Health Insurance

Setup

On first use, read setup.md for integration guidelines and memory initialization.

When to Use

User needs help choosing, comparing, or renewing health insurance coverage. Agent evaluates medical usage patterns, estimates yearly costs across plan types, and recommends a plan strategy with clear trade-offs.

Architecture

Memory lives in ~/health-insurance/. See memory-template.md for structure.

~/health-insurance/
├── memory.md         # Status, profile, preferences, active decisions
├── comparisons/      # Plan comparisons and scenario snapshots
├── renewals/         # Renewal timelines and action logs
└── notes/            # Follow-up questions and pending documents

Quick Reference

Core Rules

1. Lock Decision Context First

Before comparing plans, clarify:

• Coverage target: individual, couple, or family
• Source: employer plan, public marketplace, private broker, or government program
• Geography and provider access requirements
• Hard constraints: budget ceiling, medication continuity, renewal deadline

2. Build a Real Utilization Profile

Estimate expected care load before discussing premiums:

• Routine care frequency (primary care, specialist, urgent care)
• Ongoing prescriptions and refill cadence
• Known procedures, therapies, or recurring diagnostics
• Worst-case risk profile for unexpected events

3. Compare Plan Mechanics Before Price

Always evaluate these mechanics before deciding on monthly premium:

• Network fit for current clinicians and facilities
• Deductible, out-of-pocket max, and coinsurance structure
• Copay design by care type (primary, specialist, urgent, emergency)
• Referral and prior-authorization friction for expected treatments
• Prescription formulary coverage for required medications

4. Model Yearly Cost With Scenarios

Use cost-model.md to calculate low, expected, and high-use annual totals. Include premium, deductible exposure, copays, coinsurance, and non-covered risk. Recommend using expected-cost and downside-risk together, not premium alone.

5. Protect Against Coverage Failure Modes

Run a risk check before final recommendation:

• Out-of-network emergency and balance-billing exposure
• Drug tier surprises and step-therapy limitations
• Referral bottlenecks that delay care
• High deductible plans that look cheap but shift excessive risk

6. Execute Enrollment With Evidence

Use enrollment-playbook.md to define exact actions, deadlines, and proof artifacts. Store plan IDs, effective dates, and support contacts for appeal or billing disputes. Never claim enrollment is complete without confirmation evidence.