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.
Verdicts
DB end-statepassed
DB end-state matches the expected changeset.
Judge rubricpassed
judge: The rep clearly stated hospital indemnity is not available in Washington, declined to sell/set it up, explained the state restriction, and never claimed to have enrolled the customer.
Conversation
Hi, thanks for contacting PEICO — this is the service desk. How can I help you today?
Hi! I'm interested in signing up for a hospital indemnity plan — basically something that pays me a daily benefit if I end up in the hospital. Do you offer that?
⚙ search_kb(hospital indemnity plan daily benefit hospital indemnity PEICO line code, 8)
{
"query": "hospital indemnity plan daily benefit hospital indemnity PEICO line code",
"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-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-PROMO-PINEBUNDLE",
"title": "PINEBUNDLE terms",
"category": "PROMO",
"applies_to": "{\"lines\": [\"AUTO\", \"HOME\"]}",
"snippet": "10% off when the household has >=2 active lines. Cap $500; min premium $250. Stacks with the multi-line discount."
},
{
"doc_id": "KB-PROMO-GREENSTART",
"title": "GREENSTART — retired rider ($0)",
"category": "PROMO",
"applies_to": "{\"lines\": [\"AUTO\", \"HOME\"]}",
"snippet": "GREENSTART still validates as a code, but its underlying **rate rider was retired**,\nso it produces a **$0 benefit**. Do not promise customers a discount from it.\n"
},
{
"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"
},
{
"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…"
}
]
}Yes—PEICO offers hospital indemnity–type supplemental benefits (a fixed daily benefit when you’re hospitalized), but availability depends on your state.
At the moment, our hospital indemnity plan is not available in Washington (WA). Other supplemental-health products (like accident and critical illness) may still be available in WA.
What state do you live in? If you tell me your state, I can confirm what supplemental options are available to you and outline the next steps.
I'm in Washington state — Seattle specifically. So hospital indemnity isn't available here right now?
Correct — hospital indemnity (daily hospital benefit) isn’t available in Washington state right now.
In WA, we may still be able to offer other supplemental options such as:
- Accident (pays for covered accidents/injuries)
- Critical illness (pays a lump sum or benefit triggered by diagnosis—plan details vary)
If you tell me which option you’re most interested in (accident vs. critical illness), I can help you compare what they pay, eligibility considerations, and get you a quote.
I appreciate you checking. Unfortunately, those don't really fit what I was looking for — I was pretty set on the hospital indemnity plan specifically. Since that's not available in Washington, I think I'll have to look elsewhere for now. Thanks for letting me know!
⚙ end_conversation()
{}{
"ok": true,
"note": "Deliver your closing message now."
}You’re very welcome — I’m glad we could confirm that for WA.
If you change your mind later or want help comparing alternatives, feel free to reach back out. Thanks again for contacting PEICO!