Store and Update Extended Health Group Benefits

This article will help you store Group Benefit details for patients with Extended Health Care coverage. Storing Extended Health Group Benefits allows you to:

• have patients notified when their benefits are close to being exhausted
• pull marketing reports based on the renewal date of a patient’s benefits

This function can be performed on EHC, MVA, WSIB, or Slip & Fall cases with Insurer Information recorded in them.

To perform the following procedures:

1. Open the Patient Manager, then locate and select a patient.
2. Open the Case with an Extended Health Insurer on file.
3. From the General tab, click on the three-dotted (…) button beside the Primary or Secondary EHC company name in the Claims section (bottom right corner).
   The EHC Details window opens.

Add Extended Health Benefit

1. On the EHC General tab, click [New Coverage] on the toolbar.
   The fields on the tab are now cleared or populated with default values.
   
2. Select Which EHC the details to apply to.
3. Select the Year Start of the coverage.
4. Select the Insurance Co. providing the health benefit or, optionally, click Add Insurance. For more information see Add and Manage Insurance Companies.
5. Select the Billing address relevant to this coverage or, optionally, click Add Address and enter the necessary details for a new billing address for the insurance company.
6. Select a Claim Form to be used for claims under this coverage.
7. If necessary, adjust billing address details (loaded when you selected a billing address in Step 5).
8. Enter Plan/Group and ID/Certificate numbers.
9. If the patient is the Plan Member, check the Same as patient box. Otherwise, enter the First/Last Name and DOB of the Plan Member.
10. Click [Save] on the toolbar.
    The Benefit Schedule Details and Adjuster Information tabs become available.

Add Benefit Schedule

1. On the Benefit Schedule Details tab, click [New Coverage] on the toolbar.
   The Add/Edit Benefit Schedule window opens.
   
2. Select a Benefit Type (Service or Product).
3. Type a Description for the benefit or choose from the list (the list includes the defined services or products, depending on the Benefit Type selected).
4. Change the Start and End date of the benefits (defaults to the start and end of the current calendar year).
   • If the benefit must be supported by a prescription, check Prescription required by box and select the type of provider who can prescribe it from the drop-down list.
   • If you selected a Product Benefit Type, in the Can be dispensed by drop-down list, select the type of provider who can dispense the product.
5. If the service or product coverage is limited, enter the Maximum Amt, otherwise, check Unlimited. Enter the Coverage Rate (as a dollar amount or percentage).
6. Select whether a Paid Receipt is required or not.
7. If you selected a Service Benefit Type, enter the number of Deductible Visits already used for this Benefit.
8. Enter the Previously Used Coverage Rate.
9. Optionally, enter descriptive Comments.
   • If you selected a Service Benefit Type, to combine other services with this one, as part of the same Benefit Schedule, in the Combination of services table, click inside an empty cell under the Item ID column and select from the list.
   • If you selected a Product Benefit Type, enter Casting details if needed.
10. Click Save & Close.

Edit Adjuster Information

1. On the Adjuster Information tab, click [Edit Adjuster Information] on the toolbar.
   The fields on the tab become modifiable.
2. Select the Adjuster Company.
3. Enter the Adjuster Claim No.
4. Enter contact information for the Adjuster, along with an explanatory Note.
5. Click [Save Adjuster Information] on the toolbar.

Edit Extended Health Benefit

1. On the EHC General tab, select an existing Coverage in the list on the left.
2. Click [Edit Coverage] on the toolbar.
3. Make changes, then Click [Save Coverage] on the toolbar.
   Note: Edit the Benefit Details on the other tabs as necessary.

Deactivate Extended Health Benefit

1. On the EHC General tab, select an existing Coverage in the list on the left.
2. Click [Edit Coverage] on the toolbar.
3. Change the Status to Inactive.
4. Click [Save Coverage] on the toolbar.

Delete Extended Health Benefit

1. On the EHC General tab, select an existing Coverage in the list on the left.
2. Click [Delete Coverage] on the toolbar.
3. Click Yes when prompted.