Detailed process
0Lead intake — zero knowledge
ZERO
Goal: Open a case with identity and loan context only; no medical claims yet.
Data to capture / use
- Name, phone, email
- State of residence
- Lead source (dialer/CRM/mortgage desk)
- Approximate loan balance / closing date if known
Platform / knowledge actions
- Create ApplicantProfile shell
- Do not run disease modules yet
- Flag case as intent-unknown until Step 1
Agent may say: Thanks for speaking with me — I’ll ask a few questions so we can see which mortgage protection options may fit before we apply anywhere.
Exit gate: Contactable person + state known.
1Lock insurance intent
INTENT
Goal: Confirm this case is mortgage protection (not FE or medical health).
Data to capture / use
- intent = mortgage_protection
- Who to cover: primary | spouse | both
- Desired face ≈ loan balance
Platform / knowledge actions
- Load mortgage SI dataset + SI/Graded BMI chart
- Hide Fully UW Preferred-only questions
- Attach vertical process checklist
Agent may say: We’re looking at coverage that can help protect the home loan if something happens to you — not a medical insurance plan.
Exit gate: Intent saved; coverage_on_whom set.
2Core demographics & loan facts
DATA
Goal: Enough non-medical data to size the case.
Data to capture / use
- DOB/age, sex
- loan_balance, loan_term_years
- property_state if different
- co_borrower_flag
Platform / knowledge actions
- Compute suggested face amount
- Age-band eligibility for SI products
- Trigger spouse branch if co-borrower
System does: Validates face vs typical SI max by age.
Exit gate: Age + loan_balance present.
3Build (BMI) + tobacco
DATA
Goal: Assign SI build class and nicotine class.
Data to capture / use
- height, weight → BMI
- tobacco products + months since last use
- vape/e-cig if any
Platform / knowledge actions
- Map to SI Level / Graded / over-max
- Set nicotine_class
- Stacking preview if high build + tobacco
Agent may say: I just need height, weight, and tobacco use — this helps match build guidelines carriers use for simplified coverage.
Exit gate: BMI computed; tobacco answered.
4Disease interview — build medical knowledge
KNOWLEDGE
Goal: Move from zero medical knowledge to complete SI disclosure profile.
Data to capture / use
- Heart, diabetes, cancer, kidney, lung, disability, mental (as needed)
- Module attributes: dates, insulin, recurrence, oxygen, SSDI
Platform / knowledge actions
- Drive questions from disease dossiers
- Store impairments[].attributes
- Stop early only if hard GI-only pattern and client wants speed — still record disclosures
Agent may say: I’ll ask health questions the same way carriers do on simplified apps — please answer fully so we don’t waste an application.
Exit gate: All R disease paths for mortgage SI completed or explicitly none.
5Spouse / income (when needed)
KNOWLEDGE
Goal: Complete household and affordability knowledge.
Data to capture / use
- If joint: spouse age/sex/tobacco (+ short health if covering spouse)
- annual_income (sanity)
- beneficiary relationship
Platform / knowledge actions
- Mark spouse profile linked or separate case
- Face vs income warning if extreme
Exit gate: Spouse fields done if co-borrower; beneficiary known.
6Decision engine — soft UW knowledge complete
DECISION
Goal: Produce explainable offer family before any carrier app.
Data to capture / use
- None new — use prior profile
Platform / knowledge actions
- Run DecisionResult: si_level | graded | gi | postpone | decline
- reasons[] + drivers[]
- suggested_next_step
System does: Knowledge is now complete enough for agent coaching — not a binding offer.
Exit gate: DecisionResult persisted with reasons.
7Carrier shortlist (rulesets)
MATCH
Goal: Map complete profile to appointed carriers.
Data to capture / use
- Agency appointments list (system/config)
Platform / knowledge actions
- Evaluate CarrierRuleset[] for mortgage_si
- Rank Level → Graded → GI
- Exclude non-appointed
Exit gate: ≥1 viable path or clear ‘no SI — postpone’.
8Induct human agent — sale briefing
AGENT
Goal: Hand licensed agent a complete case pack to run the sale conversation.
Data to capture / use
- None new — use prior profile
Platform / knowledge actions
- Generate agent brief: profile summary, DecisionResult, carrier shortlist, disclosure script, missing fields
- Assign agent / open dialer wrap-up
Agent may say: Based on what you shared, simplified level coverage may / may not fit; here’s what I recommend we apply for and why — final decision is always the carrier’s.
Exit gate: Agent acknowledges brief; client call/meeting scheduled or live.
9Client close conversation & disclosures
SALE
Goal: Honest disclosure, product choice, premium quote via carrier tool, consent to apply.
Data to capture / use
- Client product choice
- Premium mode
- Replacement questions if any
- E-sign consent
Platform / knowledge actions
- Deep-link carrier e-app / quote
- Freeze interview snapshot for audit
- Log disclosures affirmed
Exit gate: Client agrees to apply to named carrier/product.
10Application submission
SALE
Goal: Submit accurate app matching captured knowledge.
Data to capture / use
- SSN/ITIN as required by carrier
- Bank/draft info if TDO
- ID verification if required
Platform / knowledge actions
- Pre-fill from ApplicantProfile
- NIGO checklist before submit
- Store confirmation #
Exit gate: App submitted / confirmation received.
11Issue, delivery, sale complete
COMPLETE
Goal: Policy issued or graded/GI waiting period explained; client has coverage path.
Data to capture / use
- Issue status
- Delivery requirements
- First premium posted
Platform / knowledge actions
- Update case status issued|pending|declined|withdrawn
- If decline: reopen Graded/GI path from same profile
- Notify agent + agency
Agent may say: Your policy is issued / pending — here’s what happens next and how the mortgage protection works.
Exit gate: Issued + delivered OR documented next path; case closed successfully.