insurance-open-enrollment-readiness

insurance-open-enrollment-readiness

Trigger phrases:

• "open enrollment prep"
• "which health plan should I pick"
• "PPO vs HDHP"
• "HSA contribution amount"

Cadence: Annual, in the user's enrollment window (often Oct-Nov).

What It Does

Open enrollment is high-stakes (the wrong plan can cost $5K+ for a family) and frictionful (compare 3 plans against actual usage in 30 minutes). The op pre-computes the math.

Inputs assembled:

• Prior-year health utilization: total claims, deductible met, OOP spent, RX patterns. Pulled from vault/health/00_current/ if installed; otherwise prompts user to upload prior-year EOB summary.
• Expected next-year events: planned procedures, expected pregnancy, ongoing therapy, recurring RX, dependents' regular care.
• Plan option set: each option with premium, deductible, OOP max, HSA-eligibility, network, and per-service copays. Pasted from employer benefits portal or vault/career/00_current/benefits/.

Comparison logic per plan:

• Total expected annual cost = annualized premium − employer HSA contribution + expected OOP up to OOP max + RX cost differential.
• HDHP+HSA path includes the tax-advantaged HSA contribution (current 2026 limits applied; configurable) and quantifies the marginal-tax savings.
• Family-vs-single tier consideration if dependents are listed.

Output: A ranked plan recommendation with the projected total cost difference and a flag for non-cost factors (network match for the user's primary doctors, prior-auth burden, in-network specialty access).

Steps

1. Read prior-year utilization from vault/health/ if available; else prompt user.
2. Read plan options from vault/career/00_current/benefits/ or accept paste.
3. For each plan: compute expected total cost across realistic scenarios (low / medium / high utilization).
4. Recommend plan and FSA/HSA contribution target.
5. Surface non-cost factors (network match, prior-auth, mental-health network).
6. Write brief to vault/insurance/02_briefs/open-enrollment-{YYYY}.md.
7. Call task-sync-to-cross-agents to push the eventual selection into health and career vaults.

Configuration

vault/insurance/config.md:

• enrollment_window_start, enrollment_window_end
• hsa_contribution_target (optional override; default = current IRS limit minus employer match)
• dependents_on_health_plan

Error Handling

• No prior utilization data: Run with low/medium/high scenarios only; recommend HDHP only if low-utilization scenario is defensible.
• Plan options not yet released by employer: Output a checklist of fields to capture once available.

Vault Paths

• Reads: optional ~/Documents/aireadylife/vault/health/, ~/Documents/aireadylife/vault/career/00_current/benefits/, ~/Documents/aireadylife/vault/insurance/config.md
• Writes: ~/Documents/aireadylife/vault/insurance/02_briefs/open-enrollment-{YYYY}.md