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Entering Insurance Plans for Patients 

The steps for entering a patient's insurance vary depending on whether or not the insurance plan already exists in the Insurance Plan List and whether or not the patient is the subscriber. Always enter insurance plan information for the subscriber before entering the plan for non-subscribers. For insurance plan examples see Insurance Plan Types.

WARNING: Before creating a new plan, always make sure a matching plan doesn't already exist in the Insurance Plan List. A plan is considered 'matching' when insurance plan information fields and benefit year match (see Insurance Plan Information Fields). If 'Create new plan if needed' is selected and an insurance plan information field or benefit year changes, a brand new plan will be created. If 'Change plan for all subscribers' is selected and an insurance plan information field or benefit year changes, the information will change for all subscribers.

To change insurance plan or benefit information, see Updating Insurance Plan Information instead.

Create a New Insurance Plan
A new insurance plan is one that doesn't already exist in the Insurance Plan List. Always add the plan for the subscriber first.

Hints: Set default options for new insurance plans in Family Module Preferences.

  • Set 'Change plan for all subscribers' as the default so that duplicate insurance plans aren't inadvertently created.
  • Set the default plan type (PPO Percentage or Category Percentage) for new plans.
  • Set the defaults for 'Claims show UCR fee, not billed fee', 'Assignment of Benefits', and COB Rule.
  1. Select the subscriber.
  2. In the Family module, click Add Insurance.



  1. Click Yes. 
  2. If the subscriber is already associated with a plan the Select Insurance Plan window will open. Click New Plan.
    Otherwise the Edit Insurance Plan window will open immediately.
  3. Enter patient information.
  4. Enter the subscriber information. Subscriber ID is required.
  5. Enter insurance plan information.
  6. Double click Benefit Information to enter benefit maximums, percentages, and frequencies, then click OK to save.
  7. Click OK to save all changes.

Note: When a new patient insurance plan is created, an entry is logged in the Audit Trail using the PatPlanCreate permission.

Add the plan for other family members (non-subscribers)

  1. Select the family member.
  2. Click Add Insurance.
  3. When asked if the patient is the subscriber, click No.



  1. Double click the subscriber to select, or click More Patients to select any patient in the database.



  1. Double click the plan to select.
  2. On the Edit Insurance Plan window, verify patient information. At a minimum select the patient's Relationship to Subscriber.
  3. Click OK to save.

Note: If coverage percentages on a plan differ for individual patients (e.g. an incentive plan), consider adding Other Benefits with a patient overrride. These benefits will only apply to the individual patient. See Same Plan with Different Coverage Levels.

Add a Plan that Already Exists
If a plan already exists in the Insurance Plan List, it can be attached to a new subscriber and family members.

  1. Select the subscriber.
  2. In the Family module, click Add Insurance.
  3. On the subscriber message, click Yes. 
  4. If the subscriber is already associated with a plan, the Select Insurance Plan window will open. Click New Plan.
    Otherwise the Edit Insurance Plan window will open immediately.
  5. Enter the patient information.
  6. Enter the subscriber information. Subscriber ID is required.
  7. Click Pick From List to open the Insurance Plan List. Double click the plan to select it.
    Note: If the plan you select is not the right plan, click Pick From List again to try a different plan.
  8. Click OK to save all changes.
  9. Add the plan to other family members (non-subscribers).

 

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