Coverage Guidance Agent
Recommends best-fit health insurance plans through smart, need-based dialogues
Description
Challenge:
Choosing the right health insurance plan is often overwhelming for customers due to jargon-heavy terms, unclear benefits, and difficulty comparing options. Static comparison tools fail to consider individual needs, such as life stage, existing conditions, location, or budget. This leads to poor plan selection, underinsurance, or post-purchase dissatisfaction. The Virtual Insurance Advisor solves this by acting as an intelligent guide—capturing user preferences and matching them to suitable plans using personalized logic and real-time policy data.
How It Works:
The agent engages users via conversational prompts to gather information on age, family composition, health history, lifestyle habits, budget, and coverage preferences. It taps into the Insurer's Plan Repository, Premium Calculator, and Benefits Matrix to shortlist suitable plans. Using rule-based and ML-driven scoring, it ranks plans by relevance—highlighting features like OPD cover, maternity benefits, waiting periods, or room rent caps. The agent also addresses FAQs, explains terms, and guides users on next steps—buy online, request call-back, or download brochure. Recommendations are dynamically updated if user inputs change.
Benefits:
Reduces plan selection time from hours to under 5 minutes.
Increases likelihood of right-fit plan purchase by 3.5x.
Delivers 90–95% match accuracy based on customer preferences.
Simplifies complex insurance terms with contextual explanations.
Improves conversion rates through guided and confident decisions.
Captures lead data for follow-ups and remarketing.
Features
The Virtual Insurance Advisor offers interactive, intelligent plan recommendation through personalized questioning and backend integration. It removes guesswork from insurance selection, empowering users to make informed choices with clarity and speed.
Features & Capabilities:
Personalized Needs Assessment: Captures lifestyle, family, and financial inputs through natural dialogues.
Real-Time Plan Matching: Shortlists plans based on user input and predefined product rules.
Benefit Highlights: Explains plan features—OPD, critical illness, day-care coverage—in layman terms.
Premium Calculator Integration: Shows estimated premiums dynamically based on sum insured and add-ons.
Exclusion Awareness: Flags common exclusions or waiting periods relevant to the user’s profile.
Multilingual Support: Enables insurance guidance in local languages.
Compare Plans Side-by-Side: Visual comparison of premiums, features, and limits across options.
Save & Revisit Option: Lets users save recommendations or email them for later review.
FAQ & Policy Glossary Integration: Clarifies terms like co-pay, no-claim bonus, or restoration benefits.
Lead Capture & Conversion Guidance: Offers call-back, online purchase, or advisor chat handoff.
Eligibility Logic
Decision Logic Flow:
This agent applies structured filtering and scoring rules to match user needs with the most relevant insurance plans. It balances user inputs with business priorities, ensuring both suitability and profitability.
Key Logic Pathways Followed:
Age & Life Stage Mapping: → Determines whether individual, floater, or family plan is ideal
Health History Evaluation: → Flags needs for critical illness or pre-existing disease riders
Budget Band Fitment: → Filters plans that exceed stated monthly/yearly premium affordability
Coverage Priorities Identification: → Scores plans that offer maternity, OPD, or specific hospitalization benefits
Waiting Period Consideration: → Highlights policies with lower waiting times for pre-existing diseases
Sum Insured Recommendation: → Suggests sum insured based on income, dependents, and urban/rural risk exposure
Location-Based Preferences: → Recommends plans with better hospital tie-ups in user's city
Exclusion Pattern Matching: → Avoids plans that exclude coverage for user-declared risks
Language & Support Preference: → Suggests plans backed by customer service in user's preferred language
Purchase Channel Prompting: → Offers digital vs. advisor-led options depending on user confidence level
