The summary below is a read-only view of the intake. Run the compliance check to surface required-field errors, WRAP↔POP consistency issues, and attorney-review triggers.
Full intake JSON
{
"benefit_programs": [
{
"carrier": "Atlas Health Plans",
"category": "medical",
"claims_admin": "Atlas Health Plans",
"claims_admin_phone": "717-555-0100",
"claims_admin_url": "https://example.com/atlas",
"cobra_administrator": null,
"employer_paid_full": false,
"funding": "self_funded",
"notes": "Self-funded across all PPO options",
"num_options": 4,
"option": "PPO Option 1",
"pcp_auto_assigned": null,
"pcp_required": false,
"plan_type": "PPO",
"post_tax": false,
"pre_tax_via_pop": true,
"subject_to_erisa": true
},
{
"carrier": "Northstar Dental",
"category": "dental",
"claims_admin": "Northstar Dental",
"claims_admin_phone": "717-555-0110",
"claims_admin_url": "https://example.com/northstar",
"cobra_administrator": null,
"employer_paid_full": false,
"funding": "fully_insured",
"notes": null,
"num_options": 1,
"option": "PPO",
"pcp_auto_assigned": null,
"pcp_required": null,
"plan_type": "PPO",
"post_tax": false,
"pre_tax_via_pop": true,
"subject_to_erisa": true
},
{
"carrier": "Clearview Vision",
"category": "vision",
"claims_admin": "Clearview Vision",
"claims_admin_phone": "717-555-0120",
"claims_admin_url": "https://example.com/clearview",
"cobra_administrator": null,
"employer_paid_full": false,
"funding": "fully_insured",
"notes": null,
"num_options": 1,
"option": "Standard",
"pcp_auto_assigned": null,
"pcp_required": null,
"plan_type": null,
"post_tax": false,
"pre_tax_via_pop": true,
"subject_to_erisa": true
},
{
"carrier": "Pillar Benefits Group",
"category": "std",
"claims_admin": "Pillar Benefits Group",
"claims_admin_phone": "717-555-0130",
"claims_admin_url": "https://example.com/pillar",
"cobra_administrator": null,
"employer_paid_full": false,
"funding": "fully_insured",
"notes": "Pre-tax STD premium \u2192 benefit will be taxable.",
"num_options": 1,
"option": "Group STD",
"pcp_auto_assigned": null,
"pcp_required": null,
"plan_type": null,
"post_tax": false,
"pre_tax_via_pop": true,
"subject_to_erisa": true
},
{
"carrier": "Pillar Benefits Group",
"category": "ltd",
"claims_admin": "Pillar Benefits Group",
"claims_admin_phone": "717-555-0130",
"claims_admin_url": "https://example.com/pillar",
"cobra_administrator": null,
"employer_paid_full": false,
"funding": "fully_insured",
"notes": "Pre-tax LTD premium \u2192 benefit will be taxable.",
"num_options": 1,
"option": "Group LTD",
"pcp_auto_assigned": null,
"pcp_required": null,
"plan_type": null,
"post_tax": false,
"pre_tax_via_pop": true,
"subject_to_erisa": true
},
{
"carrier": "Pillar Benefits Group",
"category": "basic_life",
"claims_admin": "Pillar Benefits Group",
"claims_admin_phone": "717-555-0130",
"claims_admin_url": "https://example.com/pillar",
"cobra_administrator": null,
"employer_paid_full": true,
"funding": "fully_insured",
"notes": null,
"num_options": 1,
"option": "Basic Life",
"pcp_auto_assigned": null,
"pcp_required": null,
"plan_type": null,
"post_tax": false,
"pre_tax_via_pop": true,
"subject_to_erisa": true
},
{
"carrier": "Pillar Benefits Group",
"category": "basic_add",
"claims_admin": "Pillar Benefits Group",
"claims_admin_phone": "717-555-0130",
"claims_admin_url": "https://example.com/pillar",
"cobra_administrator": null,
"employer_paid_full": true,
"funding": "fully_insured",
"notes": null,
"num_options": 1,
"option": "AD&D",
"pcp_auto_assigned": null,
"pcp_required": null,
"plan_type": null,
"post_tax": false,
"pre_tax_via_pop": false,
"subject_to_erisa": true
},
{
"carrier": "Pillar Benefits Group",
"category": "eap",
"claims_admin": "Pillar Benefits Group",
"claims_admin_phone": "717-555-0130",
"claims_admin_url": "https://example.com/pillar",
"cobra_administrator": null,
"employer_paid_full": true,
"funding": "fully_insured",
"notes": null,
"num_options": 1,
"option": "EAP",
"pcp_auto_assigned": null,
"pcp_required": null,
"plan_type": null,
"post_tax": false,
"pre_tax_via_pop": false,
"subject_to_erisa": true
}
],
"completed_by": {
"email": "hr@odinpetsupplies.example",
"name": "Pat Olsen",
"phone": ""
},
"created_at_utc": "2025-01-15T14:00:00Z",
"created_by": "demo@valhallaos.com",
"employer": {
"address": {
"city": "Anytown",
"state": "PA",
"street1": "200 Commerce Drive",
"street2": null,
"zip": "17000"
},
"affiliated_employers": [],
"contact_person": {
"email": "hr@odinpetsupplies.example",
"name": "Pat Olsen",
"phone": null,
"title": "Human Resource Manager"
},
"dba_name": null,
"ein": "00-0000000",
"full_time_employees": 88,
"has_collectively_bargained_employees": false,
"is_governmental_or_municipal": false,
"is_religious_entity": false,
"legal_name": "Odin Pet Supplies, Inc.",
"part_time_employees": 7,
"participating_employees": 80,
"phone": null,
"total_employees": 95
},
"intake_id": "intake_sample_001",
"intake_version": 1,
"language_accessibility": {
"non_english_languages": [],
"threshold_met": false
},
"pop_plan": {
"cash_option": {
"amount": null,
"annual": null,
"benefits_that_must_be_waived": [],
"distribution_timing": null,
"offered": false,
"period": null,
"proof_of_other_coverage_required": null,
"prorated_for_midyear": null,
"waiving_spouse_can_receive": null
},
"component_plans": [
"medical",
"dental",
"vision",
"std",
"ltd",
"basic_life",
"hsa_contributions"
],
"effective_date": "2025-05-01",
"eligibility": {
"age_requirement": null,
"effective_date_rule": "first_of_month_following_or_coinciding",
"effective_date_rule_other": null,
"length_of_service": {
"unit": "days",
"value": 30
},
"min_hours_exceptions": [
"none"
],
"min_hours_explanation_if_not": null,
"min_hours_per_week": 30,
"min_hours_same_for_all_lines": true,
"other_requirements": null,
"rehire_period": null,
"service_explanation_if_not": null,
"service_same_for_all_lines": true,
"waiting_period_waivers": [
"none"
]
},
"hsa": {
"attestation_exceptions": null,
"attestations_accurate": true,
"benecon_administered": false,
"change_frequency": "per_pay",
"employer_annual_contribution": 0,
"funding_timing_explanation": null,
"max_contribution_other": null,
"max_contribution_rule": "irs_max",
"midyear_hire_explanation": null,
"midyear_hire_full_contribution": null,
"offered": true,
"prefunded_at_start_of_year": null
},
"is_grandfathered": false,
"most_recent_amendment_date": "2025-05-01",
"open_enrollment_months": [
"April"
],
"original_effective_date": "2025-05-01",
"participation": {
"annual_election_required": false,
"required": true,
"separate_enrollment_form": false
},
"plan_year": {
"end_month": 4,
"start_month": 5
}
},
"schema_version": "0.1.0",
"wrap_plan": {
"agent_for_service_of_process": {
"name": "Pat Olsen",
"title": "Human Resource Manager"
},
"cobra": {
"all_benefits_separately_electable": true,
"hra_electable_without_medical": null,
"medical_electable_without_hra": null,
"standalone_eap_through_cobra": false,
"subject_to_cobra": true,
"type": "federal"
},
"effective_date": "2025-05-01",
"eligibility": {
"age_requirement": null,
"effective_date_rule": "first_of_month_following_or_coinciding",
"effective_date_rule_other": null,
"length_of_service": {
"unit": "days",
"value": 30
},
"min_hours_exceptions": [
"none"
],
"min_hours_explanation_if_not": null,
"min_hours_per_week": 30,
"min_hours_same_for_all_lines": true,
"other_requirements": null,
"rehire_period": null,
"service_explanation_if_not": null,
"service_same_for_all_lines": true,
"waiting_period_waivers": [
"none"
]
},
"hipaa": {
"compliance_status": "complied",
"phi_via_secure_email": true
},
"is_grandfathered": false,
"named_fiduciary": {
"address": null,
"name": "Pat Olsen",
"phone": null,
"title": "Human Resource Manager"
},
"original_effective_date": "2025-05-01",
"plan_administrator": {
"address": null,
"name": null,
"phone": null,
"same_as_sponsor": true
},
"plan_number": "501",
"plan_title": "Odin Pet Supplies, Inc. Employee Benefit Plan",
"plan_year": {
"end_month": 4,
"start_month": 5
},
"retiree_coverage": {
"dependents_covered": null,
"eligibility_requirements": null,
"lines": [],
"offered": false,
"reenrollment_after_term": null,
"remain_if_other_active_coverage": null,
"spouses_covered": null,
"termination_rule_retiree": null,
"termination_rule_spouse_dep": null
},
"spousal_exclusion": {
"applicable_benefits": [],
"type": "none"
},
"spouses_domestic_partners": {
"affidavit_annual": null,
"affidavit_required": null,
"cohabitation_duration": null,
"cohabitation_required": null,
"domestic_partners_covered": false,
"same_sex_dp_covered": null,
"same_sex_spouses_eligible": true
},
"termination": {
"explanation_if_not": null,
"same_for_all_lines": true,
"when": "end_of_month"
}
}
}