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Insurance service stages and branch acceptance catalog
Status: companion to the branching service specification. These are Atlas design requirements informed by source patterns, not universal insurance rules. Sources accessed October 7, 2026. All people, evidence, providers and financial effects are synthetic.
Common state and authoring contract
A wizard step holds a presentation boundary; a Camunda task holds an actor handoff or durable wait. Draft steps can persist before process start. Every persisted case pins compatible content/process/rule versions. Release activation validates a finite acyclic graph, reachable review, mandatory routes, unique IDs, valid bindings, supported conditions and both locales. Define comparison/membership/presence/all/any conditions as bounded data. Repeatable groups have stable row IDs and limits. No recursive graphs, scripts or arbitrary evaluator functions.
The BFF derives allowed next/back/edit routes and current step from authorized context. Record revision protects each cursor/answer update. Next, save, final submission and reviewer completion have different validation scope. Editing a routing answer invalidates later answers/evidence applicability and requires visible confirmation before discarding entered values. Final attestation binds the current normalized packet, pinned release and revision; editing afterwards invalidates attestation.
For each branch ID below, acceptance evidence must cover trigger, skip, Back/correction changing the trigger, save/resume, English/Spanish parity, unauthorized/stale requests and applicable missing-evidence/request-information recovery. Validate the *next authorized screen and eventual owner outcome*, not merely a branch flag. Capture a real-engine representative route for each product and a matrix of focused branch cases.
Life insurance
Stages: Identify insured/owner → coverage → beneficiaries → current coverage → health screening → authorizations → review → underwriting.
- L01 owner differs from insured: relationship and synthetic authority.
- L02 multiple primary/contingent beneficiaries: repeatable classes with allocation check.
- L03 replacement or use of existing policy values: prior-policy detail and acknowledgment.
- L04 health/tobacco/activity disclosure: condition/treatment/provider detail and EOI.
- L05 requested group coverage triggers fixture EOI: subject-specific disclosures.
- L06 missing records/exam: same-case evidence request.
- L07 death claim: reporter versus beneficiary versus representative with separate claimant packet and authority evidence.
Boundary: Initial application and death claim are distinct journeys. No draft or EOI automatically changes coverage. Positive health answers route to review, never automatic denial.
Evidence anchors: Protective application, MetLife EOI, New York Life claim. Full source and edition limitations are in the research notes.
Medicare supplement
Stages: Residence/identity → Medicare dates → current coverage → asserted enrollment route → route-specific evidence/health → fictional plan → replacement acknowledgment → review.
- M01 asserted initial Medigap enrollment: verify dates using synthetic fixture.
- M02 guaranteed-issue/state protection/under-65 assertion: reason/event/notice and reviewer verification.
- M03 underwritten route: health details.
- M04 replacement: prior insurer/plan/dates and acknowledgment.
- M05 current Medicare Advantage: coordination review.
- M06 missing Part B date or proof: save and targeted information task.
Boundary: Medigap initial open enrollment is distinct from annual Medicare enrollment. Atlas does not determine real protections or direct users to cancel old coverage. Premium preference reuses separate simulated payment owner.
Evidence anchors: Medicare buying Medigap, Medicare changing policies. Full source and edition limitations are in the research notes.
Disability income
Stages: Policy/employment → work interruption → cause/treatment → occupation/income → contributor evidence → declarations → review → continuing/RTW update.
- D01 continuous versus intermittent: dates or repeatable absence intervals.
- D02 injury/pregnancy/illness: applicable incident or delivery/treatment details.
- D03 recurrence: related-case reference and changed facts.
- D04 other-income applied versus awarded: receipt versus decision evidence.
- D05 group employer contribution: payroll/work duties separate from clinician statement.
- D06 resumed part-time work: earnings period/hours and separate RTW review.
- D07 extension: changed period/treatment/evidence with same-case review.
Boundary: Employer leave approval and insurer benefit approval remain distinct. Clinician contributions are simulated records/documents, with no new real-provider portal. Manager projections exclude diagnoses, medical documents and bank data. Existing >14-day fixture branch remains labeled fictional.
Evidence anchors: Guardian STD instructions, The Standard LTD packet. Full source and edition limitations are in the research notes.
Dental
Stages: Policy/patient → transaction purpose → provider/service lines → procedure detail → other coverage → evidence → review → synthetic benefit breakdown.
- N01 pretreatment estimate versus completed treatment: estimate is not a claim/payout.
- N02 dependent patient: authorized relationship.
- N03 repeated procedures: stable line IDs, dates, synthetic category/fees.
- N04 prosthetic replacement: prior placement and missing-tooth detail.
- N05 orthodontic: appliance date and treatment plan.
- N06 accident: event details.
- N07 other coverage/secondary payer: prior EOB and amounts.
- N08 targeted procedure attachment or unreadable-image correction: same-case line-specific evidence.
Boundary: Use synthetic procedure categories rather than copy a copyrighted CDT catalog. Existing dental scope records benefit usage once and has no separate disbursement. Estimate is an explicitly new simulated review variant, not a binding quote.
Evidence anchors: ADA form hosted by Sun Life, Sun Life submission tips. Full source and edition limitations are in the research notes.
Long-term care
Stages: Insured/authority → care need → setting/provider → assessment preparation → care plan/eligibility review → expense period → reviewer outcome → later invoices/reassessment.
- C01 representative: separate authority and permission evidence.
- C02 ADL assistance versus cognitive support: assessment-specific questions.
- C03 home agency/independent caregiver/facility/adult day care: setting-specific provider contribution.
- C04 related caregiver: manual fixture-policy review.
- C05 eligibility confirmed but invoices/wait conditions outstanding: eligible-not-payable state.
- C06 independent caregiver invoice: daily tasks/hours/rate/certification.
- C07 facility invoice: period/confinement evidence.
- C08 move/hospitalization/changed care/recovery: reassessment or closure, not duplicate original claim.
Boundary: No universal ADL threshold, waiting period or family-care exclusion is inferred. Server fixtures identify any supported limit. Insured eligibility, provider eligibility and payable expenses are separate owner decisions. Unknown payment blocks another effect.
Evidence anchors: Genworth assessment, Genworth initial eligibility, Genworth payments. Full source and edition limitations are in the research notes.
Annuities
Stages: Contract/owner → request category → amount/schedule or service change → authority → payout/withholding if financial → impact/consent → review/MFA → servicing outcome.
- A01 partial withdrawal versus surrender: amount versus explicit closure-impact confirmation.
- A02 recurring establish/change/stop: schedule, changed fields, or stop skipping amount setup.
- A03 qualified-contract assertion: requested RMD-review context without real tax calculation.
- A04 new bank/joint owner/representative: approved authority and synthetic bank evidence.
- A05 waiver assertion: reason/evidence/manual contract review.
- A06 beneficiary/contact servicing: exact before/after values and applicable class allocations/authority.
- A07 financial effect: fresh server-verified MFA/current eligibility, reservation and uncertainty reconciliation.
Boundary: No tax recommendation, guarantee requirement or carrier charge becomes an unlabeled Atlas rule. Beneficiary change does not transfer contract ownership. New banking setup does not authorize withdrawal. All money effects remain simulated and require #98 mitigation.
Evidence anchors: Fidelity recurring withdrawal form, Fidelity beneficiary form. Full source and edition limitations are in the research notes.
Explicit deferrals and fixture choices
External clinician/provider portals, legal appeal deadlines, real signature guarantees and independent statutory appeal processes are deferred. Simulated contributor evidence and a reviewer information loop are sufficient for this prototype. A later appeal journey requires its own spec; it is not silently bundled into these wizards.
New variants included here are life death claims, dental pretreatment review, continuing care periods, annuity recurring distributions and beneficiary/contact servicing. Each needs its own complete tracer bullet and fictional fixture contract. Keep current core balance/benefit limits and distinguish accepted owner rules from newly proposed scenario choices. Existing records remain on their compatible releases.
Research and code inventory