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Edit Entry Screen

With the Edit screen, you can edit information that was previously recorded. You may change any of the information for a record. The input fields for Health Insurance are described below. Some of these fields are required and some are optional. The required fields are indicated by an asterisk symbol (*). You must click the Save button for your changes to be recorded. After you click "Save" or "Cancel" you will be taken back to the Summary screen. The "Reset" button will return the fields to the original values before any changes were made. You may also choose to delete the entry by clicking the "Delete" button. If for some reason the system is not able to process your entry, the page will refresh with a message explaining what must be done to proceed.

Using this Page

Health Insurance Company (Required) - Enter the name of your health insurance company in this field. This name will be used to identify this record in the Summary screen. You may enter up to 50 characters.

ID Number (Required) - Enter the health insurance policy number here. You may enter up to 30 characters.

First Name of Insured (Required) - Enter the first name of the person on the health insurance policy. You may enter up to 50 characters.

Last Name of Insured (Required) - Enter the last name of the person on the health insurance policy. You may enter up to 50 characters.

Start Date (Required) - Enter the date the policy was started. Select a date by clicking on the calendar icon. The calendar icon will open a pop-up window with a clickable calendar. By clicking a date in the calendar, the date field will be automatically set and you may continue filling out the form.

End Date - Enter the date the coverage ended. Select a date by clicking on the calendar icon. The calendar icon will open a pop-up window with a clickable calendar. By clicking a date in the calendar, the date field will be automatically set and you may continue filling out the form.

Group Number - Enter the group policy number. You may enter up to 30 characters.

Pre-Approval Number - Enter the phone number for the pre-approval services of the health insurance company. You may enter up to 20 characters.

Health Insurance Company Phone Number - Enter the phone number of the health insurance company. You may enter up to 20 characters.

Comments - This is where you can enter any additional thoughts you had about this particular health insurance record. You may enter up to 255 characters.

Save - You must click this button to save the entry.