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Health Insurance Application

Generate accurate and consistent data from any document, any layout.

Insurance Document Intelligence

The world's best health application extraction

Streamline health insurance enrollment with intelligent document processing. Extract applicant information, dependent details, and plan selections automatically. Enable faster enrollment and improved member onboarding.

health-insurance-application.pdf

Viewer

JSON

application_date

2024-03-30

application_number

HLT-APP-2024-345678

application_type

Individual & Family

plan_selected

Gold PPO 1500

effective_date_requested

2024-05-01

applicant_name

Maria Elena Rodriguez

applicant_dob

1980-07-15

applicant_ssn_last4

2345

applicant_gender

Female

applicant_address

789 Health Way, Miami, FL 33101

applicant_phone

(305) 555-0901

applicant_email

mrodriguez@email.com

applicant_citizenship

US Citizen

applicant_tobacco_use

Dependents

3 items

name

relationship

dob

ssn_last4

tobacco_use

Carlos Rodriguez

Spouse

1978-11-22

6789

Sofia Rodriguez

Child

2012-03-10

0123

Miguel Rodriguez

Child

2015-08-28

4567

coverage_tier

Family

monthly_premium

1850

plan_details

deductible_individual: 1500, deductible_family: 3000, out_of_pocket_max_individual: 6000, out_of_pocket_max_family: 12000, primary_care_copay: 25, specialist_copay: 50

current_coverage

Yes

current_carrier

Previous Health Insurance Co

reason_for_new_coverage

Open Enrollment

primary_care_physician

Dr. Ana Garcia, MD

pcp_npi

1234567890

payment_method

Bank Draft

bank_name

Florida Credit Union

routing_number_last4

6789

account_number_last4

4321

agent_name

Robert Smith

agent_npn

12345678

{ "application_date": "2024-03-30", "application_number": "HLT-APP-2024-345678", "application_type": "Individual & Family", "plan_selected": "Gold PPO 1500", "effective_date_requested": "2024-05-01", "applicant_name": "Maria Elena Rodriguez", "applicant_dob": "1980-07-15", "applicant_ssn_last4": "2345", "applicant_gender": "Female", "applicant_address": "789 Health Way, Miami, FL 33101", "applicant_phone": "(305) 555-0901", "applicant_email": "mrodriguez@email.com", "applicant_citizenship": "US Citizen", "applicant_tobacco_use": "No", "dependents": [ { "name": "Carlos Rodriguez", "relationship": "Spouse", "dob": "1978-11-22", "ssn_last4": "6789", "tobacco_use": "No"}, { "name": "Sofia Rodriguez", "relationship": "Child", "dob": "2012-03-10", "ssn_last4": "0123"}, { "name": "Miguel Rodriguez", "relationship": "Child", "dob": "2015-08-28", "ssn_last4": "4567"} ], "coverage_tier": "Family", "monthly_premium": 1850, "plan_details": { "deductible_individual": 1500, "deductible_family": 3000, "out_of_pocket_max_individual": 6000, "out_of_pocket_max_family": 12000, "primary_care_copay": 25, "specialist_copay": 50 }, "current_coverage": "Yes", "current_carrier": "Previous Health Insurance Co", "reason_for_new_coverage": "Open Enrollment", "primary_care_physician": "Dr. Ana Garcia, MD", "pcp_npi": "1234567890", "payment_method": "Bank Draft", "bank_name": "Florida Credit Union", "routing_number_last4": "6789", "account_number_last4": "4321", "agent_name": "Robert Smith", "agent_npn": "12345678"}

health-insurance-application.pdf

Viewer

JSON

application_date

2024-03-30

application_number

HLT-APP-2024-345678

application_type

Individual & Family

plan_selected

Gold PPO 1500

effective_date_requested

2024-05-01

applicant_name

Maria Elena Rodriguez

applicant_dob

1980-07-15

applicant_ssn_last4

2345

applicant_gender

Female

applicant_address

789 Health Way, Miami, FL 33101

applicant_phone

(305) 555-0901

applicant_email

mrodriguez@email.com

applicant_citizenship

US Citizen

applicant_tobacco_use

Dependents

3 items

name

relationship

dob

ssn_last4

tobacco_use

Carlos Rodriguez

Spouse

1978-11-22

6789

Sofia Rodriguez

Child

2012-03-10

0123

Miguel Rodriguez

Child

2015-08-28

4567

coverage_tier

Family

monthly_premium

1850

plan_details

deductible_individual: 1500, deductible_family: 3000, out_of_pocket_max_individual: 6000, out_of_pocket_max_family: 12000, primary_care_copay: 25, specialist_copay: 50

current_coverage

Yes

current_carrier

Previous Health Insurance Co

reason_for_new_coverage

Open Enrollment

primary_care_physician

Dr. Ana Garcia, MD

pcp_npi

1234567890

payment_method

Bank Draft

bank_name

Florida Credit Union

routing_number_last4

6789

account_number_last4

4321

agent_name

Robert Smith

agent_npn

12345678

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