Insurance coverage can vary widely. When referrals are required for certain coverage types or when coverage categories share combined maximums, the detailed coverage tracker helps automate and simplify tracking a patient’s remaining funding.
| Note: TELUS insurers are not currently supported for this coverage type |
Add Insurance to a Patient Profile
From the Patient Profile> Insurance tab, select +New Insurance.
Policy Details
Enter the Policy Details:
- Insurance Company
- Policy Holder
- Policy Holder DOB
- Relationship to Policy Holder
- Policy # (may vary)
- Certificate # (may vary)
Click here for more about what each field represents.
| Custom Label | Custom Labels help you to distinguish one insurance from another when a client has multiple insurances. This will replace the default insurance label (e.g., Sunlife 885884) with the custom label you've created (i.e. Primary EHB). |
| Insurance Company | Select from the drop-down menu the insurance company. If you cannot locate the company, you can add them in manually. Head to Settings > Third-Party Companies and select + New. |
| Policy Holder | This will default to the patient. If the Policy Holder is the spouse, parent or other, replace the name to exactly how it appears on the insurance card. |
| Policy Holder DOB | This will default to the patient's date of birth entered in the patient profile. Edit this field if the policy holder is other than the patient. |
| Relationship to Policy Holder | This will default to 'Self'. If otherwise, select from the drop-down menu. (e.g., Spouse) |
| Policy # & Certificate # / ID # | Depending on the insurance company, some identifier fields may not be applicable. Typically the Policy, Certificate (also known as ID) is entered. |
Deductible
| Amount | Enter the deductible amount for the coverage term. |
| Amount Paid? | If the deductible has already been paid (partially or in full) enter the amount paid here. |
| Paid This Year? | Select Yes or No depending on if the deductible was Paid within the current coverage term. |
Policy Rules
Select the Coverage Type: Per Detailed Category
Click here for more about what each field represents.
| Coverage Reset | Select which month the coverage is reset. |
| Calculation Order | Choose from the available drop-down options depending on the insurance calculation method. The most common order is Max, Deductible, Percent. |
| Combined Coverage |
If any category is combined with another, select Configure to create combinations. Learn more here. |
| Provincial Coverage Exhausted |
Leave this set to No, unless Provincial Coverage Applies to this insurance profile. |
Per Detailed Category Rules
Click here for more about what each field represents.
| Unlimited | Select this check box if the category has no maximum per year. Proceed to complete the percentage and other details of coverage. |
| Not Covered |
This function is optional but recommended to use for removing categories from displaying in insurance remaining in other areas of Juvonno. |
| Category |
The category created in Products & Services settings |
| % |
Enter the percentage the category is covered for. |
| Max $/Year |
Enter the maximum amount covered per policy year. |
| Max Assessment |
Enter the maximum amount covered for the initial claim for under this category. |
| Max Subsequent | Enter the maximum amount covered for any claims submitted after the assessment under this category. |
| Used Elsewhere |
If the patient has used an amount elsewhere within the current policy year, enter it here. This amount will reset to 0 once the coverage reset is reached. |
| Max Visits |
If the category has a maximum number of visits per policy year, enter it here. Once the max is reached, the invoice will be made out to the patient. |
| Referral Required? |
Select the check box if the category requires a doctor's referral. |
| Referral Expiry |
If applicable, use the calendar to select the date of which the referral expires. The date will appear when checking coverage remaining in other parts of Juvonno (such as Appointment Booking or Checkout). When the expiry is within 10 days, the text will appear in red to visually assist the user in informing the patient. |
| Coverage Remaining |
This amount will calculate based on the amounts entered in the row. Select Save on the window and re-open to view an update to the total. |
Combined Coverages
Choose a category from the drop-down list, and select Add Category to include it in the Combination (on the right). Once you have added all applicable categories to the list, select Create New Combination. Choose OK to exit and find the combined categories included in the list of Category Rules.
How to Delete/Modify an Existing Combination
Up at the top of the combined configured combination window the combined coverages will appear.
Select Configure and choose Delete next to the combination you would like to remove.
Other
Click here for more about what each field represents.
Default
Select Yes or No to set this as the default insurance selected when booking/billing appointments.
Status
Leave this field as Active (by default). When the insurance is no longer valid, set to Inactive.
| Note: Feel free to enter any other notes that may not apply within the Policy Rules section. Use the +Timestamp action to apply the current date and time to the note. |