insurance-deductible-progress-snapshot

insurance-deductible-progress-snapshot

Trigger: Called by op-review-brief, op-coverage-audit, op-open-enrollment-readiness, or on-demand ("how close am I to my deductible").

What It Does

The user's deductible position changes the math for any near-term medical decision. Once the deductible is met, additional in-network spend is covered at the coinsurance rate; once the OOP max is met, additional spend is fully covered. Patients facing $X of upcoming care benefit from knowing whether to schedule before or after January 1.

Health plan snapshot:

• Plan name, family vs individual deductible structure.
• Deductible: amount met YTD / total / remaining.
• OOP max: amount met YTD / total / remaining.
• Days remaining in plan year.
• Projected EOY deductible position based on YTD pace.
• Decision flags: "if you have $X+ of upcoming elective care, schedule before EOY since you've met deductible" / "delay to next plan year — you're early in this one."

Auto deductible snapshot (per vehicle policy):

• Collision deductible amount.
• Comprehensive deductible amount.
• Recent claim history (last 3 years) — if claims-free, the user may be eligible for a deductible waiver renewal benefit.

Data sources, in order: vault/health/00_current/eob/ (preferred — actual EOB data), then vault/insurance/00_current/deductible-tracker.md (manual user log), then vault/insurance/00_current/policies/health-*.md (just shows the totals; YTD is unknown).

Steps

1. Read the active health plan's deductible and OOP max from policy record.
2. If vault/health/00_current/eob/ exists, sum YTD covered-charge user portion to compute amount-met figures.
3. Else read vault/insurance/00_current/deductible-tracker.md if user maintains it manually.
4. Compute remaining and project EOY based on YTD pace (months_elapsed / 12).
5. Read auto policies for collision and comprehensive deductibles.
6. Compose snapshot output.
7. Return to caller; do not write to open-loops directly (caller decides whether to flag).

Configuration

vault/insurance/config.md:

• plan_year_start_month (default 1, January)
• health_plan_tier — individual or family (drives which deductible figure to use)

Error Handling

• No EOB data and no manual tracker: Return totals only with note that YTD position is unknown; suggest enabling EOB ingest.
• Plan-year start mid-year (e.g. July): Use configured start; days-remaining math adjusts automatically.

Vault Paths

• Reads: ~/Documents/aireadylife/vault/insurance/00_current/policies/, optional ~/Documents/aireadylife/vault/health/00_current/eob/, ~/Documents/aireadylife/vault/insurance/00_current/deductible-tracker.md
• Writes: None (returns data to caller)