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Critical Illness claims for configured benefits, checked against the plan before they pay.

A Critical Illness benefit is a single, often large payment, and the plan's terms decide whether and how much it pays. For the benefits configured for your plans, Trestl checks each claim against those terms before payment and can review the supporting clinical documentation.

Talk about your Critical Illness book

What the member and the plan get.

Claims are checked against the member’s plan before payment, and every finding shows its reason.

  1. Covered by the plan

    Claims for the benefits configured for your plans are checked against the conditions the plan covers.

  2. Paid as and when the plan's terms allow

    The rate and timing terms configured from your plan are applied before payment, and a payment they do not support is flagged.

  3. Supported by the clinical recordAI-assisted

    Supporting clinical documents are reviewed with AI assistance, and a possible mismatch is held for review.

From the member’s side: a spouse benefit paid at the wrong rate.

Overpayment · Alex, whose spouse is covered under a group Critical Illness plan. The people and amounts are made up.

  1. Day 1

    Alex’s spouse is diagnosed with a covered condition, and Alex files the claim.

  2. Without a check

    The benefit pays at 100% of the employee amount, $20,000, instead of the plan’s 50% for a spouse.

  3. Months later

    An audit finds the error. A letter asks the family to return $10,000 during treatment.

  4. With Trestl

    The claim waits for an examiner before payment, with the reason. The examiner confirms it, and the family is paid the right $10,000 once.

It fits the way your team already works.

  1. You send the claims

    The way your system already shares them.

  2. We check them against the plan

    Before your payment run.

  3. Your examiners decide what we flag

    With the reason in front of them. Claims that match pay on schedule.

Ready for your security review: a platform hosted in the US, each client’s data kept apart, encryption, and a BAA. Security and trust

What reviewers ask about Critical Illness

Does Trestl replace our claims adjudication system?
No. Trestl reviews claims before payment and presents findings to your analysts or returns them to your system. Your team, or your authorized TPA, keeps claim adjudication, appeal, and payment authority.
Is an AI-assisted flag a denial?
No. AI-assisted checks surface items for an analyst to review. An alert is not a final denial or a confirmed saving; people make the decision and the decision is recorded.
Is clinical documentation used to train AI models?
No. Documents are analyzed with Google Cloud Vertex AI inside our Google Cloud business associate agreement. Google Cloud’s service terms prohibit using customer content to train or fine-tune its models.
Which Critical Illness plans can Trestl check?
Checks are configured from your certificates of coverage and the covered-condition list for your plans. Which benefits are in scope is confirmed against your policy wording during discovery.

The other lines we cover.

Start with a conversation about your lines.

A first call about your lines and how claims move today. No claim files or health information needed for the call.

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