hlth-supp-not-major-medical

{
  "query": "health coverage plan eligibility suitability required disclosures PEICO HLTH line",
  "limit": 8
}

{
  "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-LEGACY-XWALK",
      "title": "Reading an EVERGREEN plan code (legacy → CANOPY)",
      "category": "HOWTO",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "PEICO is migrating from the legacy **EVERGREEN** mainframe to **CANOPY**. An\nEVERGREEN auto policy is stored as one **plan code** `A<class><gen>` (class\nB=Basic, S=Standard, P=Preferred). A plan code does NOT map to a CANOPY tier on\nits own…"
    },
    {
      "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- …"
    },
    {
      "doc_id": "KB-AUTO-TIERS",
      "title": "Auto tiers: Sapling → Pine → Evergreen → Sequoia",
      "category": "POLICY",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "Tiers bundle coverages. Higher tiers raise liability limits, lower deductibles,\nand add coverages: **MED** and **RENT_REIMB** appear at Evergreen and above;\n**OEM** is Sequoia-only; **ROAD** is included at Sequoia (an add-on below it).\n"
    },
    {
      "doc_id": "KB-AUTO-GAP",
      "title": "GAP coverage eligibility",
      "category": "UNDERWRITING",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "Loan/Lease GAP is available only on **financed or leased** vehicles. It cannot be\nadded to a vehicle owned outright.\n"
    },
    {
      "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-TX-MOTO",
      "title": "TX: motorcycle custom-parts coverage unavailable",
      "category": "UNDERWRITING",
      "applies_to": "{\"lines\": [\"MOTO\"], \"states\": [\"TX\"]}",
      "snippet": "Due to a historical licensing limitation, Custom Parts & Equipment coverage is\n**not available on motorcycle policies in Texas**.\n"
    }
  ]
}

{
  "query": "HLTH Massachusetts hospital indemnity availability PEICO",
  "limit": 8
}

{
  "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-LEGACY-XWALK",
      "title": "Reading an EVERGREEN plan code (legacy → CANOPY)",
      "category": "HOWTO",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "PEICO is migrating from the legacy **EVERGREEN** mainframe to **CANOPY**. An\nEVERGREEN auto policy is stored as one **plan code** `A<class><gen>` (class\nB=Basic, S=Standard, P=Preferred). A plan code does NOT map to a CANOPY tier on\nits own…"
    },
    {
      "doc_id": "KB-CA-RATING",
      "title": "CA: prohibited auto rating factors",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"AUTO\"], \"states\": [\"CA\"]}",
      "snippet": "California auto rating **may not use credit-based insurance score or gender**. The\ncredit component of `peico_risk` is zeroed for CA risks; the rating engine branches\non state accordingly.\n"
    }
  ]
}

{
  "query": "KB supplemental health hospital indemnity MA accident critical illness pricing factors",
  "limit": 8
}

{
  "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-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-LEGACY-XWALK",
      "title": "Reading an EVERGREEN plan code (legacy → CANOPY)",
      "category": "HOWTO",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "PEICO is migrating from the legacy **EVERGREEN** mainframe to **CANOPY**. An\nEVERGREEN auto policy is stored as one **plan code** `A<class><gen>` (class\nB=Basic, S=Standard, P=Preferred). A plan code does NOT map to a CANOPY tier on\nits own…"
    },
    {
      "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- …"
    },
    {
      "doc_id": "KB-LOYALTY-AUTHORITY",
      "title": "PineRewards points: what a service rep may post",
      "category": "POLICY",
      "applies_to": "{\"lines\": \"ALL\"}",
      "snippet": "Tiers (Seedling → Sprout → Timber → OldGrowth) are assigned annually from\ntenure and lifetime earning, **not** the current point balance. Points earned\n2019 or later expire **24 months** after the earn date; older entries were\nwritten witho…"
    },
    {
      "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-CLAIMS-STATUS",
      "title": "Claim status: FNOL → OPEN → CLOSED, and who may move it",
      "category": "POLICY",
      "applies_to": "{\"lines\": \"ALL\"}",
      "snippet": "**FNOL** = loss reported, not yet accepted for handling. **OPEN** = accepted\nand with an adjuster (the adjuster sets the reserve). **CLOSED** = resolved.\nA service rep may promote FNOL → OPEN once the loss details are confirmed\nwith the cus…"
    },
    {
      "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": "suitability record required fields HLTH Massachusetts",
  "limit": 8
}

{
  "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-LEGACY-XWALK",
      "title": "Reading an EVERGREEN plan code (legacy → CANOPY)",
      "category": "HOWTO",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "PEICO is migrating from the legacy **EVERGREEN** mainframe to **CANOPY**. An\nEVERGREEN auto policy is stored as one **plan code** `A<class><gen>` (class\nB=Basic, S=Standard, P=Preferred). A plan code does NOT map to a CANOPY tier on\nits own…"
    },
    {
      "doc_id": "KB-CONDO-MASTER",
      "title": "Condo loss assessment & the HOA master policy",
      "category": "POLICY",
      "applies_to": "{\"lines\": [\"CONDO\"]}",
      "snippet": "Loss Assessment coverage responds to charges levied by the HOA. Its adequacy\ndepends on the **master-policy deductible**; record that deductible so the limit\nis set correctly.\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"
    },
    {
      "doc_id": "KB-DISC-WHOLE-LIFE",
      "title": "Whole life disclosures: surrender, cash value, not an investment",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"LIFE_W\"]}",
      "snippet": "Before binding whole life, disclose and record: (1) **surrender charges** apply for\nthe first several policy years and reduce early cash value; (2) cash value accrues\nslowly and may be borrowed against, reducing the death benefit; (3) whole…"
    },
    {
      "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-DISC-UMUIM",
      "title": "UM/UIM selection or rejection",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "The customer must affirmatively **select or reject** Uninsured/Underinsured Motorist\ncoverage; the choice (and limits, if selected) is disclosed and recorded at bind.\nSome states mandate UM/UIM at or above the BI limit.\n"
    }
  ]
}

{
  "sql": "SELECT line, tier_id, tier_code, code FROM (SELECT line, tier_id, NULL as tier_code, code FROM tiers) LIMIT 1"
}

{
  "rows": [
    {
      "line": "AUTO",
      "tier_id": "AUTO:SAPLING",
      "tier_code": null,
      "code": "SAPLING"
    }
  ],
  "row_count": 1,
  "truncated": false
}

{
  "sql": "SELECT tier_id, line, code, label, sellable, retired_on FROM tiers WHERE line LIKE 'HLTH%' OR line='HLTH' OR line='LIFE_T' LIMIT 50"
}

{
  "rows": [
    {
      "tier_id": "LIFE_T:PINE",
      "line": "LIFE_T",
      "code": "PINE",
      "label": "Pine",
      "sellable": 1,
      "retired_on": null
    },
    {
      "tier_id": "LIFE_T:EVERGREEN",
      "line": "LIFE_T",
      "code": "EVERGREEN",
      "label": "Evergreen",
      "sellable": 1,
      "retired_on": null
    },
    {
      "tier_id": "LIFE_T:SEQUOIA",
      "line": "LIFE_T",
      "code": "SEQUOIA",
      "label": "Sequoia",
      "sellable": 1,
      "retired_on": null
    },
    {
      "tier_id": "HLTH:SAPLING",
      "line": "HLTH",
      "code": "SAPLING",
      "label": "Sapling",
      "sellable": 1,
      "retired_on": null
    },
    {
      "tier_id": "HLTH:PINE",
      "line": "HLTH",
      "code": "PINE",
      "label": "Pine",
      "sellable": 1,
      "retired_on": null
    },
    {
      "tier_id": "HLTH:EVERGREEN",
      "line": "HLTH",
      "code": "EVERGREEN",
      "label": "Evergreen",
      "sellable": 1,
      "retired_on": null
    }
  ],
  "row_count": 6,
  "truncated": false
}

{
  "sql": "SELECT state, line, tier_id, coverage_id, effect, condition, reason_doc, notes FROM eligibility_rules WHERE line='HLTH' AND (state='MA' OR state IS NULL) LIMIT 50"
}

{
  "rows": [
    {
      "state": null,
      "line": "HLTH",
      "tier_id": null,
      "coverage_id": null,
      "effect": "REQUIRE",
      "condition": "suitability_record_suitable",
      "reason_doc": "KB-SUITABILITY",
      "notes": null
    }
  ],
  "row_count": 1,
  "truncated": false
}

{
  "sql": "SELECT p.policy_id FROM policies p WHERE p.line='HLTH' LIMIT 1"
}

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

{
  "sql": "SELECT tier_id, code, label, sellable, retired_on FROM tiers WHERE line='HLTH' ORDER BY position"
}

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

{
  "sql": "SELECT coverage_id, included, default_value, editable FROM tier_coverage_defaults WHERE tier_id='HLTH:SAPLING'"
}

{
  "rows": [
    {
      "coverage_id": "HLTH:ACCIDENT",
      "included": 1,
      "default_value": "500000",
      "editable": 1
    },
    {
      "coverage_id": "HLTH:CRIT_ILL",
      "included": 0,
      "default_value": null,
      "editable": 1
    },
    {
      "coverage_id": "HLTH:ER_BENEFIT",
      "included": 1,
      "default_value": "25000",
      "editable": 1
    },
    {
      "coverage_id": "HLTH:HOSP_INDEM",
      "included": 0,
      "default_value": null,
      "editable": 1
    },
    {
      "coverage_id": "HLTH:WELLNESS",
      "included": 0,
      "default_value": null,
      "editable": 1
    }
  ],
  "row_count": 5,
  "truncated": false
}

{
  "sql": "SELECT count(*) as cnt, state, tier_id, coverage_id, effect, condition, reason_doc FROM eligibility_rules WHERE line='HLTH' GROUP BY state, tier_id, coverage_id, effect, condition, reason_doc LIMIT 20"
}

{
  "rows": [
    {
      "cnt": 1,
      "state": null,
      "tier_id": null,
      "coverage_id": null,
      "effect": "REQUIRE",
      "condition": "suitability_record_suitable",
      "reason_doc": "KB-SUITABILITY"
    },
    {
      "cnt": 1,
      "state": "WA",
      "tier_id": null,
      "coverage_id": "HLTH:HOSP_INDEM",
      "effect": "DENY",
      "condition": null,
      "reason_doc": "KB-WA-HOSP-INDEM"
    }
  ],
  "row_count": 2,
  "truncated": false
}

{
  "sql": "SELECT coverage_id, label, code, kind, notes FROM coverages WHERE line='HLTH' ORDER BY coverage_id"
}

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

{
  "sql": "SELECT rt.rate_table_id, rt.line, rt.region, rt.version, rt.effective_start, rt.effective_end FROM rate_tables rt WHERE rt.line='HLTH' LIMIT 20"
}

{
  "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"
    },
    {
      "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"
    },
    {
      "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"
    },
    {
      "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"
    },
    {
      "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"
    }
  ],
  "row_count": 5,
  "truncated": false
}

{
  "sql": "SELECT region FROM addresses a JOIN states s ON s.state=a.state WHERE a.state='MA' LIMIT 1"
}

{
  "error": "sql_error",
  "detail": "ambiguous column name: region"
}

{
  "sql": "SELECT a.region FROM addresses a WHERE a.state='MA' LIMIT 5"
}

{
  "rows": [
    {
      "region": "R-NE"
    }
  ],
  "row_count": 1,
  "truncated": false
}

{
  "facts": {
    "line": "HLTH",
    "tier": "HLTH:SAPLING",
    "state": "MA",
    "region": "R-NE",
    "age": 28,
    "coverages": [
      "ACCIDENT",
      "ER_BENEFIT"
    ],
    "coverage_values": {
      "ACCIDENT": "500000",
      "ER_BENEFIT": "25000"
    },
    "billing_plan": "INSTALLMENTS",
    "promo_code": null
  },
  "as_of": "2025-06-01"
}

{
  "as_of": "2025-06-01",
  "base_premium_cents": 27700,
  "final_premium_cents": 27700,
  "breakdown": [
    {
      "step": "BASE",
      "code": "base",
      "detail": "base_rate $180",
      "factor": null,
      "amount_cents": null,
      "running_cents": 18000
    },
    {
      "step": "BASE",
      "code": "tier:HLTH:SAPLING",
      "detail": "tier factor ×1.0",
      "factor": 1,
      "amount_cents": null,
      "running_cents": 18000
    },
    {
      "step": "BASE",
      "code": "region:R-NE",
      "detail": "region factor ×1.2",
      "factor": 1.2,
      "amount_cents": null,
      "running_cents": 21600
    },
    {
      "step": "RISK",
      "code": "factor:age",
      "detail": "age=28 ×1.0",
      "factor": 1,
      "amount_cents": null,
      "running_cents": 21600
    },
    {
      "step": "FEES",
      "code": "policy_fee",
      "detail": "+ policy fee",
      "factor": null,
      "amount_cents": 2500,
      "running_cents": 24100
    },
    {
      "step": "FEES",
      "code": "installment",
      "detail": "+ fractional-pay surcharge",
      "factor": null,
      "amount_cents": 3600,
      "running_cents": 27700
    }
  ]
}

{}

{
  "ok": true,
  "note": "Deliver your closing message now."
}