{"id":7695,"date":"2023-03-05T10:50:33","date_gmt":"2023-03-05T10:50:33","guid":{"rendered":"https:\/\/docs.daftra.com\/user_manual\/%d9%83%d9%8a%d9%81-%d9%8a%d8%b9%d9%85%d9%84-%d9%86%d8%b8%d8%a7%d9%85-%d8%a7%d9%84%d8%aa%d8%a3%d9%85%d9%8a%d9%86-%d8%a7%d9%84%d8%b7%d8%a8%d9%8a\/"},"modified":"2025-02-25T12:27:25","modified_gmt":"2025-02-25T12:27:25","slug":"how-does-the-medical-insurance-system-work","status":"publish","type":"user_manual","link":"https:\/\/docs.daftra.com\/en\/user_manual\/how-does-the-medical-insurance-system-work\/","title":{"rendered":"How does the Medical Insurance System Work?"},"content":{"rendered":"<section class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_column_text]One of the fields that require an accounting system for insurance is the medical field. That&#8217;s why the software has prepared a specialized application for insurance agents that you can rely on to handle the accounting affairs of insurance companies you contract with, with ease. We provide you with a guide for medical insurance in system, so you can understand how to use this important application and manage it yourself.<\/p>\n<p>In this topic, we will practically apply it to our dental clinic account and delve into the details of:<\/p>\n<ul>\n<li>Adding a new insurance company to your clinic&#8217;s account.<\/li>\n<li>Adding an insurance category\/segment to the insurance company.<\/li>\n<li>Linking the client to a specific insurance company and insurance category.<\/li>\n<li>Processing the rules of the insurance category.<\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Adding a New Insurance Company to Your Clinic&#8217;s Account&#8221; font_container=&#8221;tag:h2|font_size:28|text_align:center|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1740480909204{background-color: #f6f9fc !important;border-radius: 4px !important;}&#8221;][vc_column_text]Adding a new insurance company to your account starts your journey with the medical insurance guide. To add a new insurance company, click &#8220;Insurance Agents&#8221; from the main menu, then select &#8220;Add Insurance Company.&#8221;<\/p>\n<p>The control panel for the insurance company appears, allowing you to input its information, as shown in the following image.<\/p>\n<p><a href=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-53.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-7720 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-53.png\" alt=\"\" width=\"1366\" height=\"608\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-53.png 1366w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-53-300x134.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-53-1024x456.png 1024w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-53-768x342.png 768w\" sizes=\"auto, (max-width: 1366px) 100vw, 1366px\" \/><\/a><\/p>\n<p>Let&#8217;s apply a practical example in the medical insurance guide using a virtual insurance company named &#8220;International Insurance Company.&#8221;<\/p>\n<p>Here&#8217;s how we fill in its details:<\/p>\n<ul>\n<li>Name: Enter the insurance company name as &#8220;International Insurance Company.&#8221;<\/li>\n<li>Phone: Record the insurance company&#8217;s phone number in this field.<\/li>\n<li>Website: Specify the insurance company&#8217;s website.<\/li>\n<li>Image: Insert the insurance company&#8217;s logo to distinguish it from others. Click the &#8220;Choose file&#8221; button and select the image from your device&#8217;s memory.<\/li>\n<li>Email: Register the insurance company&#8217;s email address.<\/li>\n<li>Status: Set the insurance company&#8217;s status as &#8220;active&#8221; to perform operations on it.<\/li>\n<\/ul>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-69\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"7b2f6f77-eec9-4c95-a828-78d0a5b3c85f\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>After filling in the data, click &#8220;Save and Continue&#8221; to add the International Insurance Company to your account. Next, we will add an insurance category specific to this company.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><a href=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-54.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-7722 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-54.png\" alt=\"\" width=\"1366\" height=\"608\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-54.png 1366w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-54-300x134.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-54-1024x456.png 1024w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-54-768x342.png 768w\" sizes=\"auto, (max-width: 1366px) 100vw, 1366px\" \/><\/a>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Adding an Insurance Category or Segment to Insurance Companies&#8221; font_container=&#8221;tag:h2|font_size:28|text_align:center|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1698733061744{background-color: #f6f9fc !important;border-radius: 4px !important;}&#8221;][vc_column_text]<\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-71\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"49be7fed-c679-43e9-badd-8352e2f4ae4e\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Once you&#8217;ve added &#8220;International Insurance Company&#8221; and filled in its data, clicking &#8220;Save and Continue&#8221; will automatically bring up the &#8220;Add Insurance Category&#8221; screen. You can then fill in the category details as shown in the image.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><a href=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-55.png\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-7724 size-full alignright\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-55.png\" alt=\"\" width=\"894\" height=\"376\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-55.png 894w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-55-300x126.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-55-768x323.png 768w\" sizes=\"auto, (max-width: 894px) 100vw, 894px\" \/><\/a><\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-73\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"d175a95a-3185-4bcf-9f3e-10517c5e0c78\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>First, specify a name for the insurance category you&#8217;re adding to International Insurance Company, let&#8217;s call it &#8220;First Category for International Insurance Company.&#8221; Then, provide the following details:<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-7726 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-55-1.png\" alt=\"\" width=\"894\" height=\"376\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-55-1.png 894w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-55-1-300x126.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-55-1-768x323.png 768w\" sizes=\"auto, (max-width: 894px) 100vw, 894px\" \/>[\/vc_column_text][vc_custom_heading text=&#8221;Categorizing the Services\/Products Included in the Insurance Category&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:justify|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221;][vc_column_text]To facilitate tracking and organization of insurance segments according to products\/services or clients, the system requests you to input products with their respective categories when creating a new insurance category. Therefore, it&#8217;s essential to have product categories in your account.[\/vc_column_text][vc_message message_box_style=&#8221;3d&#8221; message_box_color=&#8221;alert-info&#8221; icon_fontawesome=&#8221;fas fa-book&#8221; css=&#8221;.vc_custom_1740481027933{margin-left: 200px !important;}&#8221;]You can refer to the guide on <a href=\"https:\/\/docs.daftra.com\/en\/tutorial\/product-categories\/\">adding a new product category <\/a>to complete this step successfully.[\/vc_message][vc_column_text]In our practical example with the dental clinic account, we&#8217;ve created the &#8220;High-Priced Services&#8221; category, and we&#8217;ve added two products to it: Dental Implants and Orthodontics.<\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-75\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"5aba27df-f596-4b4a-a116-d3b3ded1aad5\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Returning to the control panel of the &#8220;First Category for International Insurance Company,&#8221; in the Categories field, select &#8220;High-Priced Services&#8221; as shown in the image.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><a href=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-58.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-7728 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-58.png\" alt=\"\" width=\"886\" height=\"379\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-58.png 886w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-58-300x128.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-58-768x329.png 768w\" sizes=\"auto, (max-width: 886px) 100vw, 886px\" \/><\/a>[\/vc_column_text][vc_custom_heading text=&#8221;The Percentage Borne by the Insured and the Insurance Company&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:left|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1698734937695{margin-left: 120px !important;}&#8221;][vc_column_text]<\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-83\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"40f07889-5236-424a-a5c6-506e793bd0d9\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Both the insured and the insurance company bear a percentage of the product&#8217;s cost, known as the &#8220;co-payment percentage.&#8221; When you specify the percentage for either party, the system automatically calculates the remaining cost borne by the other party. For example, if you set a 60% co-payment percentage for the insurance company (Company Co-payment), the client will automatically bear a 40% co-payment percentage (Client Co-payment).<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><a href=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-57.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-7730\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-57.png\" alt=\"\" width=\"888\" height=\"377\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-57.png 888w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-57-300x127.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-57-768x326.png 768w\" sizes=\"auto, (max-width: 888px) 100vw, 888px\" \/><\/a>[\/vc_column_text][vc_custom_heading text=&#8221;The Maximum Co-payment Limit&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:left|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221;][vc_column_text]The system allows us to set a maximum payment limit for either party (the insured and the insurance company).<\/p>\n<p>For example, if it is agreed that the maximum limit for the insurance company&#8217;s payment is 10,000, and the cost of the service the customer will receive is 100,000, the customer&#8217;s cost will be 10,000 only, even if the co-payment percentage for them is higher. This ensures that the maximum payment limit is not exceeded.<\/p>\n<p><a href=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-59-1.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-7734\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-59-1.png\" alt=\"\" width=\"892\" height=\"378\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-59-1.png 892w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-59-1-300x127.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-59-1-768x325.png 768w\" sizes=\"auto, (max-width: 892px) 100vw, 892px\" \/><\/a>[\/vc_column_text][vc_custom_heading text=&#8221;The Additional Discount Percentage at the Invoice Item Level&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:left|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221;][vc_column_text]<\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-97\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"184f94fc-2ce3-438e-81e7-72dda2e06a29\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>We can add a discount to the co-payment cost for the client, not the insurance company. This discount is applied after splitting the co-payment percentage between the client and the insurance company.<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-7740 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-60-1.png\" alt=\"\" width=\"890\" height=\"378\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-60-1.png 890w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-60-1-300x127.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-60-1-768x326.png 768w\" sizes=\"auto, (max-width: 890px) 100vw, 890px\" \/>[\/vc_column_text][vc_message message_box_style=&#8221;3d&#8221; message_box_color=&#8221;alert-warning&#8221;]Here, it should be noted that in order for the system to apply discounts to services within insurance categories on invoices, we need to enable the <a href=\"https:\/\/docs.daftra.com\/en\/tutorial\/discount-and-advanced-payment\/\">discount feature at the item level<\/a>.[\/vc_message][vc_custom_heading text=&#8221;Save the Insurance Category After Filling in the Required Data&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:left|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1698735921068{margin-left: 120px !important;}&#8221;][vc_column_text]<\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-99\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"07926c09-0b0f-46ca-84ff-9b6fbbfc6031\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>After understanding the meaning of each field in the insurance category and successfully adding it as described earlier, save the insurance category by clicking on &#8220;Save,&#8221; as shown in the following image:<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-7738 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-60-2.png\" alt=\"\" width=\"890\" height=\"378\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-60-2.png 890w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-60-2-300x127.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-60-2-768x326.png 768w\" sizes=\"auto, (max-width: 890px) 100vw, 890px\" \/>[\/vc_column_text][vc_custom_heading text=&#8221;Adding a New Insurance Category to an Insurance Company&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:left|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1698736323412{margin-left: 120px !important;}&#8221;][vc_column_text]You can add one or more insurance categories to any of your insurance companies in your account by clicking on &#8216;Insurance Agents&#8217; from the main menu, and then &#8216;Manage Insurance Agents.&#8217;<\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-103\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"069d8288-930a-438a-bad5-ba244f70c72b\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Then, select the insurance company to which you want to add an insurance category, as shown in the following image:<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-7742 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-61.png\" alt=\"\" width=\"1366\" height=\"644\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-61.png 1366w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-61-300x141.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-61-1024x483.png 1024w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-61-768x362.png 768w\" sizes=\"auto, (max-width: 1366px) 100vw, 1366px\" \/><\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-105\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"86108eef-c26d-45c8-9650-17b0ea26e5e7\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>After entering the insurance company&#8217;s profile, click on &#8216;<strong>New Class,<\/strong>&#8216; as shown in the following image:<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><a href=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-62.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-7744 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-62.png\" alt=\"\" width=\"899\" height=\"470\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-62.png 899w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-62-300x157.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/Screenshot-62-768x402.png 768w\" sizes=\"auto, (max-width: 899px) 100vw, 899px\" \/><\/a><\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-107\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"6d3bcb77-f9ed-4aff-b615-197218075e4f\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Then continue filling in the insurance category details as explained above.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Linking the Client to a Specific Insurance Company and Insurance Category&#8221; font_container=&#8221;tag:h2|font_size:28|text_align:center|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1698736878917{margin-left: 200px !important;background-color: #f6f9fc !important;border-radius: 4px !important;}&#8221;][vc_column_text]After adding a new insurance company and insurance category, we are now going to link the client to them so that the system can automatically apply insurance when creating invoices for this client. To do this, we need to have clients in the account.[\/vc_column_text][vc_message message_box_style=&#8221;3d&#8221; message_box_color=&#8221;alert-info&#8221; icon_fontawesome=&#8221;fas fa-book&#8221; css=&#8221;.vc_custom_1740481083250{margin-left: 200px !important;}&#8221;]If you need assistance with this process, you can refer to <a href=\"https:\/\/docs.daftra.com\/en\/tutorial\/adding-a-client\/\">the guide for adding a new client<\/a>.[\/vc_message][vc_column_text]Since we already have clients in the account for our dental clinic example, we will select one of our clients, &#8216;Patt.&#8217;<\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-111\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"de1e859d-e8e2-46ea-ab16-f75f68367ab4\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>First, we click on &#8216;Patients&#8217; in the main menu, then &#8216;Manage Patients,&#8217; and select &#8216;Patt&#8217; as shown in the image.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-30669 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/6776898.png\" alt=\"\" width=\"1301\" height=\"639\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/6776898.png 1301w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/6776898-300x147.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/6776898-1024x503.png 1024w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/6776898-768x377.png 768w\" sizes=\"auto, (max-width: 1301px) 100vw, 1301px\" \/><\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-115\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"17b59ac1-c111-465a-9b4d-dbd697becb5d\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>In the patient&#8217;s file, click on &#8220;Edit&#8221; as shown in the following picture:<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-30671 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/8734934.png\" alt=\"\" width=\"1024\" height=\"514\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/8734934.png 1024w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/8734934-300x151.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/8734934-768x386.png 768w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/p>\n<p>Below the &#8220;Account Information&#8221; field in the patient&#8217;s data control panel, you will find two options:<\/p>\n<ol>\n<li><strong>Insurance Company:<\/strong> Select from the available options; in this case, choose &#8220;International Insurance Company&#8221;.<\/li>\n<li><strong>Insurance Category:<\/strong> Choose from the available options, which is &#8220;The First Category for International Insurance Company&#8221; in this instance.<\/li>\n<\/ol>\n<p>Beneath these two fields, you can input the client&#8217;s insurance number in the &#8220;Client Insurance Number&#8221; field.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-30673 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/893409.png\" alt=\"\" width=\"862\" height=\"601\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/893409.png 862w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/893409-300x209.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/893409-768x535.png 768w\" sizes=\"auto, (max-width: 862px) 100vw, 862px\" \/><\/p>\n<p>Then click &#8220;<strong>Save<\/strong>&#8220;[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Cases for Configuring Insurance Category Settings and How Each Case Is Processed&#8221; font_container=&#8221;tag:h2|font_size:28|text_align:center|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1698738661279{background-color: #f6f9fc !important;border-radius: 4px !important;}&#8221;][vc_column_text]<\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-123\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"843760e7-93f0-4d14-8f11-4b51f5ae0203\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Pay attention to the following rules to understand how the system calculates the co-payment for both the client and the insurance company.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>[\/vc_column_text][vc_custom_heading text=&#8221;Case 1: No maximum payment or discount&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:left|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1698738674650{margin-left: 120px !important;}&#8221;][vc_column_text css=&#8221;.vc_custom_1740481945837{margin-left: 200px !important;}&#8221;]<\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-127\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"c90dd2fd-45bd-4c9f-8e12-30d4d268bdf4\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>In this case, where co-payment percentages are defined for both the client and the insurance company, without setting a maximum payment or discount, the system automatically divides the total cost of the service\/product in proportion to the client&#8217;s and insurance company&#8217;s percentages.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>For example:<\/p>\n<ul>\n<li><strong>Client:<\/strong> Patt (insured by the International Insurance Company &#8211; The First Category for International Insurance Company).<\/li>\n<li><strong>Service:<\/strong> Dental Implant (with a cost of 50,000, categorized as a high-price product).<\/li>\n<li><strong>Co-payment Percentage:<\/strong> Client (40%), Insurance Company (60%).<\/li>\n<li><strong>Discount:<\/strong> None<\/li>\n<li><strong>Maximum Payment:<\/strong> None<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-30675 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/89r5304.png\" alt=\"\" width=\"765\" height=\"491\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/89r5304.png 765w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/89r5304-300x193.png 300w\" sizes=\"auto, (max-width: 765px) 100vw, 765px\" \/>[\/vc_column_text][vc_message message_box_style=&#8221;3d&#8221; message_box_color=&#8221;grey&#8221; icon_fontawesome=&#8221;fas fa-microscope&#8221; css=&#8221;.vc_custom_1698740260099{margin-left: 200px !important;}&#8221;]<\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-137\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"ea9456ad-a768-423b-b966-288f46fc3822\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Note and Explanation:<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-139\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"83da9e73-35ee-4173-90bd-3c63fd701fb6\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>We notice that the system automatically charged the client (20,000) and the insurance company (30,000) in proportion to their co-payment percentages.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>[\/vc_message][vc_custom_heading text=&#8221;Case 2: There Is a Maximum Client Co-payment with No Discount&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:left|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221;][vc_column_text]In this case, where a maximum client co-payment is set without specifying a discount, the system charges both the client and the insurance company according to their respective co-payment percentages. If the cost exceeds the maximum client co-payment limit, the system ensures not to exceed this limit by transferring the remaining portion of the total cost of the product or service to the insurance company.<\/p>\n<p>Illustrative Example:<\/p>\n<ul>\n<li>Client: Patt (insured by International Insurance Company &#8211; First Category for International Insurance).<\/li>\n<li>Service: Dental Implant (costing 50,000, categorized as high-priced products).<\/li>\n<li>Co-payment Percentage: Client (40%), Insurance Company (60%).<\/li>\n<li>Discount: None<\/li>\n<li>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-135\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"4f8abb1e-1ef7-4a11-b560-3e26dad44d11\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Maximum Client Co-payment: Maximum co-payment of 10,000 (for the client).<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 gizmo:bg-transparent dark:bg-gray-800 gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-136\"><\/div>\n<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-30682 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/6578909.png\" alt=\"\" width=\"1156\" height=\"618\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/6578909.png 1156w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/6578909-300x160.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/6578909-1024x547.png 1024w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/6578909-768x411.png 768w\" sizes=\"auto, (max-width: 1156px) 100vw, 1156px\" \/>[\/vc_column_text][vc_message message_box_style=&#8221;3d&#8221; message_box_color=&#8221;grey&#8221; icon_fontawesome=&#8221;fas fa-microscope&#8221;]Note and Explanation:<\/p>\n<p>We can see that the system charged the client &#8220;Patt&#8221; an amount that does not exceed his specified maximum co-payment limit (10,000) when it was expected to charge him according to his co-payment percentage (20,000). Meanwhile, the insurance company covered the remaining cost of the service (40,000).[\/vc_message][vc_custom_heading text=&#8221;Case 3: There is a maximum insurance company contribution limit, and there is no discount&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:left|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1698740887664{margin-left: 120px !important;}&#8221;][vc_column_text]In this case, the system charges both the client and the insurance company according to their respective co-payment percentages. If the cost exceeds the maximum insurance company contribution limit, the system ensures not to exceed this limit by charging the remaining cost to the client.<\/p>\n<p>Example for illustration:<\/p>\n<ul>\n<li>Client: Patt (insured by International Insurance Company &#8211; First Category for International Insurance Company).<\/li>\n<li>Service: Dental implant (costs 50,000, within the high-price product category).<\/li>\n<li>Co-payment percentage: Client (40%), Insurance Company (60%).<\/li>\n<li>Discount: None<\/li>\n<li>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-145\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"95ab1e36-0495-443e-a10c-8cb268cb5f54\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Maximum payment limit: Maximum insurance company contribution limit of 10,000.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"flex justify-between empty:hidden gizmo:justify-start gizmo:gap-3 lg:block gizmo:lg:flex\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-30680 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/9834390-2.png\" alt=\"\" width=\"1156\" height=\"618\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/9834390-2.png 1156w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/9834390-2-300x160.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/9834390-2-1024x547.png 1024w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/9834390-2-768x411.png 768w\" sizes=\"auto, (max-width: 1156px) 100vw, 1156px\" \/>[\/vc_column_text][vc_message message_box_style=&#8221;3d&#8221; message_box_color=&#8221;grey&#8221; icon_fontawesome=&#8221;fas fa-microscope&#8221;]<b>Note and Explanation:<\/b><\/p>\n<p>In this scenario, you will notice that the system has charged the insurance company an amount that does not exceed the specified maximum contribution limit (10,000) when it was expected to be charged according to its co-payment percentage (30,000). Meanwhile, the client has been charged the remaining cost of the service (40,000).[\/vc_message][vc_custom_heading text=&#8221;Case 4: There is a discount, and there is no maximum limit&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:left|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1703166333491{margin-left: 120px !important;}&#8221;][vc_column_text]In this scenario, where a discount is set for the client (typically, the discount is applied to the client and not the insurance company) without a maximum limit, the system loads the cost for both the client and the insurance company according to their respective co-payment percentages and then applies the discount to the client&#8217;s co-payment percentage.<\/p>\n<p>Illustrative Example:<\/p>\n<ul>\n<li>Client: Patt (insured by International Insurance Company &#8211; First Category for International Insurance).<\/li>\n<li>Service: Dental Implants (costing 50,000, which falls under the high-price product category).<\/li>\n<li>Co-payment Percentage: For the client (40%), and the insurance company (60%).<\/li>\n<li>Discount: 10%<\/li>\n<li>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-151\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"65676c46-2b62-4e8f-bbc8-3739d8e40ebf\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Maximum Payment Limit: None.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"flex justify-between empty:hidden gizmo:justify-start gizmo:gap-3 lg:block gizmo:lg:flex\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-30684 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/43-4.png\" alt=\"\" width=\"1158\" height=\"618\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/43-4.png 1158w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/43-4-300x160.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/43-4-1024x546.png 1024w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/43-4-768x410.png 768w\" sizes=\"auto, (max-width: 1158px) 100vw, 1158px\" \/>[\/vc_column_text][vc_message message_box_style=&#8221;3d&#8221; message_box_color=&#8221;grey&#8221; icon_fontawesome=&#8221;fas fa-microscope&#8221;]<\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-157\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"32a193fb-c570-4a57-ad34-e9af728e9233\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p><strong>Note and Explanation:<\/strong><\/p>\n<p>The system charged the insurance company (30,000) by its specified co-payment percentage and charged the client (18,000) after applying a discount (10%) to the client&#8217;s co-payment amount.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>[\/vc_message][vc_custom_heading text=&#8221;Case 5: There Is a Discount, and There Is an Insurance Company Maximum&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:left|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1698742460360{margin-left: 120px !important;}&#8221;][vc_column_text]In this case, where a discount is set for the client and an insurance company maximum is defined, the system loads the cost for both the client and the insurance company according to their co-payment percentages. If the insurance company&#8217;s co-payment exceeds the maximum, the excess over the maximum is charged to the client, and then the system applies the discount to the client&#8217;s co-payment percentage.<\/p>\n<p>Illustrative Example:<\/p>\n<ul>\n<li>Client: Patt (insured by International Insurance Company &#8211; First Category for International Insurance Company).<\/li>\n<li>Service: Dental implant (costing 50,000, falling into the high-priced product category).<\/li>\n<li>Co-payment percentage: Client (40%), Insurance Company (60%).<\/li>\n<li>Discount: 10%<\/li>\n<li>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-155\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"8569537b-3f74-4b9a-ab7d-d549b4746611\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Insurance Company Maximum: 10,000.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 gizmo:bg-transparent dark:bg-gray-800 gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-156\"><\/div>\n<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-30687 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/9344.png\" alt=\"\" width=\"1158\" height=\"619\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/9344.png 1158w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/9344-300x160.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/9344-1024x547.png 1024w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/9344-768x411.png 768w\" sizes=\"auto, (max-width: 1158px) 100vw, 1158px\" \/>[\/vc_column_text][vc_message message_box_style=&#8221;3d&#8221; message_box_color=&#8221;grey&#8221; icon_fontawesome=&#8221;fas fa-microscope&#8221;]<b>Note an Explanation:<\/b><\/p>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-159\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"0d9f529a-28c0-4394-9f02-212efff2d04d\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>We can observe that the system only charged the insurance company (10,000), adhering to the specified maximum co-payment for the insurance company. However, the system charged the client (36,000), which is the sum of the client&#8217;s co-payment amount (20,000) plus the excess over the client&#8217;s maximum co-payment (20,000). Then, the system applied a discount percentage (10%) to the (40,000), making the total cost payable by the client (36,000).<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>[\/vc_message][vc_custom_heading text=&#8221;Case 6: There Is a Discount and a Maximum for the Client&#8221; font_container=&#8221;tag:h3|font_size:22|text_align:left|color:%2304306b|line_height:2&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1698743848133{margin-left: 120px !important;}&#8221;][vc_column_text]Here we encounter an issue when the client benefits from the maximum co-payment, as they will receive a discount due to not exceeding this limit, in addition to the discount allocated to them in the insurance category. According to common insurance practices, this situation is handled differently, and it will become clear in the following paragraphs.<\/p>\n<ul>\n<li>Client: Patt (insured by International Insurance Company &#8211; First category of International Insurance Company).<\/li>\n<li>Service: Dental implant (costing 50,000 and classified as a high-priced product).<\/li>\n<li>Co-payment percentage: For the client (40%), and the insurance company (60%).<\/li>\n<li>Discount: 10%<\/li>\n<li>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-161\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"54b5d975-4f12-4570-b0b2-8454a56c4d4b\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>Maximum co-payment: Maximum co-payment of 10,000 (for the client).<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 gizmo:bg-transparent dark:bg-gray-800 gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-162\"><\/div>\n<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-30689 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/92480.png\" alt=\"\" width=\"1158\" height=\"619\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/92480.png 1158w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/92480-300x160.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/92480-1024x547.png 1024w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/92480-768x411.png 768w\" sizes=\"auto, (max-width: 1158px) 100vw, 1158px\" \/>[\/vc_column_text][vc_message message_box_style=&#8221;3d&#8221; message_box_color=&#8221;grey&#8221; icon_fontawesome=&#8221;fas fa-microscope&#8221;]<b>Note and Explanation:<\/b><\/p>\n<p>We noticed that the cost borne by the client is 10,000, which is the maximum co-payment. However, the cost borne by the insurance company is 38,888. Where does this number come from?<\/p>\n<p>Let&#8217;s first discuss the case from a hypothetical perspective. The system was supposed to load the insurance company with 30,000 and the client with 20,000 based on the co-payment percentage for each. To avoid exceeding the maximum payment for the client, the system loaded an additional 10,000 on the insurance company (the value exceeding the maximum payment).<\/p>\n<p>Therefore, the cost borne by the client is 10,000, and the cost borne by the insurance company is 40,000. This contradicts the result obtained, which divided the cost with the insurance company being 38,888.[\/vc_message][vc_custom_heading text=&#8221;Here is an explanation of what happened:&#8221; font_container=&#8221;tag:h4|font_size:18|text_align:left|color:%2304306b|line_height:0&#8243; use_theme_fonts=&#8221;yes&#8221; css=&#8221;.vc_custom_1698744247284{margin-left: 120px !important;}&#8221;][vc_column_text]The system loaded the client with a virtual cost, on which it applied a discount of 10% to make it exactly 10,000 (the maximum payment for the client). It then subtracted this virtual cost from the total cost of the service (50,000) to calculate the cost borne by the insurance company.<\/p>\n<p>As shown on the invoice, (11,111) is the virtual cost, and the system derived this value using the following equation, where we denote the unknown with (C):<\/p>\n<ul>\n<li>C &#8211; 0.1C (10% discount) = Maximum payment for the client (10,000)<\/li>\n<li>C &#8211; 0.1C = 10,000<\/li>\n<li>0.9C = 10,000<\/li>\n<li>0.9C \u00f7 0.9 = 10,000 \u00f7 0.9<\/li>\n<li>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-167\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"40180252-e67f-4c6f-abba-e7785b3cb7a8\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>C = 11,111<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 gizmo:bg-transparent dark:bg-gray-800 gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-168\"><\/div>\n<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-30691 size-full\" src=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/348790342.png\" alt=\"\" width=\"1015\" height=\"615\" srcset=\"https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/348790342.png 1015w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/348790342-300x182.png 300w, https:\/\/docs.daftra.com\/wp-content\/uploads\/2023\/03\/348790342-768x465.png 768w\" sizes=\"auto, (max-width: 1015px) 100vw, 1015px\" \/><\/p>\n<p>So, (C) is the virtual cost that the system loaded for the client, and then it subtracted it from the total cost of the service to calculate the cost borne by the insurance company:<\/p>\n<ul>\n<li>Insurance Company&#8217;s Payment = Total Cost of the Service &#8211; Virtual Client Cost<\/li>\n<li>Insurance Company&#8217;s Payment = 50,000 &#8211; 11,111 = 38,888<\/li>\n<\/ul>\n<p>The system processes this equation as explained to avoid applying the discount after applying the maximum payment.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]<\/p>\n<div class=\"post-inner-content\">\n<div class=\"entry-content\">\n<div class=\"group w-full text-token-text-primary border-b border-black\/10 gizmo:border-0 dark:border-gray-900\/50 gizmo:dark:border-0 bg-gray-50 gizmo:bg-transparent dark:bg-[#444654] gizmo:dark:bg-transparent\" data-testid=\"conversation-turn-169\">\n<div class=\"p-4 gizmo:py-2 justify-center text-base md:gap-6 md:py-6 m-auto\">\n<div class=\"flex flex-1 gap-4 text-base mx-auto md:gap-6 gizmo:gap-3 gizmo:md:px-5 gizmo:lg:px-1 gizmo:xl:px-5 md:max-w-2xl lg:max-w-[38rem] gizmo:md:max-w-3xl gizmo:lg:max-w-[40rem] gizmo:xl:max-w-[48rem] xl:max-w-3xl }\">\n<div class=\"relative flex w-[calc(100%-50px)] flex-col gizmo:w-full lg:w-[calc(100%-115px)] agent-turn\">\n<div class=\"flex-col gap-1 md:gap-3\">\n<div class=\"flex flex-grow flex-col gap-3 max-w-full\">\n<div class=\"min-h-[20px] flex flex-col items-start gap-3 whitespace-pre-wrap break-words overflow-x-auto\" data-message-author-role=\"assistant\" data-message-id=\"36daaca1-da59-4b6f-817d-4b661a4760df\">\n<div class=\"markdown prose w-full break-words dark:prose-invert light\">\n<p>With this, we have reached the end of the Medical Insurance Guide. We have learned how to add a new insurance company to the account, add an insurance category or class to it, link the client to an insurance company and a specific insurance category, and the mechanism for processing insurance category rules.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<footer class=\"entry-meta\"><\/footer>\n<\/div>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][\/vc_column][\/vc_row]<\/p>\n<\/section>","protected":false},"author":16,"template":"","categories":[2036,2175,2174],"tags":[4202,4212,4206,4201,4211],"class_list":["post-7695","user_manual","type-user_manual","status-publish","hentry","category-sales","category-manage-insurance-agents","category-insurance-agents","tag-add-insurance-agent","tag-add-insurance-class","tag-edit-insurance-agent","tag-insurance-agent","tag-insurance-class"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v17.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>How does the Medical Insurance System Work? 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