Insurance Policies

Insurance Policies

A Policy represents an Insurance card and includes:

  • Insurance
  • Policy number
  • Group number
  • Policy holder
  • Copay


Difference between Guarantor and Policy Holder 

  • The Guarantor is the person who is responsible for payment and is the person who will receive the Statement.
  • The Policy Holder/Insured is the person who carries the Insurance and is not necessarily the Guarantor.

Examples of Policy Holder and Patient's Relationship to the Policy Holder

  • A husband may be insured through his wife's insurance. The wife is the Policy Holder or Insured, and the Relationship of the Patient to the Policy Holder is 01 (Spouse).
  • A child is covered under his father's policy. The father is the Policy Holder and the Relationship of the Patient to the Policy Holder is 19 (Child).

The most frequently used relationships are:

  • 01: Spouse
  • 18: Self
  • 19: Child
  • 20: Employee/Attorney
  • 53: Life Partner
  • G8: Other Relationship

The Insured Relationship is found on the Add/Modify Policy screen. If the relationship is any thing other than self, the Policy Holder's information fields display. The Policy Holder's Date of Birth is required.


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