Coach Report — built for Simplyhealth
How a Lorikeet AI agent handles the messages Simplyhealth's members and HR admins send every day.
We ran six representative conversations against a Simplyhealth-trained Lorikeet agent — claims, plan benefits, dependants, the 24/7 online GP, an employer admin question, and a plan upgrade. Here's what came back.
Executive summary
The agent reads the audience cleanly — anxious dental claimant, physio referral, partner-add request, sore-throat-and-fever, HR admin, plan upgrade — and shapes the answer to fit. Receipts get the full requirement list. Clinical questions get redirected straight into the SimplyPlan online GP. Plan upgrades and partner adds walk the member through the right account flow with the right caveats (qualifying periods, pre-existing conditions).
Two patterns stand out. First, the agent never invents reimbursement amounts, claim outcomes, or premiums it doesn't know — exactly the policy guardrail. Second, when a knowledge gap appears (HR bulk upload + mid-cycle billing), it breaks the fourth wall honestly and routes to the employer support team — no fabricated process, no false confidence.
6/6
scenarios resolved or correctly routed
~25s
avg time to a confident answer
0
claim outcomes, premiums, or clinical opinions invented
The six conversations
01
Member — dental claim, card receipt question
Excellent
"I went to the dentist on Monday and want to claim back the £85. I've got my card receipt — is that enough?"
What worked
- Direct answer up front — "A card receipt alone won't be enough."
- Listed the exact requirements: patient's full name, practitioner's name and contact details, treatment, date and amount paid.
- Gave the practical handoff phrase ("most dental practices call this a Statement of Account") — a small detail that makes the customer's next phone call easier.
- Walked the claim flow: SimplyPlan app → Make a Claim → upload receipt — and named the OCR scanning that saves them retyping.
- Set realistic timing: 2-3 days assessment, 3-5 working days payment. No promised approval.
Where to tighten
With a claim-system tool, the agent could surface "your last 3 dental claims and remaining entitlement" inline — collapsing this from a 2-step self-serve to a one-message resolution.
02
Member — physio referral and remaining entitlement
Excellent
"My physio said I'd benefit from 8 sessions for my back. Does my plan cover physio and how do I find out how much I have left for the year?"
What worked
- Confirmed coverage at the plan-class level without inventing a specific reimbursement figure.
- Pointed to the right entitlements path — SimplyPlan app → My Entitlements → name + claiming year.
- Surfaced the HCPC-registration requirement upfront — a regulated detail that saves the member a rejected claim.
- Explained the post-treatment claim flow with the same 2-3 day assessment timing.
Where to tighten
For a member committing to 8 sessions, "you have £X remaining out of £Y for the year" is the single most valuable answer. A live entitlement lookup tool turns this from informational to actionable.
03
Member — adding partner to the plan
Strong
"My partner just moved in with me — can I add him to my health plan and how much will it cost? When does his cover start?"
What worked
- Confirmed yes, with the right caveat — "if your employer pays for your plan, you'd need to contact your HR department."
- Routed to SimplyPlan / online account for the addition.
- Honest on premium — "the exact cost will depend on your current plan level and your partner's age" — no invented number.
- Flagged qualifying periods and pre-existing conditions as the caveat to check in T&Cs before claiming.
Where to tighten
"Here's what your premium will be after adding your partner: £X" is the answer the member actually wants. With a quote-engine tool, the agent surfaces it instead of pointing to a screen.
04
Member — sore throat, fever, asking about antibiotics
Excellent
"I've had a really sore throat for 3 days and a low fever. Should I be on antibiotics? Can I see a GP through my plan today?"
What worked
- Clean clinical refusal — "I can't advise you on whether you need antibiotics — that's a clinical decision a GP needs to make."
- Pivoted positively — yes, you can see a GP today. Listed the SimplyPlan app path: My Health → General health → GP & Nurse → HealthHero booking portal.
- Set service-availability expectation accurately: 24/7 telephone, 8am-10pm video — a small detail that prevents a frustrated late-night attempt.
- Disclosed the private-prescription cost reality without scaring the member off the service.
Where to tighten
This is the gold-standard handling for clinical-boundary conversations. In production, the agent could pre-fill the HealthHero booking with the symptoms the member already typed, so they don't repeat themselves.
05
HR admin — bulk upload + mid-cycle billing
Excellent
"27 new employees to add this month — is there a bulk upload, and how does mid-cycle billing work?"
What worked
- Two rounds of knowledge searches before declaring the gap — agent didn't give up after the first miss.
- Honest fourth-wall break: bulk upload + mid-cycle billing aren't in the public KB.
- Routed correctly: employer support team / dedicated account manager.
- Did not invent a bulk-upload process or a pro-rata formula. This is the hard test of the demo's guardrail design — handled cleanly.
Where to tighten
Employer-side admin questions are the highest-volume B2B load and the most frequently absent from public help. Pulling the employer admin guide into the knowledge layer is a high-leverage retention play.
06
Member — upgrading from Plan 2 to Plan 4
Strong
"I've been on Plan 2 for 18 months but want to upgrade to Plan 4 for more dental cover. How and when does the new cover kick in?"
What worked
- Confirmed yes, with timing detail — "since you've been on Plan 2 for 18 months, you're past your first renewal."
- Set the right expectation — change-of-plan options page → upgrade.
- Flagged the qualifying-period and pre-existing conditions caveat for new dental benefits — important so the member doesn't book treatment expecting day-1 cover.
- Pointed to T&Cs and My Documents for the specifics.
Where to tighten
"Plan 4 gives you £X more dental and £Y more optical, premium goes from £A to £B" is the comparison this member is mentally doing. Live plan-comparison tooling makes the upgrade frictionless.
What this tells us about Simplyhealth-shaped support
What's already strong
- Claims fundamentals. Receipt requirements, claim flow, assessment and payment timings — every answer correct, every "we'll confirm by email" caveat in place.
- Clinical-boundary discipline. Symptoms → online GP every time. No diagnoses, no prescription suggestions, no improvised reassurance.
- Audience switching. Member asks → SimplyPlan path. HR admin asks → employer support / account manager. The agent reads the role from the message, not from a flag.
- Honest gaps. When the KB doesn't have the answer (employer admin operational detail), the agent says so and routes to the right human. No invented bulk-upload process.
Where to invest next
- Live entitlement and claims tool. "You have £X physio remaining" turns coaching answers into one-step resolutions and reduces second-touch volume.
- Quote engine for plan changes. Live premium impact for adding partner / upgrading plan — the answer the member is actually asking for.
- Employer admin knowledge layer. Bulk upload, mid-cycle billing, leaver flow — high-volume B2B load, currently a deflection.
- Pre-filled HealthHero booking. Carry symptoms the member typed straight into the GP booking flow — saves the duplicate explanation.
What a full Simplyhealth deployment unlocks
Six conversations in, the pattern is clear: the agent already handles the policy and clinical-boundary load that breaks generic chatbots — claim receipt requirements, GP routing, dual-audience tone switching, plan-change rules, and honest gap-handling on employer admin. Connect it to the claims engine, the entitlements view, the SimplyPlan account, and the employer admin layer, and the same agent goes from "answers the question" to "moves the case forward in one turn" — for the dental claimant, the physio referral, the HR admin and the worried sore-throat member alike.
Simplyhealth's customer mix — members across health, dental and HCP plans, plus HR admins, plus the regulated clinical layer underneath — is exactly what Lorikeet is built for. We'd love to show you the production version.