Fit guidelines - Prescience Partner API

Share this page with the advisors who decide which clients get a Prescience quote. The MCP server’s fit_check tool applies the same criteria, and the agent README and the Fit guidelines tab of the partner portal repeat them.

When to quote Prescience

Criterion	Guideline
Metal tier	The client is quoting gold or platinum, or wants rich benefits. Prescience Diamond has the richest coverage with the lowest member out-of-pocket costs; Prescience Value has a lower price with a higher member out-of-pocket maximum.
State	California is a strong state. New Jersey is workable. Other states have not been confirmed as strong; a quote shows whether the market comparison holds.
Group size	5 to 50 employees is the best range. Under 5 employees is a poor fit. Over 200 employees goes to Prescience underwriting review before the quote is final.
Funding	Group plans only. An ICHRA is not a fit.
PEO	A PEO plan on a first-year teaser rate is a poor fit, because a first-year rate is hard for any quote to beat. A PEO plan past its first year can fit.

What `fit_check` returns

fit_check takes what you know about the client (state, employees, currentPlanMetal, currentFunding, quotingMetals, peoFirstYear) and returns fit and reasons. Every input is optional, and details you leave out are not held against the group.

`fit`	When
`poor`	A criterion rules the group out: an ICHRA, a first-year PEO plan, or under 5 employees.
`strong`	Nothing counts against the group and at least one thing counts for it.
`possible`	Anything else, including when nothing was given.

currentFunding is one of fully_insured, level_funded, peo or ichra.

Fit flags on a quote

Each plan in a quote also carries fit_flags, computed from the group’s census and the quote’s numbers. Check them before you present a plan:

Flag	Meaning
`savings_under_6pct`	Annual savings against the benchmark are at least 0% and under 6%.
`benchmark_cheaper`	The benchmark plan costs less a year than this version.
`worst_year_above_benchmark_premium`	The modeled worst year is above the benchmark’s annual premium.
`group_under_5`	The group has fewer than 5 employees.
`group_over_200`	The group has more than 200 employees.
`benchmark_not_cheapest`	The plan was compared with a platinum PPO other than the cheapest. The plan is `in_review`.
`below_margin_floor`	Value only. The plan is `in_review`.
`in_review`	The version is subject to Prescience underwriting review.

Final pricing, eligibility and network are confirmed during underwriting and onboarding.