Extract data from benefits enrollment forms

A benefits enrollment form is where an employee chooses the health, dental, and vision coverage they will carry for the plan year, and it is the record a benefits team keys into the carrier feeds and the payroll deduction file. During open enrollment a company processes one for every participating employee, each electing a coverage tier, naming the plans, listing dependents and beneficiaries, and signing off. The form and its plan documents sit inside the employer's group health plan, a benefit plan under the Employee Retirement Income Security Act (ERISA), the federal law that sets the disclosure and fiduciary rules for such plans and requires a Summary Plan Description to be furnished to participants. When Aisha Kwan enrolls at Northgate Logistics Inc. for the 2026 plan year at the family tier effective 2026-01-01, the elections on that form flow to three carriers and to payroll. The numbers that have to line up are the contributions. Each elected benefit carries a monthly premium split between the employee and the employer, and the employee's share across all lines has to match the per-pay-period deduction payroll will take. For a family-tier election of a PPO Gold medical plan, a Dental Basic plan, and a Vision Standard plan, employee contributions of $320, $28, and $9 a month sum to $357 a month, or $4,284 across the 2026 plan year, while the employer contributes $1,033 a month on top. Each line also carries its deductible and the dependents it covers, and the beneficiary designations name a spouse or child with their relationship and date of birth. Talonic reads the benefits enrollment form and returns the employee record, the coverage tier and elected plans, the per-line contributions and deductibles, and the beneficiary designations as typed fields, with the contribution totals reconciled. A family-tier enrollment effective 2026-01-01 through 2026-12-31, with a $357 monthly employee contribution, loads into the benefits administration system instead of a retyped form, so a benefits analyst reconciles the payroll deduction from structured data.

What gets extracted from benefits enrollment forms

How extraction works for benefits enrollment forms

Benefits enrollment forms come out of platforms such as Workday and bswift, paper open-enrollment packets, and carrier portals rendered to PDF, so the way elections and contributions are laid out changes from one employer's plan to the next. Talonic classifies the form and maps it to the benefits schema in the Field Registry, which separates the employee record, the elected benefits, the per-line coverage detail, and the beneficiary designations. Monthly contributions are typed as numbers in their ISO 4217 currency and the employee's share is reconciled across the medical, dental, and vision lines so it ties to the payroll deduction, each line keeps its plan code, deductible, and covered dependents, and the coverage tier is captured as its own field. Effective and expiration dates for the plan year are parsed to ISO 8601, beneficiaries are kept with their relationship and date of birth, and the acknowledgment and signature status is read to confirm the election is complete. Every value returns with a confidence score and a pixel-region pointer under DIN SPEC 91491, so a benefits administrator can verify a contribution or a plan election against the source form before loading it. The extraction structures what the form and its plan documents state and does not provide benefits or tax advice.

Sample extraction

A family-tier benefits enrollment form with three elected lines

{
  "document_number": "BEN-2026-1180",
  "document_date": "2025-11-14",
  "candidate_name": "Aisha Kwan",
  "employee.id": "EMP-33914",
  "employee.date_of_birth": "1989-07-22",
  "employer": "Northgate Logistics Inc.",
  "employee.department": "Finance",
  "enrollment_period": "2026 Plan Year",
  "effective_date": "2026-01-01",
  "expiration_date": "2026-12-31",
  "coverage_tier": "family",
  "health_plan.selected": "PPO Gold",
  "dental_plan.selected": "Dental Basic",
  "vision_plan.selected": "Vision Standard",
  "employee_monthly_contribution_total": 357,
  "employer_monthly_contribution_total": 1033,
  "currency": "USD",
  "acknowledgment.read_waiver": true,
  "employee_signature": "Aisha Kwan",
  "coverage_details": [
    {
      "coverage_type": "medical",
      "plan_code": "PPO Gold",
      "monthly_contribution": 320,
      "employer_contribution": 980,
      "deductible": 1500,
      "covered_dependents": 3
    },
    {
      "coverage_type": "dental",
      "plan_code": "Dental Basic",
      "monthly_contribution": 28,
      "employer_contribution": 42,
      "deductible": 50,
      "covered_dependents": 3
    },
    {
      "coverage_type": "vision",
      "plan_code": "Vision Standard",
      "monthly_contribution": 9,
      "employer_contribution": 11,
      "deductible": 0,
      "covered_dependents": 3
    }
  ],
  "beneficiaries": [
    {
      "beneficiary.name": "Jordan Kwan",
      "beneficiary.relationship": "spouse",
      "beneficiary.date_of_birth": "1988-04-03"
    },
    {
      "beneficiary.name": "Maya Kwan",
      "beneficiary.relationship": "child",
      "beneficiary.date_of_birth": "2016-09-12"
    }
  ]
}

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