Employee census files, rebuilt in each carrier's layout with every gap listed for your account manager.

Today an account manager or benefits analyst sorts the employer's rows into employees, spouses and children, fixes the date formats, fills in tiers and eligibility classes, and moves it all into each carrier's template. Then comes the email to the employer about the lines that don't add up.

In the proof of concept, AI does that first pass. It drafts each census in the target carrier's layout, with a list of every missing or suspect line and the reason. Nothing goes to a carrier or the employer. Your reviewer, whoever cleans these best, sets each draft beside the census your team actually sent.

Each carrier sets its own columns. QualChoice's small group quote form for Arkansas wants one row per person, the employee first with the spouse and each child beneath, then gender, a birth date written mm/dd/yyyy, the home ZIP code and one coverage code: EO, ES, EC with the number of children, EF, or W for a waiver. It needs no names at the quoting stage, insists on its exact column fields, and warns that missing or wrong details can make the proposed rates invalid. Florida Health Care Plans' census for groups of 2 to 50 adds county and tobacco columns, splits waivers into covered elsewhere and no other coverage, and gives every employee a status: Active, COBRA, FL-COBRA, Waiting Period or Part Time.

Ages are read on a fixed date. For small group pricing, federal rules use each enrollee's age on the date the policy is issued or renewed. A birth date has to be measured against the requested effective date, then, not the day payroll ran the export, and someone whose birthday falls between the two can price at the older age. Tobacco has a narrow definition too: use on average four or more times a week within no longer than the past six months, with religious or ceremonial use excluded. Where tobacco is rated at all, the draft carries the employer's answer as given and lists every blank.

Dependents follow federal rules, and payroll rarely shows them. A plan that offers coverage for children must offer it until age 26, whether the child is married, a student, working, living elsewhere, financially independent or eligible for other coverage. Nothing obliges a plan to cover a dependent's own child. A payroll export usually shows a deduction tier, not the people behind it, so the draft lists every family tier with no dependent rows, every child 26 or older and every grandchild, for your account manager to raise. Whether anyone stays on the plan is for the employer, the plan and the carrier to settle, never the draft.

The census is wider than payroll. New Jersey's employer certification form, posted by the state's Department of Banking and Insurance, asks for everyone who works for the employer and is paid regularly, owners, partners, officers and independent contractors included, eligible or not. It also wants people no longer working who are still covered through continuation or total disability. Each line carries a status letter: F full-time, P part-time, T temporary, I independent contractor, D totally disabled, C continuee under state or federal law, U covered through a welfare arrangement set up under a collective bargaining agreement. Former employees on continuation coverage draw no pay, so a census built from a payroll export leaves them out until someone adds them back.

Counting decides which market a group is in. Moda Health's 2017 Oregon group size form counts, month by month for the prior year, the employees who worked 130 hours or more, adds the hours of everyone below that, capped at 120 per person a month and divided by 120, and averages the result over twelve months. It leaves out sole proprietors and their spouses, partners, temporary, seasonal, leased and contract workers, retirees and former employees on continuation, and treats a controlled group under section 414 of the Internal Revenue Code as one employer. Your reviewer will watch for a waiver with no reason, a hire date after the effective date and a class the employer never defined.

Once your reviewer signs off, every new census that comes in over the next month or so goes through the same job.

Your account manager checks each draft and decides what to ask the employer and which carriers receive the file. The AI never sends a census, never contacts an employer, an employee or a carrier, and never decides who is eligible or which tier anyone belongs in.

The reviewer from the test keeps scoring live drafts against the criteria you wrote down at the start.