Insurance Plans

Create, view, and update insurance plans. Per OpenDental API.

What are Insurance Plans in OpenDental?

Insurance Plans (InsPlans) are the specific benefit plans offered by a Carrier. One carrier (e.g., Delta Dental) can have many plans—PPO, HMO, group plans by employer, etc. Each plan defines coverage rules: FeeSched (allowed amounts), PlanType (Percentage, PPO, Flat Copay, Capitation), GroupName/GroupNum, and COB (coordination of benefits). Create plans under a carrier, then use InsSubs to add subscribers and PatPlans to assign patients.

All Insurance Plans

PlanNum	GroupName	GroupNum	CarrierNum	PlanType	FeeSched	CobRule	Status	Actions

InsPlans - GET Response

GET /insplans. Optional: PlanType, CarrierNum. Per OpenDental API.

Example Response:

[
  {
    "PlanNum": 6,
    "GroupName": "United States Post Office",
    "GroupNum": "PB181863",
    "PlanNote": "Mostly covered.",
    "FeeSched": 54,
    "PlanType": "p",
    "ClaimFormNum": 1,
    "ClaimsUseUCR": "false",
    "CopayFeeSched": 0,
    "EmployerNum": 23,
    "CarrierNum": 10,
    "IsMedical": "false",
    "FilingCode": 4,
    "ShowBaseUnits": "false",
    "CodeSubstNone": "true",
    "IsHidden": "false",
    "MonthRenew": 0,
    "FilingCodeSubtype": 0,
    "CobRule": "Standard",
    "SecUserNumEntry": 0,
    "SecDateEntry": "2023-01-21",
    "SecDateTEdit": "2023-01-21 06:47:00",
    "BillingType": 40,
    "ExclusionFeeRule": "PracticeDefault",
    "ManualFeeSchedNum": 0,
    "IsBlueBookEnabled": "false",
    "InsPlansZeroWriteOffsOnAnnualMaxOverride": "Default",
    "InsPlansZeroWriteOffsOnFreqOrAgingOverride": "Default"
  }
]

All Fields:

PlanNum: Unique plan ID (read-only)
GroupName: Typically same as employer, identifies plan difference
GroupNum: Plan number (Canada)
PlanNote: Note for plan, same for all subscribers
FeeSched: FK to feesched.FeeSchedNum
PlanType: "" (Percentage), "p" (PPO), "f" (Flat Copay), "c" (Capitation)
ClaimFormNum: FK to claimform.ClaimFormNum
ClaimsUseUCR: "true" or "false"
CopayFeeSched: FK feesched when FeeSchedType is CoPay
EmployerNum: FK to employer.EmployerNum
CarrierNum: FK to carrier.CarrierNum
IsMedical: "true" or "false"
FilingCode: FK to insfilingcode.InsFilingCodeNum
ShowBaseUnits: "true" or "false"
CodeSubstNone: Ignore substitution codes
IsHidden: "true" or "false"
MonthRenew: 1-12 or 0 (calendar year)
FilingCodeSubtype: FK insfilingcodesubtype
CobRule: Basic, Standard, CarveOut, SecondaryMedicaid
SecUserNumEntry, SecDateEntry, SecDateTEdit: Audit (read-only)
BillingType: FK definition.Category=4
ExclusionFeeRule: PracticeDefault, DoNothing, UseUcrFee
ManualFeeSchedNum: FK feesched (ManualBlueBook), 0 = None
IsBlueBookEnabled: "true" or "false"
InsPlansZeroWriteOffsOnAnnualMaxOverride: Default, Yes, No
InsPlansZeroWriteOffsOnFreqOrAgingOverride: Default, Yes, No

Insurance Plans

Insurance Plans

All Insurance Plans

Create Insurance Plan

Required

Plan Info

Plan Type & Fees

Claims & Billing

Other Options

Result:

Search & Update Plan

Update Plan

Result:

Insurance Plans

All Insurance Plans

Create Insurance Plan

Required

Plan Info

Plan Type & Fees

Claims & Billing

Other Options

Result:

Search & Update Plan

Update Plan

Result:

InsPlans - GET Response

Example Response:

All Fields:

Create InsPlan - JSON Structure

Example Request (all fields optional except CarrierNum):

Example Response (200 OK):

Update InsPlan - JSON Structure

PUT Request (all 24 fields optional):