAPLI…)

{
  "facts": {
    "line": "HLTH",
    "coverages": [
      "ACCIDENT",
      "ER_BENEFIT",
      "CRIT_ILL"
    ],
    "tier": "SAPLING",
    "region": "R-W",
    "age": 40
  }
}

{
  "as_of": "2025-06-01",
  "base_premium_cents": 25340,
  "final_premium_cents": 25340,
  "breakdown": [
    {
      "step": "BASE",
      "code": "base",
      "detail": "base_rate $180",
      "factor": null,
      "amount_cents": null,
      "running_cents": 18000
    },
    {
      "step": "BASE",
      "code": "tier:SAPLING",
      "detail": "tier factor ×0.8",
      "factor": 0.8,
      "amount_cents": null,
      "running_cents": 14400
    },
    {
      "step": "BASE",
      "code": "region:R-W",
      "detail": "region factor ×1.1",
      "factor": 1.1,
      "amount_cents": null,
      "running_cents": 15840
    },
    {
      "step": "RISK",
      "code": "factor:age",
      "detail": "age=40 ×1.0",
      "factor": 1,
      "amount_cents": null,
      "running_cents": 15840
    },
    {
      "step": "COVERAGE",
      "code": "CRIT_ILL",
      "detail": "+ CRIT_ILL $70",
      "factor": null,
      "amount_cents": 7000,
      "running_cents": 22840
    },
    {
      "step": "FEES",
      "code": "policy_fee",
      "detail": "+ policy fee",
      "factor": null,
      "amount_cents": 2500,
      "running_cents": 25340
    }
  ]
}

⚙ quote({"region":"R-W","age":40,"tier":"SAPLING","coverages":["ACCIDENT","ER_BENEFIT…)

{
  "facts": {
    "region": "R-W",
    "age": 40,
    "tier": "SAPLING",
    "coverages": [
      "ACCIDENT",
      "ER_BENEFIT",
      "WELLNESS"
    ],
    "line": "HLTH"
  }
}

{
  "as_of": "2025-06-01",
  "base_premium_cents": 21340,
  "final_premium_cents": 21340,
  "breakdown": [
    {
      "step": "BASE",
      "code": "base",
      "detail": "base_rate $180",
      "factor": null,
      "amount_cents": null,
      "running_cents": 18000
    },
    {
      "step": "BASE",
      "code": "tier:SAPLING",
      "detail": "tier factor ×0.8",
      "factor": 0.8,
      "amount_cents": null,
      "running_cents": 14400
    },
    {
      "step": "BASE",
      "code": "region:R-W",
      "detail": "region factor ×1.1",
      "factor": 1.1,
      "amount_cents": null,
      "running_cents": 15840
    },
    {
      "step": "RISK",
      "code": "factor:age",
      "detail": "age=40 ×1.0",
      "factor": 1,
      "amount_cents": null,
      "running_cents": 15840
    },
    {
      "step": "COVERAGE",
      "code": "WELLNESS",
      "detail": "+ WELLNESS $30",
      "factor": null,
      "amount_cents": 3000,
      "running_cents": 18840
    },
    {
      "step": "FEES",
      "code": "policy_fee",
      "detail": "+ policy fee",
      "factor": null,
      "amount_cents": 2500,
      "running_cents": 21340
    }
  ]
}

⚙ quote({"tier":"SAPLING","line":"HLTH","age":40,"coverages":["ACCIDENT","ER_BENEFIT"…)

{
  "facts": {
    "tier": "SAPLING",
    "line": "HLTH",
    "age": 40,
    "coverages": [
      "ACCIDENT",
      "ER_BENEFIT",
      "HOSP_INDEM"
    ],
    "region": "R-W"
  }
}

{
  "as_of": "2025-06-01",
  "base_premium_cents": 27340,
  "final_premium_cents": 27340,
  "breakdown": [
    {
      "step": "BASE",
      "code": "base",
      "detail": "base_rate $180",
      "factor": null,
      "amount_cents": null,
      "running_cents": 18000
    },
    {
      "step": "BASE",
      "code": "tier:SAPLING",
      "detail": "tier factor ×0.8",
      "factor": 0.8,
      "amount_cents": null,
      "running_cents": 14400
    },
    {
      "step": "BASE",
      "code": "region:R-W",
      "detail": "region factor ×1.1",
      "factor": 1.1,
      "amount_cents": null,
      "running_cents": 15840
    },
    {
      "step": "RISK",
      "code": "factor:age",
      "detail": "age=40 ×1.0",
      "factor": 1,
      "amount_cents": null,
      "running_cents": 15840
    },
    {
      "step": "COVERAGE",
      "code": "HOSP_INDEM",
      "detail": "+ HOSP_INDEM $90",
      "factor": null,
      "amount_cents": 9000,
      "running_cents": 24840
    },
    {
      "step": "FEES",
      "code": "policy_fee",
      "detail": "+ policy fee",
      "factor": null,
      "amount_cents": 2500,
      "running_cents": 27340
    }
  ]
}

⚙ query_db(SELECT * FROM policies WHERE line = 'HLTH' LIMIT 5)

{
  "sql": "SELECT * FROM policies WHERE line = 'HLTH' LIMIT 5"
}

{
  "rows": [],
  "row_count": 0,
  "truncated": false
}

⚙ query_db(SELECT * FROM policies LIMIT 3)

{
  "sql": "SELECT * FROM policies LIMIT 3"
}

{
  "rows": [
    {
      "policy_id": "POL-nest-household-p_auto",
      "cust_id": "CUST-nest-household",
      "line": "AUTO",
      "tier_id": "AUTO:PINE",
      "status": "ACTIVE",
      "effective_date": "2025-01-15",
      "expiration_date": "2026-01-15",
      "term_months": 12,
      "rating_as_of": "2025-01-15",
      "base_premium_cents": 80320,
      "final_premium_cents": 49184,
      "premium_breakdown": "[{\"step\": \"BASE\", \"code\": \"base\", \"detail\": \"base_rate $900\", \"factor\": null, \"amount_cents\": null, \"running_cents\": 90000}, {\"step\": \"BASE\", \"code\": \"tier:PINE\", \"detail\": \"tier factor \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 90000}, {\"step\": \"BASE\", \"code\": \"region:R-MW\", \"detail\": \"region factor \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 90000}, {\"step\": \"RISK\", \"code\": \"factor:driver_age\", \"detail\": \"driver_age=44 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 90000}, {\"step\": \"RISK\", \"code\": \"factor:risk_score\", \"detail\": \"risk_score=765 \\u00d70.84\", \"factor\": 0.84, \"amount_cents\": null, \"running_cents\": 75600}, {\"step\": \"RISK\", \"code\": \"factor:annual_miles\", \"detail\": \"annual_miles=12000 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 75600}, {\"step\": \"RISK\", \"code\": \"factor:vehicle_age\", \"detail\": \"vehicle_age=4 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 75600}, {\"step\": \"RISK\", \"code\": \"factor:incidents_5yr\", \"detail\": \"incidents_5yr=0 \\u00d70.95\", \"factor\": 0.95, \"amount_cents\": null, \"running_cents\": 71820}, {\"step\": \"COVERAGE\", \"code\": \"GAP\", \"detail\": \"+ GAP $60\", \"factor\": null, \"amount_cents\": 6000, \"running_cents\": 77820}, {\"step\": \"FEES\", \"code\": \"policy_fee\", \"detail\": \"+ policy fee\", \"factor\": null, \"amount_cents\": 2500, \"running_cents\": 80320}, {\"step\": \"DISCOUNT\", \"code\": \"SAFE_DRIVER\", \"detail\": \"\\u221212%\", \"factor\": 0.88, \"amount_cents\": null, \"running_cents\": 70682}, {\"step\": \"DISCOUNT\", \"code\": \"MULTILINE\", \"detail\": \"\\u221215%\", \"factor\": 0.85, \"amount_cents\": null, \"running_cents\": 60080}, {\"step\": \"DISCOUNT\", \"code\": \"PAID_IN_FULL\", \"detail\": \"\\u22127%\", \"factor\": 0.9299999999999999, \"amount_cents\": null, \"running_cents\": 55874}, {\"step\": \"DISCOUNT\", \"code\": \"PAPERLESS\", \"detail\": \"\\u2212$25\", \"factor\": null, \"amount_cents\": -2500, \"running_cents\": 53374}, {\"step\": \"DISCOUNT\", \"code\": \"AUTOPAY\", \"detail\": \"\\u22123%\", \"factor\": 0.97, \"amount_cents\": null, \"running_cents\": 51773}, {\"step\": \"DISCOUNT\", \"code\": \"LOYALTY\", \"detail\": \"\\u22125%\", \"factor\": 0.95, \"amount_cents\": null, \"running_cents\": 49184}]",
      "rating_inputs": "{\"billing\": {\"plan\": \"PAY_IN_FULL\", \"autopay\": true, \"paperless\": true}, \"incidents_5yr\": 0, \"smoker\": false, \"promo_code\": null}",
      "underlying_policy_id": null,
      "bundle_id": "BND-nest-household",
      "rep_id": "REP-1001",
      "created_at": "2025-06-01"
    },
    {
      "policy_id": "POL-nest-household-p_home",
      "cust_id": "CUST-nest-household",
      "line": "HOME",
      "tier_id": "HOME:EVERGREEN",
      "status": "ACTIVE",
      "effective_date": "2025-01-15",
      "expiration_date": "2026-01-15",
      "term_months": 12,
      "rating_as_of": "2025-01-15",
      "base_premium_cents": 170868,
      "final_premium_cents": 131533,
      "premium_breakdown": "[{\"step\": \"BASE\", \"code\": \"base\", \"detail\": \"$4.2/$1k \\u00d7 RC $380,000.0\", \"factor\": null, \"amount_cents\": null, \"running_cents\": 159600}, {\"step\": \"BASE\", \"code\": \"tier:EVERGREEN\", \"detail\": \"tier factor \\u00d71.22\", \"factor\": 1.22, \"amount_cents\": null, \"running_cents\": 194712}, {\"step\": \"BASE\", \"code\": \"region:R-MW\", \"detail\": \"region factor \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 194712}, {\"step\": \"RISK\", \"code\": \"factor:roof_age\", \"detail\": \"roof_age=11 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 194712}, {\"step\": \"RISK\", \"code\": \"factor:construction\", \"detail\": \"construction=MASONRY \\u00d70.95\", \"factor\": 0.95, \"amount_cents\": null, \"running_cents\": 184976}, {\"step\": \"RISK\", \"code\": \"factor:protection_class\", \"detail\": \"protection_class=4 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 184976}, {\"step\": \"RISK\", \"code\": \"factor:dist_to_coast_mi\", \"detail\": \"dist_to_coast_mi=60 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 184976}, {\"step\": \"RISK\", \"code\": \"factor:risk_score\", \"detail\": \"risk_score=765 \\u00d70.88\", \"factor\": 0.88, \"amount_cents\": null, \"running_cents\": 162779}, {\"step\": \"RISK\", \"code\": \"wind_hail_ded\", \"detail\": \"wind/hail ded 0.02 \\u00d70.96\", \"factor\": 0.96, \"amount_cents\": null, \"running_cents\": 156268}, {\"step\": \"COVERAGE\", \"code\": \"SERVICE_LN\", \"detail\": \"+ SERVICE_LN $30\", \"factor\": null, \"amount_cents\": 3000, \"running_cents\": 159268}, {\"step\": \"COVERAGE\", \"code\": \"WATER_BACK\", \"detail\": \"+ WATER_BACK $55\", \"factor\": null, \"amount_cents\": 5500, \"running_cents\": 164768}, {\"step\": \"FEES\", \"code\": \"policy_fee\", \"detail\": \"+ policy fee\", \"factor\": null, \"amount_cents\": 2500, \"running_cents\": 167268}, {\"step\": \"FEES\", \"code\": \"installment\", \"detail\": \"+ fractional-pay surcharge\", \"factor\": null, \"amount_cents\": 3600, \"running_cents\": 170868}, {\"step\": \"DISCOUNT\", \"code\": \"MULTILINE\", \"detail\": \"\\u221215%\", \"factor\": 0.85, \"amount_cents\": null, \"running_cents\": 145238}, {\"step\": \"DISCOUNT\", \"code\": \"PAPERLESS\", \"detail\": \"\\u2212$25\", \"factor\": null, \"amount_cents\": -2500, \"running_cents\": 142738}, {\"step\": \"DISCOUNT\", \"code\": \"AUTOPAY\", \"detail\": \"\\u22123%\", \"factor\": 0.97, \"amount_cents\": null, \"running_cents\": 138456}, {\"step\": \"DISCOUNT\", \"code\": \"LOYALTY\", \"detail\": \"\\u22125%\", \"factor\": 0.95, \"amount_cents\": null, \"running_cents\": 131533}]",
      "rating_inputs": "{\"billing\": {\"plan\": \"INSTALLMENTS\", \"autopay\": true, \"paperless\": true}, \"incidents_5yr\": 0, \"smoker\": false, \"promo_code\": null}",
      "underlying_policy_id": null,
      "bundle_id": "BND-nest-household",
      "rep_id": "REP-1001",
      "created_at": "2025-06-01"
    },
    {
      "policy_id": "POL-heritage-auto-p_auto",
      "cust_id": "CUST-heritage-auto",
      "line": "AUTO",
      "tier_id": "AUTO:HERITAGE",
      "status": "ACTIVE",
      "effective_date": "2025-02-01",
      "expiration_date": "2026-02-01",
      "term_months": 12,
      "rating_as_of": "2025-02-01",
      "base_premium_cents": 199544,
      "final_premium_cents": 176297,
      "premium_breakdown": "[{\"step\": \"BASE\", \"code\": \"base\", \"detail\": \"base_rate $900\", \"factor\": null, \"amount_cents\": null, \"running_cents\": 90000}, {\"step\": \"BASE\", \"code\": \"tier:HERITAGE\", \"detail\": \"tier factor \\u00d71.35\", \"factor\": 1.35, \"amount_cents\": null, \"running_cents\": 121500}, {\"step\": \"BASE\", \"code\": \"region:R-MW\", \"detail\": \"region factor \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 121500}, {\"step\": \"RISK\", \"code\": \"factor:driver_age\", \"detail\": \"driver_age=67 \\u00d71.18\", \"factor\": 1.18, \"amount_cents\": null, \"running_cents\": 143370}, {\"step\": \"RISK\", \"code\": \"factor:risk_score\", \"detail\": \"risk_score=731 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 143370}, {\"step\": \"RISK\", \"code\": \"factor:annual_miles\", \"detail\": \"annual_miles=8000 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 143370}, {\"step\": \"RISK\", \"code\": \"factor:vehicle_age\", \"detail\": \"vehicle_age=9 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 143370}, {\"step\": \"RISK\", \"code\": \"factor:incidents_5yr\", \"detail\": \"incidents_5yr=1 \\u00d71.2\", \"factor\": 1.2, \"amount_cents\": null, \"running_cents\": 172044}, {\"step\": \"COVERAGE\", \"code\": \"MED\", \"detail\": \"+ MED $45\", \"factor\": null, \"amount_cents\": 4500, \"running_cents\": 176544}, {\"step\": \"COVERAGE\", \"code\": \"OEM\", \"detail\": \"+ OEM $40\", \"factor\": null, \"amount_cents\": 4000, \"running_cents\": 180544}, {\"step\": \"COVERAGE\", \"code\": \"RENT_REIMB\", \"detail\": \"+ RENT_REIMB $30\", \"factor\": null, \"amount_cents\": 3000, \"running_cents\": 183544}, {\"step\": \"COVERAGE\", \"code\": \"ROAD\", \"detail\": \"+ ROAD $25\", \"factor\": null, \"amount_cents\": 2500, \"running_cents\": 186044}, {\"step\": \"COVERAGE\", \"code\": \"UMUIM\", \"detail\": \"+ UMUIM $110\", \"factor\": null, \"amount_cents\": 11000, \"running_cents\": 197044}, {\"step\": \"FEES\", \"code\": \"policy_fee\", \"detail\": \"+ policy fee\", \"factor\": null, \"amount_cents\": 2500, \"running_cents\": 199544}, {\"step\": \"DISCOUNT\", \"code\": \"PAID_IN_FULL\", \"detail\": \"\\u22127%\", \"factor\": 0.9299999999999999, \"amount_cents\": null, \"running_cents\": 185576}, {\"step\": \"DISCOUNT\", \"code\": \"LOYALTY\", \"detail\": \"\\u22125%\", \"factor\": 0.95, \"amount_cents\": null, \"running_cents\": 176297}]",
      "rating_inputs": "{\"billing\": {\"plan\": \"PAY_IN_FULL\", \"autopay\": false, \"paperless\": false}, \"incidents_5yr\": 1, \"smoker\": false, \"promo_code\": null}",
      "underlying_policy_id": null,
      "bundle_id": null,
      "rep_id": "REP-1001",
      "created_at": "2025-06-01"
    }
  ],
  "row_count": 3,
  "truncated": false
}

⚙ quote({"region":"R-W","coverages":["ACCIDENT","ER_BENEFIT","CRIT_ILL"],"age":40,"ti…)

{
  "facts": {
    "region": "R-W",
    "coverages": [
      "ACCIDENT",
      "ER_BENEFIT",
      "CRIT_ILL"
    ],
    "age": 40,
    "tier": "PINE",
    "line": "HLTH"
  }
}

{
  "as_of": "2025-06-01",
  "base_premium_cents": 29300,
  "final_premium_cents": 29300,
  "breakdown": [
    {
      "step": "BASE",
      "code": "base",
      "detail": "base_rate $180",
      "factor": null,
      "amount_cents": null,
      "running_cents": 18000
    },
    {
      "step": "BASE",
      "code": "tier:PINE",
      "detail": "tier factor ×1.0",
      "factor": 1,
      "amount_cents": null,
      "running_cents": 18000
    },
    {
      "step": "BASE",
      "code": "region:R-W",
      "detail": "region factor ×1.1",
      "factor": 1.1,
      "amount_cents": null,
      "running_cents": 19800
    },
    {
      "step": "RISK",
      "code": "factor:age",
      "detail": "age=40 ×1.0",
      "factor": 1,
      "amount_cents": null,
      "running_cents": 19800
    },
    {
      "step": "COVERAGE",
      "code": "CRIT_ILL",
      "detail": "+ CRIT_ILL $70",
      "factor": null,
      "amount_cents": 7000,
      "running_cents": 26800
    },
    {
      "step": "FEES",
      "code": "policy_fee",
      "detail": "+ policy fee",
      "factor": null,
      "amount_cents": 2500,
      "running_cents": 29300
    }
  ]
}

⚙ quote({"tier":"PINE","line":"HLTH","coverages":["ACCIDENT","ER_BENEFIT"],"region":"…)

{
  "facts": {
    "tier": "PINE",
    "line": "HLTH",
    "coverages": [
      "ACCIDENT",
      "ER_BENEFIT"
    ],
    "region": "R-W",
    "age": 40
  }
}

{
  "as_of": "2025-06-01",
  "base_premium_cents": 22300,
  "final_premium_cents": 22300,
  "breakdown": [
    {
      "step": "BASE",
      "code": "base",
      "detail": "base_rate $180",
      "factor": null,
      "amount_cents": null,
      "running_cents": 18000
    },
    {
      "step": "BASE",
      "code": "tier:PINE",
      "detail": "tier factor ×1.0",
      "factor": 1,
      "amount_cents": null,
      "running_cents": 18000
    },
    {
      "step": "BASE",
      "code": "region:R-W",
      "detail": "region factor ×1.1",
      "factor": 1.1,
      "amount_cents": null,
      "running_cents": 19800
    },
    {
      "step": "RISK",
      "code": "factor:age",
      "detail": "age=40 ×1.0",
      "factor": 1,
      "amount_cents": null,
      "running_cents": 19800
    },
    {
      "step": "FEES",
      "code": "policy_fee",
      "detail": "+ policy fee",
      "factor": null,
      "amount_cents": 2500,
      "running_cents": 22300
    }
  ]
}

⚙ quote({"region":"R-W","age":40,"tier":"EVERGREEN","line":"HLTH","coverages":["ACCID…)

{
  "facts": {
    "region": "R-W",
    "age": 40,
    "tier": "EVERGREEN",
    "line": "HLTH",
    "coverages": [
      "ACCIDENT",
      "CRIT_ILL",
      "ER_BENEFIT",
      "WELLNESS"
    ]
  }
}

{
  "as_of": "2025-06-01",
  "base_premium_cents": 42200,
  "final_premium_cents": 42200,
  "breakdown": [
    {
      "step": "BASE",
      "code": "base",
      "detail": "base_rate $180",
      "factor": null,
      "amount_cents": null,
      "running_cents": 18000
    },
    {
      "step": "BASE",
      "code": "tier:EVERGREEN",
      "detail": "tier factor ×1.5",
      "factor": 1.5,
      "amount_cents": null,
      "running_cents": 27000
    },
    {
      "step": "BASE",
      "code": "region:R-W",
      "detail": "region factor ×1.1",
      "factor": 1.1,
      "amount_cents": null,
      "running_cents": 29700
    },
    {
      "step": "RISK",
      "code": "factor:age",
      "detail": "age=40 ×1.0",
      "factor": 1,
      "amount_cents": null,
      "running_cents": 29700
    },
    {
      "step": "COVERAGE",
      "code": "CRIT_ILL",
      "detail": "+ CRIT_ILL $70",
      "factor": null,
      "amount_cents": 7000,
      "running_cents": 36700
    },
    {
      "step": "COVERAGE",
      "code": "WELLNESS",
      "detail": "+ WELLNESS $30",
      "factor": null,
      "amount_cents": 3000,
      "running_cents": 39700
    },
    {
      "step": "FEES",
      "code": "policy_fee",
      "detail": "+ policy fee",
      "factor": null,
      "amount_cents": 2500,
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Hi Dana, thank you so much for verifying your details. I located your profile in our system, and I see you are located in Seattle, Washington.

I must let you know that our daily Hospital Indemnity benefit is not currently filed in the state of Washington, so regulatory rules prevent us from offering that specific per-day benefit there.

However, we have several other excellent Supplemental Health (HLTH) coverage options that are fully available in Washington. Before we look at those, there are a few important compliance disclosures I want to make sure you have:

Supplemental Coverage Only: This policy is supplemental health coverage (which includes accident, critical illness, and emergency room benefits). It is NOT ACA major-medical coverage, does not satisfy any healthcare coverage mandate, and does not replace regular health insurance.
Pre-Existing Conditions: Pre-existing condition limitations apply for a defined look-back period.
Suitability Requirement: Before we can bind any Supplemental Health policy, we will complete a brief suitability review together (discussing things like your income, dependents, existing coverage, stated needs, financial horizon, and risk tolerance) to make sure the plan is an appropriate fit for your needs.
10-Day Free-Look Period: If you decide to sign up, you have a 10-day "free-look" period after policy delivery, during which you can cancel for a full refund of any premium paid.

If you are interested, we can customize a policy in one of our three tiers, omitting the hospital indemnity portion to make it compliant with Washington state guidelines. Here are the options and their annual premiums for someone of your age (40):

1. Sapling Tier (Entry Level)

Accident Benefit: $5,000 lump sum per covered accident.
Emergency Room Benefit: $250.
Annual Premium: $183.40
Optional additions: You can add Critical Illness ($10,000 benefit) for +$70.00/year, or a Wellness Benefit for +$30.00/year.

2. Pine Tier (Mid Level)

Accident Benefit: $10,000 lump sum per covered accident.
Emergency Room Benefit: $500.
Critical Illness Lump Sum: $10,000.
Annual Premium: $293.00 (with Critical Illness included) or $223.00 (without Critical Illness).

3. Evergreen Tier (Premium Level)

Accident Benefit: $25,000 lump sum per covered accident.
Emergency Room Benefit: $1,000.
Critical Illness Lump Sum: $25,000.
Wellness Benefit: Included.
Annual Premium: $422.00

How do these options sound to you? Would you like to proceed with setting up a quote for one of these, or do you have any questions about the benefits?

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Customer

I appreciate you explaining that. I understand the hospital indemnity isn't available in Washington. That's helpful to know. Honestly though, I was really looking specifically for that daily hospital benefit — that's what would work best for my situation. Since that's not an option, I don't think the accident or critical illness plans are quite what I need right now. Thanks for walking me through everything though, and for all the details about the other coverage. I'll keep PEICO in mind if my needs change.

Agent

⚙ end_conversation()

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I completely understand, Dana. Supplemental health needs are highly personal, and it's important to have the exact protection that fits your situation.

Thank you so much for considering PEICO, and for your time today! If your circumstances or insurance needs change in the future, please don't hesitate to reach back out. Have a wonderful rest of your day!

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