Insurance Plan Coverage

  • Created:
  • / Author: nebras-dentalore

For each insurance plan created, the user could manage the coverage ratio that this plan will cover for patient and his family.
In order to configure required coverage on a specific plan, follow the following:

  • Press on your name at the upper right side and select “Settings”.

  • Expand “Insurance” menu and select “Plan“
  • From ‘Plan‘ main view, Select required plan; Press “View” icon.
  • You will be directed to the “Edit Insurance Plan” page; Select ‘Coverage’ tab.

‘Coverage’ tab is mainly divided in 2 sections: (Maximum Benefit) and (Coverage Table).
1- Maximum Benefit Section
Section contains 2 fields that manage the coverage for patient and his family through:
  • Individual
    – The insurance plan covers the patient according to set coverage amount until the sum of all of his procedures’ insurance portion reach the maximum benefit then all fees directly will go to patient.
  • Family
    – The Sum of insurance portion for all done procedures (For all Family Members) must not exceeds the maximum benefit.

Note that:
– By default the (Individual) and (Family) numeric boxes display amount = Zero which means that the insurance plan is Not restricted to a specific amount, it could always cover the patient and all of his family members.
– If patient finishes his insurance coverage (Individual), the family coverage will not cover any amount for him.
– Maximum Benefit will be renewed yearly.

2- Coverage Table
The coverage table is mainly consists of 2 parts; Main Grid view and Secondary Grid view that could be managed from the (Expand and Collapse) arrow. By default both grids are open.

First: Main Grid View

Columns of the Main Grid View are:
  • Transactions Column
    – Contains 1 action “Expand-Collapse” arrow that’s used to display and hide the secondary grid view.
  • Begin Procedure
    – Displays the Start code of procedure according to the ADA Code; of procedures included in each category. 
  • End Procedure
    – Displays the End code of procedure according to the ADA Code; of procedures included in each category. 
  • Category
    – Displays the name of procedures’ Category. 
    – “Category” column contains a Filter Icon that enables user to search for a specific category. Default selection is: All.

  • Coverage
    – Displays the percentage of coverage that the insurance plan should cover for each category. 
    – When user insert value in this field; automatically this value will be applied to all procedures included in this category. And if user need to change the coverage percentage of specific procedure, she/he could update it manually from the procedure itself in the secondary grid view.

Second: Secondary Grid View

Columns of the Secondary Grid View are:

  • ADA Code
    – Displays the ADA Code equivalent to each listed procedure in the category.
    – Procedures displayed sorted in Ascending order by ADA Code.
    – “ADA Code” column contains a Filter Icon that enables user to search for a specific Procedure. Default selection is: All.
  • Procedure
    – Displays the procedure’s name.
    – “Procedure” column contains a Filter Icon that enables user to search for a specific Procedure. Default selection is: All.
  • Amount
    – Displays the amount (fees) of procedure set for it in the selected price list used for the insurance plan.
  • Coverage
    – Displays the percentage of coverage for each procedure. 
    – This field is disabled by default.
    – In order to be able to manually change the coverage value, You must tick the check box of required procedure in the “Manual” column, then update the coverage.


  • Insurance Portion
    – Is the calculated amount in which insurance shall pay against each procedure depending on the amount (fees) of procedure and coverage value.
  • Patient Portion
    – Is the calculated amount that patient shall pay for the procedure after the insurance covers part of the fees.
    – Patient Portion = Fees – Insurance Portion
  • Manual
    – Is the column that enables user to manually update (Change) the coverage percentage for each procedure, that the “Right” mark means that the procedure’s coverage is manually set while the “False” mark means that the procedure’s coverage value is taken from the category coverage value.
>> Note that: Any change (Update) in the coverage of insurance plan will affect only the new created procedures not the old one.
 

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