Viewing benefits

Benefits indicate which services are covered under a benefit plan, at what percentage, how long a waiting period you may have, and any rules that apply. To view benefit information:

  1. Select Benefits/Eligibility from the menu. The Benefit Quickview screen appears.
  1. In the Patient Information section, select the button of the person you would like to view benefits for. The Patient Information screen appears displaying the benefit information.


Benefit Information

Benefit information is divided into several sections. At the top of the benefit information are any client-specific messages followed by:

Below this is information on benefit levels, waiting periods, and rules, followed by maximums and deductibles, ortho age limits, and COB information, if the benefit program includes those.

Benefit levels

For easy reference, benefit levels, waiting periods, and rules are assigned to several standard categories. These categories in turn contain subcategories, and within these, individual procedures or services.

Benefits may also vary by provider network. If so, the information is displayed for each network.

Routine Procedures list routine procedures, dates of services provided, and whether they are covered for the participating and non participating networks.

You can also use the Code Search feature to find benefit information for a specific procedure code or service. Enter the procedure code and click the Find button to jump to benefit information for that code.

For each procedure category and/or code:

Maximums and deductibles

The maximums and deductibles section shows dollar amounts and other information for maximums and deductibles.

back to top

Ortho Age Limit

The age limits for orthodontic treatment, if applicable. If the benefit plan does not cover orthodontics, this section does not appear.

back to top

Related Topics

View Claims

Understanding eligibility for dependents

Benefit Quickview