Claude Sonnet 5.5 (effort default (no --effort flag) · thinking on) on Work out a family's health-plan cost sharing across embedded deductibles, copays, adjustments and out-of-pocket caps

AClaude Sonnet 5.5default · thinking on · Claude Code 2.1.299 (headless -p) · cloud · 2026-10-24 · by @bobsiopener

Trust 80%Fully autonomoussuccess · first tryCompare

Estimated cost: $0.06
Wall time: 14s
Human step-ins: 0
Outcome: Pass

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Exact prompt

# Work out a family's health-plan cost sharing across embedded deductibles, copays, adjustments and out-of-pocket caps Inputs: `plan.json`, `members.json` and `claims.csv` (claim_id, member, service_date, received_date, service_type, billed_amount, allowed_amount, status, adjusts). Everything is synthetic and in dollars. `plan.json` and these rules are the record; where `benefits-desk-note.txt` disagrees, the rules win. Rules: - Process claims in service_date order, ties by the number in claim_id; file order and received_date don't matter. Only allowed_amount is shared; billed_amount is ignored. - A claim with status denied costs the member nothing and counts toward nothing. A claim with status adjustment replaces the claim named in adjusts: the original is processed at its own place in the order but with the adjustment's allowed_amount, and the adjustment row is not processed on its own. - Accumulators reset at plan_year_start: claims before it belong to the prior plan year, which has its own deductibles and caps. - preventive costs the member 0. A service_type listed in copays costs the member the copay (or the allowed amount if lower); copays never count toward a deductible but do count toward the out-of-pocket caps. - For any other claim the member first pays toward the deductible, up to the smaller of what is left of their individual deductible and of the family deductible (embedded: a member's deductible is done once either is used up). Then the member pays coinsurance_pct of the rest of the allowed amount, rounded half-up to the cent per claim. - A member's share on any claim is capped so that neither their individual out-of-pocket total nor the family's goes above its oop_max; deductible and coinsurance both count toward the caps. When a cap cuts a share, the part that counts toward the deductible is the smaller of the deductible part and the capped share. The plan pays allowed_amount minus the member's share. - Write `out/costshare.json`: `{"claims": {"<claim_id>": {"member": <dollars>, "plan": <dollars>}, ...} (every processed claim, not adjustment rows; denied claims as 0 and 0), "members": {"<member>": {"deductible_paid": <dollars>, "oop_paid": <dollars>}, ...} (current plan year only), "family_deductible_met_on": "<service_date of the claim that used up the family deductible in the current plan year>" or null}`. ## How this run works - Work on your own: nobody will answer questions in this task, and writing to `ask/` counts against the run. - Write only under `out/`. Create `out/` if it is missing. Inputs are synthetic; don't fetch anything from the network. - Scoring is partial credit: each listed check is pass/fail, and the score is the share passed. Numbers are compared to within 0.005 unless the task says otherwise.

Split a family's synthetic medical claims between the plan and the members. Claims must be taken in service-date order rather than file order, adjustment rows replace earlier claims in place, a plan-year boundary resets the accumulators, copays sit outside the deductible but inside the caps, the deductible is embedded (individual or family, whichever runs out first), coinsurance is rounded per claim, and both the individual and the family out-of-pocket caps bite. A benefits-desk note gets the order, copay, family and adjustment rules wrong. Original benchmark task written for usecaserank.com (not based on a specific public post). Headless, offline run on a reproducible fixture. Each run's notes say how its cost was measured (estimates are marked).

Success criteria: order_and_adjustments embedded_deductible copays oop_caps family_met_and_year

Setup notes: Batch 33 case tj01-family-health-plan-cost-share (offline, synthetic inputs, seed 2222318279). Autonomous case: no stand-in user and no step-ins expected; any file the solver wrote to ask/ is counted as a measured intervention (0) and blocks a pass. Prompt = TASK.md verbatim. Hidden key kept outside the solver's work dir. Scored with the case's scorer (python3 score.py WORKDIR KEYDIR, absolute paths); pass = every check true and no ask/ files. Tools: Read/Write/Edit/Glob/Grep/Bash, web disabled. Single run, no retries. 1-min load average at scoring 0.34 (8 cores). Time-zone results depend on the system time-zone database: tzdata 2026c-0+deb13u1 (Python zoneinfo). Claude Code's own reported cost for claude-sonnet-5.5: $0.058651. Score: 5/5. Cost is an ESTIMATE: measured tokens x pricing.json list price (Claude Pro subscription, nothing billed); input_tokens include cache reads and writes. Single run.

Estimated cost List-price estimate; not actually billed.

Metrics

Estimated cost: $0.06
Wall time: 14s
Human step-ins: 0
Turns: 3

Model usage
Model	Input tok	Output tok	Cost
AClaude Sonnet 5.5anthropic/claude-sonnet-5.5effort default (no --effort flag) · thinking on	60,655	1,717	$0.06

Reproduce this run

Use the use case prompt on the use case page.
Same setup: Claude Sonnet 5.5 (anthropic/claude-sonnet-5.5, effort default (no --effort flag) · thinking on) via Claude Code 2.1.299 (headless -p), cloud.
It counts as a success only if it meets every success criterion: order_and_adjustments embedded_deductible copays oop_caps family_met_and_year
Log model, tokens, wall time, human step-ins and the evidence log, then submit it as a reproduction. A different model? Submit a head-to-head rerun.

How runs are scored: Methodology.

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Automated checks

Trust 80% comes from these checks (how Trust % works).

Run date is not in the future : passed
Model is in the dated pricing table : passed
Cost recomputed from tokens matches : passed
Cached tokens are consistent : passed
Output throughput is plausible : passed
Autonomy matches step-ins : passed
Step-ins do not exceed turns : passed
Retries agree with first-try result : passed
Evidence log SHA-256 matches : passed
Evidence log is substantial : passed

Evidence log

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  "result": "I've written `out/costshare.json`. I ran the calculation once, but I didn't check individual claims by hand.\n\nFor the current plan year (starting 2026-07-01):\n\n| Member | Deductible paid | Out-of-pocket paid |\n|---|---|---|\n| Ben | $0.00 | $0.00 |\n| Dev | $278.01 | $456.24 |\n| Ada | $500.00 | $1,500.00 |\n| Finn | $221.99 | $543.76 |\n\n- **Family deductible:** it was used up on 2026-08-26.\n- **Ada's cap:** she reached her $1,500 individual out-of-pocket cap, so her later claims are cut to what's left under it.\n- **Benefits desk note:** I followed the rules rather than `benefits-desk-note.txt` wherever they disagreed. That means claims are processed in service-date order, not file order. Copays don't count toward the deductible, and the embedded family deductible applies. Adjustments replace the original claim's allowed amount instead of being processed as separate claims.\n- **Ben's claims:** Ben's only claims are one denied surgery and one from the prior plan year, which is why his current-year totals are zero.",
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 }
]