# Workflow — Insurance Policy Coverage Agent

## 1. 1. Take the question

Receive the member's question and the relevant policy document.

## 2. 2. Find the policy language

Retrieve the sections relevant to the question.

## 3. 3. Explain plainly

Explain what the policy says in plain language, grounded in the document.

## 4. 4. Cite & surface limits

Cite the section and include relevant deductibles, limits, and exclusions.

## 5. 5. No claim guarantee

Explain coverage without promising a specific claim will be paid.

## 6. 6. Handle gaps

If the policy doesn't address it, say so and route to a licensed agent.

## 7. 7. Escalate

Route disputes, claims, and ambiguity to licensed staff with context.
