New group installs, checked item by item before the package goes and again before the first bill.

Today an implementation specialist gathers the employer application, the enrollment forms or file, the waivers, the wage report and the first payment, and ticks them off against the carrier's new group checklist. Later someone compares the carrier's setup with the plans, tiers and contributions the employer signed for, sometimes only when the ID cards or the first bill turn up wrong.

In the proof of concept, AI runs both checks on copies. Before submission it lists every missing, unsigned or mismatched item against that carrier's checklist. After setup it compares what the carrier sent back with the signed choices. Nothing is filled in, signed, submitted or sent. Your reviewer, the person who runs installs best, compares each list with what your team actually caught.

Every carrier publishes its own package list. Blue Shield of California's new group checklist asks for a first payment, either its initial payment form or a business check for the first month's premium, a master group application, applications from each enrolling employee and dependent, refusal of coverage forms from everyone eligible who waives, and the employer's most recently filed DE 9C. Hires after that filing go on a payroll register, a new hire not yet on payroll needs a W-4, and an eligible owner missing from the DE 9C needs a signed owner eligibility form. In New York the payroll proof is the NYS-45-ATT, and Independent Health's broker checklist says the paperwork is due complete by the 15th of the month before the effective date, or the group is not accepted.

The waiting period has a federal ceiling. A group health plan may not make anyone wait more than 90 days once they are otherwise eligible, and every calendar day counts, weekends and holidays included; when day 91 lands on a weekend or holiday, coverage may start sooner. An orientation period of no more than one month, or a cumulative hours requirement of no more than 1,200 hours, may come first. Late and special enrollees are different, because the time before they enroll is not a waiting period. The draft reads the waiting period on the employer application, sets each hire date against it and the requested effective date, and lists every line that seems to run past day 90.

Eligible classes have to be about the job. Federal nondiscrimination rules name full-time or part-time status, work location, union membership, date of hire, length of service and occupation as classes that may be bona fide, and rule out any class built on a health factor. For the employer shared responsibility rules, the IRS treats someone averaging 30 hours of service a week, or 130 a month, as full-time, measured month by month or over a look-back period. The draft holds each enrollment and waiver against the classes the application defines and lists anyone who fits none of them.

State rules shape what the carrier can ask for. New Jersey's small employer rules measure participation on employees working 25 or more hours a week, leave out anyone still in a permitted waiting period, and count an employee covered through a spouse's group plan, another group plan, Medicare, Medicaid or NJ FamilyCare as taking part. The participation minimum does not apply to applications received in the employer annual open enrollment period. A carrier there may require the application with its employer certification and complete enrollment and waiver forms, may hold no more than one month's premium in advance, refunded if no plan is issued, and must answer within 15 business days; approved coverage starts no later than the first of the month after the approval notice.

Waivers and signatures carry their own rules. A plan may ask an employee who declines to state in writing that other coverage is the reason, but only if the employee was told of that requirement at or before declining, and the notice of special enrollment rights is due by the first offer to enroll. After losing other coverage, marrying, having a baby or adopting, an employee gets at least 30 days to ask in; a newborn is covered from the date of birth. Health Net's 2019 census enrollment guide for California groups adds paper rules: each enrollment form must be signed before the file is sent, and a member whose arbitration clause is unsigned or altered must not be sent at all. Once the carrier assigns the group number and sends back its setup, the draft sets plans, tiers, rates and members against the signed choices.

When your reviewer says yes, new installs over the following month or so run through the same two checks.

Your implementation lead approves every list and decides what goes back to the employer and what goes to the carrier. The AI never fills in, signs or submits a form, never enrolls anyone, never contacts an employer, an employee or a carrier, and never decides who is eligible.

Whoever judged the test goes on judging the live lists, on the success criteria agreed at the start.