For HR Teams
How Ben AI works for HR Teams
From plan setup to enrollment completion — everything automated, nothing manual.
For HR Teams
From plan setup to enrollment completion — everything automated, nothing manual.
AI Plan Setup
Upload a Summary of Benefits and Coverage as a PDF. The AI engine reads every field — deductibles, out-of-pocket maximums, copays, coinsurance, Rx tiers, and rate tables — then structures them into plan data with confidence scores for each extraction.
No data entry. No spreadsheet mapping. Review the extracted values, adjust any low-confidence fields, and publish.
SBC Documents
Summary of Benefits
Rate Sheets
Census Files
SPD Booklets
Enrollment Management
Configure your enrollment period once — dates, eligibility rules, contribution strategies, waiting periods — and the platform handles everything. Real-time tracking shows exactly where every employee stands.
Open Enrollment Progress
Acme Corp — 2026 Benefits Enrollment
0%
132 of 156 enrolled
Automatically determines who is eligible based on employment status, hire date, hours worked, and waiting periods. Handles new hires, rehires, and status changes.
Define employer contributions by plan, tier, salary band, or department. Supports flat dollar, percentage, defined contribution, and composite rating models.
Employees who don't make active elections are automatically renewed into their current plans. Changed rates and new plan mappings are handled without HR intervention.
AI-Powered Employee Guidance
No extra cost. No scheduling. No hold queues. Every employee in your organization gets access to Ben — an AI benefits coach that guides them through enrollment with personalized recommendations based on their actual health profile.
The result: higher enrollment completion, fewer HR tickets, and employees who are confident they picked the right plan.
The AI engine recommends plans based on each employee's actual health data — age, family size, medications, planned procedures, and prior-year claims. Not generic advice. Personalized math.
Employees can talk through their options in plain language. The AI voice coach listens, navigates the enrollment screen, selects plans, and completes elections — all while the employee watches.
Employees see exactly how each plan choice hits their take-home pay — per paycheck, not annual. Deductions are calculated with their actual pay frequency, tax bracket, and pre-tax elections.
The AI explains WHY it recommends each plan — in plain English, not insurance jargon. Employees understand the trade-offs and feel confident in their choice.
Before & After AI-Guided Enrollment
Measured outcomes across 50+ employer groups
Enrollment completion rate
Before
64%
With Ben AI
94%
Avg. time to complete
Before
35min
With Ben AI
8min
HR support tickets during OE
Before
340%
With Ben AI
45%
Employees confident in choice
Before
38%
With Ben AI
89%
HR Test Mode
What if you could rehearse open enrollment as many times as you want — and shape the experience for your employees — before going live?
No engineering tickets. No prompt files. No consultants. Just you, Ben, and a stage.
The journey · three stages
01
HR sees what employees see
Every screen. Every Ben prompt. Every decision point. You experience the enrollment end-to-end, exactly as your employees will.
02
feedback chat in real-time
“Slow down.” “Use ‘health plan’ instead of ‘medical.’” “Skip the surgery question.” Ben categorizes your feedback and applies it on the spot.
Slow down a bit.
Applied
Got it. Pacing adjusted.
Use “health plan”
Applied
Updated throughout.
03
approve and go live
When it sounds like you, click Approve & Launch. Your tuned experience goes live for every employee — not a single line of code changed.
“It’s the first time HR has had this much control
before going live.”
Priya Sankar · Benefits Manager, Helios Health
Per-Employer Customization
Every company is different. Ben should be too.
HR can train Ben to match your culture — the language you use, the pace your employees prefer, the topics that matter, the questions to skip. Same code, different behavior. Ben sounds like a coworker who already understands your company.
Formal or casual. Plain English or industry shorthand. “Health plan” or “medical insurance”. Ben matches your workplace voice.
Quick and decisive for engineers, thorough and educational for new grads. Ben adjusts how much he explains and how fast he moves.
Skip questions that don’t fit your culture. Highlight benefits employees actually use. Avoid jargon that confuses your population.
Context-Aware Greetings
Ben knows whether it’s open enrollment, new hire eligibility, or a qualifying life event — and greets each employee accordingly. No generic intros.
“Congratulations Sarah — you qualify for benefits at Acme as of April 1, 2026. Let’s walk through your options.”
“It’s open enrollment time at Acme. I’ll show you what’s changed and help you decide if your current plan is still the right fit.”
“I see you’ve had a qualifying life event. You have 30 days to update your coverage. Let’s figure out what changes make sense.”
Billing & Reconciliation
Monthly premium billing is generated automatically with pro-rating for mid-month changes. When carrier invoices arrive, the AI reconciliation engine compares every line item to your enrollment data and flags discrepancies — missing employees, rate mismatches, retroactive adjustments.
Enrollment Data
Elections finalized
Premium Calc
Pro-rated billing
Carrier Invoice
AI reconciliation
Discrepancy Check
Flagged variances
Payroll File
ADP / Paychex / Gusto
The reconciliation engine compares your enrollment records to carrier invoices line by line. It identifies rate variances, missing members, duplicate charges, and retroactive adjustments — then generates a resolution report.
Mid-month enrollments, terminations, and plan changes are pro-rated automatically. The platform tracks effective dates down to the day and calculates partial-month premiums based on carrier billing rules.
Track outstanding balances by carrier, payment due dates, and payment history. The platform generates remittance reports and flags overdue payments before they trigger coverage lapses.
Generate payroll deduction files in the format your payroll provider expects — ADP, Paychex, Gusto, and generic CSV. Pre-tax, post-tax, and Roth deductions are categorized automatically.
EDI 834 & Carrier Connectivity
Upload a carrier's EDI requirements and the AI engine configures the connection — field mapping, loop structure, segment qualifiers, and transmission protocol. No EDI expertise required.
834 files are generated and transmitted on your schedule. When carriers send back 999 acknowledgments, the platform processes accepted and rejected transactions and surfaces issues that need attention.
Upload carrier spec sheet
AI maps fields to 834 loops and segments
Configures SFTP credentials and schedule
Validates test file before go-live
Full-file and change-only modes
Supports all transaction types (enrollment, termination, change)
Dependent and beneficiary data included
Audit trail for every file sent
Automatic acknowledgment ingestion
Accepted transactions marked complete
Rejected transactions flagged with error codes
Retry queue for failed transmissions
Compliance Automation
Benefits compliance is complex — ACA reporting, COBRA administration, ERISA filings, nondiscrimination testing, and 50-state mandates. The platform tracks every obligation and generates the filings so your team never misses a deadline.
Compliance Calendar
2026 Key Deadlines — Auto-tracked
JAN
31
ACA W-2 reporting deadline
ACAFEB
28
1095-C distribution to employees
ACAMAR
31
1094-C / 1095-C electronic filing
ACAAPR
15
Section 125 plan year begins (common)
ERISAJUL
31
Form 5500 filing deadline
ERISASEP
30
PCORI fee payment due
ACAOCT
15
Medicare Part D creditable coverage notice
CMSNOV
01
Open enrollment period begins (typical)
OEFull-time equivalent (FTE) tracking by month
Affordability testing against federal poverty line and W-2 safe harbors
1094-C and 1095-C generation with IRS-ready formatting
Measurement, stability, and administrative period management
Qualifying event detection from employment status changes
Automated notice generation (initial, election, early termination)
Premium tracking with 2% admin fee calculation
Payment deadline monitoring and coverage lapse warnings
Summary Plan Description (SPD) distribution and tracking
Form 5500 data preparation with schedule attachments
Section 125 plan document generation and amendments
Summary of Material Modifications (SMM) when plans change
Section 125 nondiscrimination testing (eligibility, benefits, key employee)
Cafeteria plan concentration testing
50-state mandate tracking with automatic plan design validation
Regulatory change monitoring with impact alerts
Reporting & Analytics
Every report HR teams run regularly is built in — enrollment summaries, billing reconciliation, ACA compliance, census data, claims analytics, and more. Export to Excel, PDF, or schedule automated delivery.
Need something custom? The AI report builder lets you ask in plain English — “Show me enrollment by department for employees hired in the last 12 months who selected the Gold PPO” — and it generates the query, runs it, and formats the results.
Enrollment Summary
Elections by plan, tier, and department
Enrollment Changes
QLE and mid-year modifications
Premium Billing
Monthly premiums by employee and plan
Carrier Reconciliation
Discrepancies between billed and invoiced
ACA Compliance
FTE counts, affordability, 1095-C status
COBRA Administration
Qualifying events, elections, payments
Census & Eligibility
Active employees with benefit eligibility
Dependent Audit
Dependent verification and documentation
Claims Analytics
Utilization trends and cost drivers
Cost Projections
Renewal modeling and budget forecasting
Employee Engagement
Enrollment completion and AI usage metrics
Payroll Deductions
Per-pay-period deduction reconciliation
AI Report Builder
Ask in plain English, get a report
“Show me employees in Engineering who selected HSA plans and their average contribution rate”
Generated report
| Employee | Plan | Tier | Contribution |
|---|---|---|---|
| J. Martinez | Bronze HSA 3000 | EE+SP | $3,850 |
| K. Chen | Bronze HSA 3000 | EE | $4,150 |
| R. Okafor | Silver HSA 2000 | EE+CH | $2,900 |
| L. Park | Bronze HSA 3000 | EE | $4,150 |
Avg. contribution: $3,762/year across 4 Engineering HSA enrollees
Security & Privacy
Benefits data includes protected health information, Social Security numbers, and compensation details. Ben AI is built with HIPAA-compliant architecture from the ground up — not bolted on after the fact.
PHI is encrypted at rest (AES-256-GCM) and in transit (TLS 1.3). Minimum necessary access principle enforced across every API endpoint. BAAs being signed with covered subprocessors.
Field-level encryption for Social Security numbers and sensitive identifiers. Encryption keys are rotated on a 90-day schedule. All PHI access is logged to an immutable audit trail.
Fine-grained permissions by role — super admin, TPA admin, broker, employer admin, HR manager, and employee. Each role sees only the data and actions they need.
Every access to PHI, every election change, every admin action is logged with user attribution, timestamp, and IP address. Immutable audit trail with 7-year retention for HIPAA and ERISA compliance.
New in 2026
Compliance
14 real-time monitors that flag issues before they become violations. ACA hour thresholds, dependent aging, COBRA deadlines, nondiscrimination risk — all watched continuously.
J. Martinez approaching 30 hrs/wk
2 hrs ago
Emma Johnson turns 26 in 6 months
Today
COBRA election deadline in 3 days
Urgent
Billing
Detects discrepancies between your enrollment and carrier invoices — then generates corrective 834 files automatically.
Analytics
Compare your enrollment patterns against industry benchmarks. Actionable insights, not just data.
Reach
SMS enrollment for deskless workers. Phone for those who prefer a call. Voice AI in the browser. Text chat. Spouse portal.
See how Ben AI replaces manual enrollment workflows with AI-powered automation. Book a demo with your actual plan data.