Analyzes and compares health insurance plans (individual vs group), calculates costs, verifies networks, and generates formatted comparison reports for decision-making
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Analyzes and compares health insurance plans (individual vs group), calculates costs, verifies networks, and generates formatted comparison reports for decision-making
version
1.0.0
author
Paragroup LLC
Insurance Plan Analyzer Skill
Purpose
This skill automates the process of comparing health insurance options, calculating total costs, analyzing coverage differences, and generating comprehensive decision reports for employees and small businesses.
When to Use This Skill
Invoke this skill when the user:
Needs to compare multiple insurance plans
Has quotes from different insurance agents or carriers
Wants to analyze individual marketplace vs. small group insurance
Compare deductibles, OOP maximums, copays across plans
Identify coverage gaps or advantages
Analyze plan types (PPO, EPO, HMO, HDH)
Evaluate network coverage
4. Special Considerations
H-1B visa holder eligibility for subsidies (affordability rule: >9.12% of income)
ICHRA (Individual Coverage HRA) setup and benefits
Doctor network verification requirements
Small group ACA compliance (owner cannot be only insured)
Pre-tax vs after-tax payment structures
5. Report Generation
Create formatted text reports for Notepad++ viewing
Generate comparison tables with proper column alignment
Provide executive summaries with clear recommendations
Include implementation timelines and next steps
Format for easy sharing with employees and stakeholders
Input Format
Required Information:
EMPLOYEE DATA:
- Name, DOB, visa status (if applicable)
- Spouse and dependent details
- Annual household income
- Current insurance (if any)
- Location (ZIP code)
QUOTE DATA:
- Carrier name
- Plan name and type (PPO/EPO/HMO)
- Monthly premium
- Deductibles (individual/family)
- Out-of-pocket maximums
- Copays (PCP, specialist, ER, etc.)
- Coinsurance split
- Employer/employee contribution split
REQUIREMENTS:
- Doctor network requirements
- Coverage effective date
- Budget constraints
- Special considerations (H-1B, ICHRA, etc.)
Output Format
Standard Comparison Report Includes:
Executive Summary with clear recommendation
Cost Comparison Table (all plans side-by-side)
Annual Savings Analysis
Coverage Details Comparison
Special Considerations (visa, tax, network)
Pros/Cons Analysis for each option
Implementation Timeline
Next Steps and Contacts
Formatting Standards:
Fixed-width text formatting for Notepad++
Tables with proper column alignment using spaces
Section headers with clear visual separators (=== lines)
Numbered lists for action items
✓/✗ symbols for quick visual scanning
⭐ symbols to highlight best options
Calculation Methods
ACA Affordability Rule:
Threshold = Household Income × 9.12%
If Employee Share > Threshold → Coverage is "Unaffordable"
If Unaffordable + Employer Sponsors H-1B → May qualify for subsidies
Employee Premium = Full Premium
Company Reimburses = X% of Premium (tax-free)
Employee Net Cost = Premium - Reimbursement
Company Cost = Reimbursement (tax-deductible)
Example Usage
Example 1: Basic Comparison
User: "I have 3 insurance quotes. Can you compare them?"
Skill: Extracts data, creates comparison table, calculates costs, recommends best option
Example 2: H-1B Subsidy Analysis
User: "My H-1B employee makes $132k. Can he get marketplace subsidies?"
Skill: Applies 9.12% rule, checks if employer coverage unaffordable, determines eligibility
Example 3: Individual vs Group Decision
User: "Should we do group insurance or individual marketplace?"
Skill: Compares costs, analyzes tax benefits, considers ICHRA, provides recommendation
Best Practices
When Analyzing Plans:
Always verify doctor network acceptance
Consider visa status implications for subsidies
Calculate both monthly and annual costs
Factor in tax benefits (pre-tax payroll vs after-tax)
Include ICHRA as an option for individual insurance
Check ACA compliance for small group plans
When Making Recommendations:
Prioritize total cost savings
Consider employee experience and ease
Evaluate tax efficiency
Account for special circumstances (visa, doctor networks)
Provide multiple options (best, good, acceptable)
Include implementation complexity in decision
Report Formatting:
Use fixed-width formatting for tables
Align columns properly with spaces (not tabs)
Keep lines under 80 characters for Notepad++ viewing
Use clear section separators
Bold recommendations with ⭐ symbols
Include contact information for next steps
Common Scenarios
Scenario 1: Small Business (2-10 employees)
Compare individual + ICHRA vs small group
Calculate minimum employer contribution (10% in NJ)
Analyze which is more cost-effective
Consider administrative burden
Scenario 2: H-1B Employee Coverage
Check subsidy eligibility (affordability rule)
Verify visa status doesn't affect coverage
Calculate with and without subsidies
Include CHIP eligibility for US citizen dependents
Scenario 3: Doctor Network Critical
Filter plans by specific doctor acceptance
Verify network status with carriers
Provide alternatives if doctor not in preferred network
Suggest doctor flexibility if significant savings available
Scenario 4: Tight Budget Constraints
Focus on lowest total cost options
Explore Bronze vs Silver vs Gold tiers
Calculate affordability impact on subsidies
Consider higher deductible plans with HSA
Key Takeaways for Users
Cost Savings Opportunities:
Individual marketplace often cheaper than small group (especially for small companies)
H-1B employees may qualify for subsidies if employer coverage "unaffordable"
ICHRA allows tax-free reimbursement of individual premiums
Pre-tax payroll deductions save ~30% in taxes
Compliance Requirements:
Small group minimum employer contribution: 10% in NJ
ACA rule: Owner cannot be only person covered in small group
H-1B subsidy eligibility: Employer must sponsor visa + coverage must be unaffordable
Decision Factors:
Total cost (not just premium)
Doctor network acceptance
Employee tax benefits
Administrative simplicity
Professional benefit image
Resources and References
Subsidy Eligibility:
ACA Affordability Percentage: 9.12% of household income (2025)
H-1B Subsidy Exception: Unaffordable employer coverage allows marketplace subsidies
NJ Small Group Requirements:
Minimum 2 employees (1 non-owner)
Minimum 10% employer contribution
Cannot exclude owner if non-owner covered
Tax Benefits:
Group insurance: Pre-tax payroll deduction
ICHRA: Tax-free employer reimbursement
Both: Employer contribution is business tax-deductible
Common Carriers:
Horizon Blue Cross Blue Shield (NJ largest)
UnitedHealthcare / Oxford
AmeriHealth
Oscar Health
Aetna CVS Health
Version History
v1.0.0 (Oct 2025): Initial release with H-1B analysis, ICHRA support, NJ small group rules
