Some insurance plans cover different plan members at varying rates, according to the frequency of their dental visits. This is most commonly called an incentive plan. Dentrix Enterprise is capable of handling incentive plans, and the setup is very similar to any other plan.
The key when creating incentive insurance plans is that, although a person only has room for four insurance plans (primary, secondary, tertiary, and quaternary), he or she is not limited to the number of plans for which he or she can be listed as a subscriber. However, as soon as no one (himself or herself or a dependent) is attached to an insurance plan, he or she will no longer be a subscriber to that plan.
For the purpose of the following example, assume that the insurance company has two plans, A and B. Plan A is for the patient who visits his dentist faithfully and is covered at 90%. Plan B is for the patient who visits sporadically and is only covered at 75%. This example is also suitable for plans that cover dependents differently from the subscriber.
To set up the subscriber
With a subscriber selected in Family File, double-click the Insurance Information block.
The Insurance Information dialog box appears. The Dental Insurance tab is selected by default.
In the Coverage Order list, select the None option that corresponds to the primary insurance plan (1).
Click the Subscriber search button .
The Select Primary Subscriber dialog box appears.
Click Current Patient.
Click the Carrier search button .
The Select Insurance dialog box appears.
Search for and select the correct carrier. If the carrier is not listed, click New Insurance Plan to add the insurance carrier.
Click OK.
In the Insurance Information dialog box, click Insurance Data.
The Dental Insurance Plan Information dialog box appears.
Enter or edit the insurance information as needed. At the end of the Group Plan name, enter one or more identifying characters (for instance, "A", "S" for subscriber, or "100" for the percentage) that will allow you to easily distinguish this plan from the others once they are created.
Click OK.
If the insurance plan is being used by more than one person, the Insurance Plan Changed dialog box appears (proceed to step 12); if not, skip steps 12 - 13.
Click Change Plan for All.
Click OK to apply the changes to the existing insurance plan information to all other subscribers and dependents who have the same insurance plan.
In the Insurance Information dialog box, click Coverage Table, and set up the coverage table.
Click OK.
A message appears.
Click OK.
To set up the dependents
While still in the subscriber's Insurance Information dialog box, from the Coverage Order list, select the None option that corresponds to the secondary insurance plan (2).
Click the Subscriber search button .
The Select Secondary Subscriber dialog box appears.
Click Current Patient.
Click the Carrier search button .
The Select Insurance dialog box appears.
Search for and select the correct carrier. If the carrier is not listed, click New Insurance Plan to add the insurance carrier.
Click OK.
In the Insurance Information dialog box, click Insurance Data.
The Dental Insurance Plan Information dialog box appears.
Change the identifying character after the Group Plan name (to "B" or whatever you choose as an identifier).
Click OK.
If the insurance plan is being used by more than one person, the Insurance Plan Changed dialog box appears (proceed to step 11); if not, skip steps 11-12.
Click Add as New Plan.
Click OK to add the insurance information to the current subscriber as a new insurance plan without changing the original plan.
In the Insurance Information dialog box, click Coverage Table, and then change the coverage table to the correct coverage for plan "B."
Click OK.
A message appears.
Click OK.
The subscriber now has both primary and secondary insurance. Although the subscriber is really not covered by the secondary coverage, leave this listed here for the moment.
In the Insurance Information dialog box, click OK to return to Family File.
From the Family Member List, double-click a dependent's name to view that dependent in Family File.
Double-click the Insurance Information block.
The Insurance Information dialog box appears. The Dental Insurance tab is selected by default.
From the Coverage Order list, select the None option that corresponds to the primary insurance plan (1).
Click the Subscriber search button , and then select the subscriber with the group plan with the name defined in step 8 (for example, "B").
The correct insurance information is now listed as the primary insurance for the dependent.
Click OK.
Repeat steps 17-21 for any other dependents as needed.
From the Family Member List, double-click the subscriber's name to view that patient in Family File.
Double-click the Insurance Information block.
The Insurance Information dialog box appears. The Dental Insurance tab is selected by default.
From the Coverage Order list, select the option that corresponds to the secondary insurance plan (2).
Click Clear Coverage. Although you will be clearing the secondary insurance from the subscriber, because the plan is attached to a dependent, the subscriber will remain as the current subscriber for the added plan.
Click OK to return to Family File. The subscriber now has only primary insurance.
Repeat steps 1-27 for any other variations to this plan. If the subscriber has secondary insurance and there are no other variations of this plan, the secondary insurance can be set up normally.