Health Plan (‌Employee Health Plan Transactions)

Health Plan (‌Employee Health Plan Transactions)


‌Employee Health Plan Transactions

Benefits >> Health Plan >> Health Plan Claims

‌Health Plan: How to Enter a Claim




Health Plan Claims

To enter a new claim, enter the:

  1. Claimant Details

  2. Claim Details

  3. Refund Details (once the claim has been processed and refunded)

After you have entered Claimant Details and saved the record, the screen will be refreshed to show the next screen for data entry: Claim Details; and so on.


‌Enter New Health Plan Claim



Company: Select the Company of the employee making the claim.

Employee: Select the employee for whom the claim is being made.

Dependant: If the claim is for the employee's dependant, select the dependant from the list of the employee's registered dependants. All other dependant details (Date of birth, age, relationship and any medical condition ) will be auto-filled from the dependant's record that is linked to the employee's profile.

Health Plan: Once the employee is selected, the health plan options available for selection are shown based on where the person is enrolled.

  1. ‌Enter Claimant Details




  2. ‌Enter Claim Details



    Claim Type Description: Select the type of claim being submitted. The Single YTD and Dependant YTD will be auto-filled based on the claim type selected.

    YTD Refund: The year-to-date refund amount for the respective claim type and employee will be calculated and displayed. This amount represents the total amount refunded to date for the respective employee and claim type e.g. the total refund for all ‘Medical’ claim types for the employee. You are not allowed to edit this amount.

    Claim Date: Enter the date that the claim was submitted by the employee.

    Provider Name: Select the provider name from the list of available options.

    Amount Claimed: Enter the full amount being claimed as entered on the claim form submitted by the employee.

    Dispatch Date: The date the claim was sent to the insurance company for processing.

    Status: The status of the claim will default to NOT SETTLED.

    You may save the record at this point and when the refund has been received for the claim then you can re-open the record and update the Refund Details as explained below.


    ‌Record showing Claim Not Settled



    ‌Upload Claim Documents



    The Document Type field defaults to CLAIM when adding a claim.



Credit Payment: Click Yes if the refund amount is to be paid to the employee’s company rather than the employee. This will apply in cases where the company has already refunded the employee

in respect of the claim. Otherwise click No.

Refund Date: Enter the date of the refund.

Cheque No: Enter the cheque no of the refund cheque.

Refund Amount: Enter the amount of the refund as displayed on the refund cheque.

Collected By: Enter the name of the person who collected and signed for receiving the refund cheque.

Once you have entered all refund details and there are no pending issues with the claim, then you can update he Claim details to SETTLED as shown below.

Save the record.

  1. ‌Enter Refund Details




‌Record showing Settled Claim



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