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Insurance Benefit Information - Row View 

Usually Insurance Benefits are entered and viewed using Simplified View. However if you uncheck the Simplified View box on the Edit Benefits window, benefits list as rows. This is useful when you don't use typical insurance categories (e.g. in a country other than the U.S. or Canada). 

  • Simplified View:  Check/uncheck the box to switch between Simplified View and Row View.
  • Benefit Year: The renewal date used to calculate benefits and the current benefit year. It applies to all benefits in the window. 
    • If plan follows calendar year (starts in January; ends in December): Check this box.
    • If the plan follows a service year (starts in a month other than January): Uncheck the box, then enter the two-digit month when benefits renew in the Month field (e.g. October = 10, February = 02).
  • Benefits: Each row represents a benefit. Double click to edit.
  • Notes: The same as subscriber notes on the Edit Insurance Plan window. Certain types of benefits are not easily codified, so they do not have a box. These types of benefits are just entered as subscriber notes for now. Examples of benefits which get entered as notes are:
    • Missing tooth exclusion (a clause that states that if a tooth was extracted before the patient became insured through them, that they will not cover any replacement teeth including a partial or a bridge).
    • Wait on major treatment (usually 6 months to a year).

Add or Edit a Benefit
Click Add, or double click a row to edit. 

  • Patient Override: Check this box if this is an incentive plan benefit where each family member is at a different percentage. These benefit changes will only affect this patient and this plan.
  • Category or Proc Code: Category refers to the Insurance Category this benefit applies to. To apply to a specfic procedure code instead, select None as the category and enter the code.
  • Type: Some types affect Insurance Remaining Estimates; others are informational only.
    • ActiveCoverage: informational only
    • CoInsurance: affects calculations for percentages, not amounts.
    • Deductible: affects calculations
    • CoPayment: informational only
    • Exclusions: informational only
    • Limitations: affects calculations for amounts, but not percentages.
  • Percent: The percentage of coverage for this category or procedure code.
  • Amount: The dollar amount that is covered for this category or procedure code.
  • Time Period: Some options affect insurance remaining calculations; others are informational only.
    • Service Year: affects calculations
    • CalendarYear: affects calculations
    • Lifetime: information only
    • Years: information only
  • Quantity/Qualifier: If there is a frequency limitation on a category or procedure, enter a number and select the qualifier that matches. This is informational only, and does not affect Insurance Remaining Estimates.
  • Coverage Level: 
    • Individual: Apply this benefit change to all individual subscribers on this plan.
    • Family: Use when a family has a benefit that is in addition to the individual coverage of the subscriber (e.g. individual preventative benefit is $250 per year, but the family has a total cap of $500). This is used when specific categories of coverage have specific limits.

To see examples of 'Other Benefit' scenarios that are known to work, see Other Benefits - Examples.


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