Health Insurance

## Setup On first use, read `setup.md` for integration guidelines and memory initialization. ## When to Use User needs help choosing, comparing, or renewing health insurance coverage. Agent evaluates medical usage patterns, estimates yearly costs across plan types, and recommends a plan strategy with clear trade-offs. ## Architecture Memory lives in `~/health-insurance/`. See `memory-template.md` for structure. ``` ~/health-insurance/ ├── memory.md # Status, profile, preferences, active decisions ├── comparisons/ # Plan comparisons and scenario snapshots ├── renewals/ # Renewal timelines and action logs └── notes/ # Follow-up questions and pending documents ``` ## Quick Reference | Topic | File | |-------|------| | Setup process | `setup.md` | | Memory template | `memory-template.md` | | Coverage framework | `coverage-framework.md` | | Annual cost modeling | `cost-model.md` | | Comparison checklist | `comparison-checklist.md` | | Enrollment and renewal playbook | `enrollment-playbook.md` | ## Core Rules ### 1. Lock Decision Context First Before comparing plans, clarify: - Coverage target: individual, couple, or family - Source: employer plan, public marketplace, private broker, or government program - Geography and provider access requirements - Hard constraints: budget ceiling, medication continuity, renewal deadline ### 2. Build a Real Utilization Profile Estimate expected care load before discussing premiums: - Routine care frequency (primary care, specialist, urgent care) - Ongoing prescriptions and refill cadence - Known procedures, therapies, or recurring diagnostics - Worst-case risk profile for unexpected events ### 3. Compare Plan Mechanics Before Price Always evaluate these mechanics before deciding on monthly premium: - Network fit for current clinicians and facilities - Deductible, out-of-pocket max, and coinsurance structure - Copay design by care type (primary, specialist, urgent, emergency) - Referral and prior-authorization friction for expected treatments - Prescription formulary coverage for required medications ### 4. Model Yearly Cost With Scenarios Use `cost-model.md` to calculate low, expected, and high-use annual totals. Include premium, deductible exposure, copays, coinsurance, and non-covered risk. Recommend using expected-cost and downside-risk together, not premium alone. ### 5. Protect Against Coverage Failure Modes Run a risk check before final recommendation: - Out-of-network emergency and balance-billing exposure - Drug tier surprises and step-therapy limitations - Referral bottlenecks that delay care - High deductible plans that look cheap but shift excessive risk ### 6. Execute Enrollment With Evidence Use `enrollment-playbook.md` to define exact actions, deadlines, and proof artifacts. Store plan IDs, effective dates, and support contacts for appeal or billing disputes. Never claim enrollment is complete without confirmation evidence. ### 7. Persist Data Only With Explicit Approval Before writing to `~/health-insurance/memory.md`, ask for explicit confirmation. Store only durable insurance context the user wants remembered for future decisions. ## Common Traps - Choosing by monthly premium only -> hidden total annual cost becomes unaffordable. - Ignoring provider network fit -> forced provider changes and unexpected out-of-network bills. - Skipping formulary checks -> medication cost spikes after enrollment. - Assuming all PPO or HMO plans behave similarly -> referral and authorization surprises. - Treating deductible and out-of-pocket max as equivalent -> underestimating downside risk. - Missing enrollment deadlines -> delayed coverage or locked plan options. ## External Endpoints This skill makes NO external network requests. | Endpoint | Data Sent | Purpose | |----------|-----------|---------| | None | None | N/A | No data is sent externally. ## Security & Privacy **Data that leaves your machine:** - Nothing. This skill is instruction-only and local by default. **Data stored locally:** - Insurance profile and comparison context explicitly approved by the user. - Stored in `~/health-insurance/memory.md`. **This skill does NOT:** - Access insurer or broker APIs automatically. - Submit enrollment forms or claims without user direction. - Read files outside `~/health-insurance/` for storage. - Write memory without explicit user confirmation. - Modify its own core instructions or auxiliary files. ## Trust This is an instruction-only skill focused on structured health insurance decisions. No credentials are required and no external service access is needed. ## Related Skills Install with `clawhub install <slug>` if user confirms: - `health` — health planning context that informs insurance priorities - `doctor` — provider interaction planning and visit preparation - `compare` — structured side-by-side decision frameworks - `money` — budgeting and cash-flow planning for premium and out-of-pocket costs ## Feedback - If useful: `clawhub star health-insurance` - Stay updated: `clawhub sync`