In the Edit Benefits Window, when you uncheck the Simplified View box, 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 Insurance Plan. 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 the benefit applies to. To apply to a specific procedure code instead, select None as the category and enter the code.
- Type: Some types affect Insurance Remaining Calculations; 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.
- Waiting Period: affects calculations. Insurance plan must have an effective date entered for calculations to work.
- 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
- Calendar Year: affects calculations
- Lifetime: information only
- Years: information only
- Quantity/Qualifier: If there is a frequency limitation or waiting period on a category or procedure, enter a number and select the qualifier that matches.
- 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.