Insurance > Benefit Plans

A text field that is used to enter your search criteria.

Tip: You can enter the first few characters of the word, or enter an underscore (_) to return all results.

A check box that, when selected, allows you to filter results based on a specific insurance company.

The ellipsis is used to display the Insurance Companies window and select an insurance company.

A check box that, when selected, indicates that individual benefit plans are included in the result list.

Note: These are benefit plans that have Can have multiple Subscribers deselected.

1. Use the check boxes, Criteria field, and Search On drop-down list to set the search parameters.
2. Click the Search For Data () icon and review the results.

Note: If your search has more than 100 results, a prompt displays. Click Yes to continue your search or click No to stop and change your criteria to narrow the results list.

Tip: Plans with start dates set in the future display in gray.

1. Click the Create a new Record () icon to display the Add Benefit Plan window.
2. Complete the fields as necessary and click OK.

1. Search for and select a listed entry.
2. Click the Edit/View Benefit Plans () icon to display the Edit Benefit Plan window.
3. Make any necessary changes and click OK.

Tip: You can also double-click a listed entry to display the Edit Benefit Plan window.

1. Search for and select multiple listed entries.
2. Click the Merge Benefit Plans () icon to display the Benefit Plan Merge window.

3. Review the listed plans and configure as necessary, then click OK to merge.

1. Search for and select a listed entry.
2. Click the Renew Benefit Plan () icon to display the Renew Benefit Plan window.
3. Review the information and make any necessary changes, then click OK.

1. Search for and select a listed entry.
2. Click the Transfer Benefit Plan Subscribers () icon to display the Transfer Benefit Plan Subscribers window.
3. Complete the fields as necessary and click OK.

A text field that indicates the benefit plan is tied to an employer.

The ellipsis is used to display the Employer List window and select an employer.

A disabled field that displays the address for the selected Employer.

A text field that indicates the insurance company that owns this policy.

The ellipsis is used to display the Insurance Companies List window and select an insurance company.

Tip: Many fields in this window auto-populate from the selected insurance company.

A text field that indicates the full name of the benefit plan.

Tip: Larger institutions may choose to add unique descriptors to this field to make searching easier.

A text field that describes the coverage of the plan.

Example: 100 / 80 / 50.

A text field that indicates this is a contract policy.

The ellipsis is used to display the Contract Policy Codes window and select a contract policy.

A text field that indicates the fee schedule associated with this policy.

The ellipsis is used to display the Fee Schedule Codes window and select a fee schedule for the policy.

A disabled button that is enabled in the Edit Benefit Plan window.

Note: This button was previously labeled Specialists...

A drop-down list that indicates the type of benefit plan.

Tip: This field defaults based on the selected insurance company and should generally not be changed.

A drop-down list that indicates where the insurance forms are sent:

• Insurance

• Patient

• Employer

• Office

Note: This field only displays and is enabled if the insurance company has the Charge Patient Visit Fee check box selected.

A text box that indicates the visit fee to charge patients.

A text field that indicates the patient coverage limit, which is enabled when the drop-down list is set to Yes or Adults only.

Note: This field is disabled when the drop-down list is set to No.

A check box that, when selected, indicates that the insurance company's fee schedule is higher than the charge for non-insured patients, and axiUm bills the higher fee to insurance, but any remaining patient portion is automatically written off.

Note: An agreement between your institution and the insurance company is recommended before this option is used.

A checkbox that, when selected, indicates this insurance company requires the policy holder and patient's signatures on claim forms.

When deselected, the claim form will print with Signature on File in the signature areas of the form.

A button that displays the Benefit Plan Coverage window or the Linked Coverage Template window and allows you to manage the coverage template associated with the benefit plan.

Note: This button is only enabled if a contract plan that has a policy code is specified in the Contract field.

A button that displays the Contract Fee Schedule Overrides window and allows you to override the contract's fee schedule for specified providers.

Note: This button was previously labeled Specialists...

A disabled field that indicates the number of subscribers associated with the benefit plan.

A text field that indicates the age limit for child coverage.

Note: For Trojan companies this number is defaulted based on the policy information in the Trojan update files. For other insurance companies, the default age at which coverage ends for a dependent child is usually 18.

A text field that indicates the age limit for student coverage.

Note: For Trojan companies this number is defaulted based on the policy information in the Trojan update files. For other insurance companies, the default age at which coverage ends for a dependent child who is a full-time student is usually 21.

A text field that indicates the category of dentistry under which this falls.

Examples: Basic, Major, and Minor.

Text fields that indicate that the first and last ADA procedure codes for this range of procedure codes.

The ellipses are used to display the Procedure Codes List window and select a procedure code.

A text field that indicates the coverage percentage for this range of procedures.

Note: Do not use the % sign here. Enter the percentage as a whole number.

A text field that indicates the number of times this procedure will be covered.

Note: This field is used if the procedure range has a frequency limit.

A text field that indicates the frequency that the procedure will be covered.

A drop-down list that indicates the frequency period that the procedure will be covered:

• N/A

• Month(s)

• Year(s)

• Policy Year(s)

• Life time

Example: 1 per lifetime.

Note: These fields are used if the procedure range has a frequency limit. A period set as 1 per year will allow the procedure to be performed once in a 365 day period, whereas a period set as 1 per policy year will allow the procedure to be performed once per fiscal year. i.e., the policy year end is on 6/30 so they could have an exam posted on 6/20 that is covered and another exam on 7/20 that will also be covered.

A text field that indicates the dollar ($) amount that will be charged to the patient whenever an item within the coverage range is entered.

This is the per procedure co-pay amount.

A text field that indicates the dollar ($) amount of the category’s deductible.

Note: This field is only enabled if the Has Category Limit/Deduct check box is selected.

A check box that, when selected, indicates that there is a category limit.

A text field that indicates the dollar ($) amount of the limit.

A drop-down list the indicates the type of limit:

• Insurance Limit

• Patient Maximum

• Patient Maximum (plus Deductible)

Note: These fields are only enabled if the Has Category Limit/Deduct check box is selected.

A text field and drop-down list that indicate the time period for which the category deductible and limit applies:

• N/A 

• Month(s)

• Year(s)

• Life time

Note: These fields are only enabled if the Has Category Limit/Deduct check box is selected.

A check box that, when selected, indicates that the patient or family deductible and limit balance as well as the category deductible and limit balance are affected when a procedure in this category is performed.

Note: This field is only enabled if the Has Category Limit/Deduct check box is selected.

A text field that indicates the dollar ($) amount of the item’s deductible.

Note: This field is only enabled if the Has Item Limit/Deduct check box is selected.

A check box that, when selected, indicates that there is an item limit.

A text field that indicates the dollar ($) amount of the limit.

Note: This field is only enabled if the Has Item Limit/Deduct check box is selected.

A text field and drop-down list that indicate the time period for which the item deductible and limit applies:

• N/A 

• Month(s)

• Year(s)

• Life time

Note: This field is only enabled if the Has Item Limit/Deduct check box is selected.

1. Click the Clear Data () icon.
2. Complete the fields as necessary and click the Add a new Record () icon.

1. Select a listed entry.
2. Make any necessary changes and click the Modify Record () icon.

1. (Optional) To preview the Benefit Plan Coverage report, click the Preview Report () icon.
2. To print the Benefit Plan Coverage report, click the Print Report () icon.

1. Select a listed entry and click the Copy Template () icon to display the Coverage Template List window.
2. Copy as necessary and close the window. For more information, see Coverage Templates.

1. Select a listed entry and click the Use Template () icon to display the Coverage Template List window.
2. Copy as necessary and close the window. For more information, see Coverage Templates.

1. Select a listed entry and click the click the Deductible Exemptions () icon to display the Deductible Exemptions for Benefit Plan window.
2. Manage the procedures as necessary and close the window.

1. Select a listed entry and click the Coverage Limited Procedures () icon to display the Coverage Limited Procedures window.
2. Manage the procedures as necessary and close the window.

A disabled field that indicates the selected benefit plan.

A text field that is used to enter your search criteria.

Tip: You can enter the first few characters of the word, or enter an underscore (_) to return all results.

A drop-down list that indicates which type of code to search on:

• ADA: American Dental Association codes.
• CPT: Current Procedural Terminology codes.

1. Use the Criteria field and the Type of Code and Search On drop-down lists to set the search parameters.
2. Click Search and review the results.

Note: If your search has more than 100 results, a prompt displays. Click Yes to continue your search or click No to stop and change your criteria to narrow the results list.

1. Under Procedures (searched for), select a listed procedure and click the () button to move to the Selected Procedures list box.
2. Repeat as necessary for each procedure you want to add.

A disabled field that indicates the selected benefit plan.

A disabled field that describes the selected benefit plan.

A text field that indicates the number of times this procedure will be covered.

Note: This field is used if the procedure range has a frequency limit.

A text field that indicates the frequency that the procedure will be covered.

A drop-down list that indicates the frequency period that the procedure will be covered:

• N/A

• Month(s)

• Year(s)

• Policy Year(s)

• Life time

Example: 1 per lifetime.

Note: These fields are used if the procedure range has a frequency limit. A period set as 1 per year will allow the procedure to be performed once in a 365 day period, whereas a period set as 1 per policy year will allow the procedure to be performed once per fiscal year. i.e., the policy year end is on 6/30 so they could have an exam posted on 6/20 that is covered and another exam on 7/20 that will also be covered.

1. Select a listed entry and review the information as necessary.

1. Click the Clear Data () icon.
2. Complete the fields as necessary and click the Add a new Record () icon.

1. Select a listed entry.
2. Make any necessary changes and click the Modify Record () icon.

A disabled field that indicates the selected benefit plan.

A text field that is used to enter your search criteria.

Tip: You can enter the first few characters of the word, or enter an underscore (_) to return all results.

A drop-down list that indicates which type of code to search on:

• ADA: American Dental Association codes.
• CPT: Current Procedural Terminology codes.

1. Use the Criteria field and the Type of Code and Search On drop-down lists to set the search parameters.
2. Click Search and review the results.

Note: If your search has more than 100 results, a prompt displays. Click Yes to continue your search or click No to stop and change your criteria to narrow the results list.

1. Under Procedures (searched for), select a listed procedure and click the () button to move to the Selected Procedures list box.
2. Repeat as necessary for each procedure you want to add.

A set of radio buttons that indicates the type of coverage to which this linked coverage template applies:

• Child

• Adult

A text field that indicates the age limit for child coverage.

Note: For Trojan companies this number is defaulted based on the policy information in the Trojan update files. For other insurance companies, the default age at which coverage ends for a dependent child is usually 18.

A text field that indicates the age limit for student coverage.

Note: For Trojan companies this number is defaulted based on the policy information in the Trojan update files. For other insurance companies, the default age at which coverage ends for a dependent child who is a full-time student is usually 21.

A disabled field that indicates the unique identifier for this coverage template, to which this benefit plan is linked, or from which this benefit plan is copied.

A disabled field that indicates the category of dentistry under which this falls.

Examples: Basic, Major, and Minor.

A disabled field that indicates the coverage percentage for this range of procedures.

Note: Do not use the % sign here. Enter the percentage as a whole number.

A disabled field that indicates the number of times this procedure will be covered.

Note: This field is used if the procedure range has a frequency limit.

Disabled fields that indicates the frequency and frequency period that the procedure will be covered.

Example: 1 per lifetime.

Note: These fields are used if the procedure range has a frequency limit. Frequency periods can be defined as Month(s), Year(s), Policy Year(s), or Lifetime. A period set as 1 per year will allow the procedure to be performed once in a 365 day period, whereas a period set as 1 per policy year will allow the procedure to be performed once per fiscal year. i.e. the policy year end is on 6/30 so they could have an exam posted on 6/20 that is covered and another exam on 7/20 that will also be covered.

A disabled field that indicates the dollar ($) amount that will be charged to the patient whenever an item within the coverage range is entered.

This is the per procedure co-pay amount.

Disabled fields that indicate the time period for which the category deductible and limit applies.

Disabled fields that indicate the time period for which the item deductible and limit applies.

1. Select a listed entry and click the Copy Template () icon to display the Coverage Template List window.
2. Copy as necessary and close the window. For more information, see Coverage Templates.

1. Select a listed entry and click the Use Template () icon to display the Coverage Template List window.
2. Copy as necessary and close the window. For more information, see Coverage Templates.

1. Select a listed entry and click the click the Deductible Exemptions () icon to display the Deductible Exemptions for Benefit Plan (View Only) window.
2. View the procedures as necessary and close the window.

A disabled field that indicates the selected benefit plan.

A text field that is used to enter your search criteria.

Tip: You can enter the first few characters of the word, or enter an underscore (_) to return all results.

A drop-down list that indicates which type of code to search on:

• ADA: American Dental Association codes.
• CPT: Current Procedural Terminology codes.

A disabled field that indicates the selected benefit plan.

A disabled field that describes the selected benefit plan.

A disabled field that indicates the number of times this procedure will be covered.

Note: This field is used if the procedure range has a frequency limit.

A disabled field that indicates the frequency that the procedure will be covered.

A disabled field that indicates the frequency period that the procedure will be covered:

• N/A

• Month(s)

• Year(s)

• Policy Year(s)

• Life time

Example: 1 per lifetime.

Note: These fields are used if the procedure range has a frequency limit. A period set as 1 per year will allow the procedure to be performed once in a 365 day period, whereas a period set as 1 per policy year will allow the procedure to be performed once per fiscal year. i.e., the policy year end is on 6/30 so they could have an exam posted on 6/20 that is covered and another exam on 7/20 that will also be covered.

A text field that is used to enter your search criteria.

Tip: You can enter the first few characters of the word, or enter an underscore (_) to return all results.

A drop-down list that indicates which Provider Type filters the results.

A drop-down list that indicates the field to search on:

• Billing Id
• Last Name
• First Name
• Taxonomy Code
• Specialty

1. Use the Criteria and search fields to set the search parameters.
2. Click Search and review the results.

1. Search for and select one or more entries from the Billing IDs List list.
2. Click the Fee Schedule ellipsis to display the Fee Schedule Codes window and select a fee schedule.
3. Click the > button to move the user(s) to the Selected Billing IDs list.

1. Select one or more entries from the Selected Billing ID list.
2. Click the Fee Schedule ellipsis to display the Fee Schedule Codes window and select a different fee schedule.
3. Click Modify to save your changes.

When necessary, you can merge plans into one. In this case, any subscribers are removed from the merged plan and the empty plan is deleted.

1. Select the checkbox next to the benefit plan you want to merge the other benefit plan subscribers into.

Tip: You can click the Edit/View Benefit Plans ( ) icon to display the Edit Benefit Plan window to review details about the benefit plan.

2. Click OK.

A disabled field that indicates the benefit plan is tied to an employer.

A disabled field that displays the address for the selected Employer.

A disabled field that indicates the insurance company that owns this policy.

A text field that describes the coverage of the plan.

Example: 100 / 80 / 50.

A text field that indicates this is a contract policy.

The ellipsis is used to display the Contract Policy Codes window and select a contract policy.

A text field that indicates the fee schedule associated with this policy.

The ellipsis is used to display the Fee Schedule Codes window and select a fee schedule for the policy.

A disabled button that is enabled in the Edit Benefit Plan window.

Note: This button was previously labeled Specialists...

A drop-down list that indicates the type of benefit plan.

Tip: This field defaults based on the selected insurance company and should generally not be changed.

A drop-down list that indicates where the insurance forms are sent:

• Insurance

• Patient

• Employer

• Office

Note: This field only displays and is enabled if the insurance company has the Charge Patient Visit Fee check box selected.

A text box that indicates the visit fee to charge patients.

A text field that indicates the patient coverage limit, which is enabled when the drop-down list is set to Yes or Adults only.

Note: This field is disabled when the drop-down list is set to No.

A check box that, when selected, indicates that the insurance company's fee schedule is higher than the charge for non-insured patients, and axiUm bills the higher fee to insurance, but any remaining patient portion is automatically written off.

Note: An agreement between your institution and the insurance company is recommended before this option is used.

A checkbox that, when selected, indicates this insurance company requires the policy holder and patient's signatures on claim forms.

When deselected, the claim form will print with Signature on File in the signature areas of the form.

Date fields that indicate the start and end dates of the policy.

Note: The Start Date defaults to the day after the policy year ends.

A disabled field that indicates the number of subscribers associated with the benefit plan.

A disabled field that indicates the employer for the plan being transferred.

A disabled field that indicates the insurance company that owns the policy for the plan being transferred.

A disabled field that indicates the group number that identifies the policy for the plan being transferred.

A disabled field that indicates the sub-group of the benefit plan number for the plan being transferred.

Note: This is used if the employer offers different benefit plans for different groups within their company.

A disabled field that indicates the selected insurance company for the plan being transferred to.

The ellipsis is used to display the Select Benefit Plan window and select a plan.

A disabled field that indicates the selected group number that identifies the policy for the plan being transferred to.

A disabled field that indicates the selected sub-group of the benefit plan number for the plan being transferred to.

Note: This is used if the employer offers different benefit plans for different groups within their company.

A text field that is used to enter your search criteria.

Tip: You can enter the first few characters of the word, or enter an underscore (_) to return all results.

A check box that, when selected, allows you to filter results based on a specific insurance company.

The ellipsis is used to display the Insurance Companies window and select an insurance company.

1. Use the check boxes, Criteria field, and Search On drop-down list to set the search parameters.
2. Click the Search For Data () icon and review the results.

Note: If your search has more than 100 results, a prompt displays. Click Yes to continue your search or click No to stop and change your criteria to narrow the results list.

Tip: Plans with start dates set in the future display in gray.