{% if eligibility.status == 'active' %} {% elif eligibility.status == 'pending' %} {% elif eligibility.status == 'expired' %} {% else %} {% endif %}

{% if eligibility.status == 'active' %} Coverage Active {% elif eligibility.status == 'pending' %} Coverage Pending {% elif eligibility.status == 'expired' %} Coverage Expired {% else %} Coverage Inactive {% endif %}

{% if eligibility.status == 'active' %} Patient has active insurance coverage with {{ insurance.insurance_provider }} {% elif eligibility.status == 'pending' %} Coverage verification is pending with {{ insurance.insurance_provider }} {% elif eligibility.status == 'expired' %} Coverage has expired. Please verify current insurance status. {% else %} No active coverage found with {{ insurance.insurance_provider }} {% endif %}

Checked: {{ eligibility.last_checked }}

Coverage Information

Status: {{ eligibility.status|title }}

Effective Date: {{ eligibility.effective_date }}

Expiration Date: {{ eligibility.expiration_date }}

Group Number: {{ eligibility.group_number }}

Verification ID: {{ eligibility.verification_id }}

Network Status: {{ eligibility.network_status|title }}

Financial Details

Deductible Remaining: ${{ eligibility.deductible_remaining|floatformat:2 }}

Copay Amount: ${{ eligibility.copay_amount|floatformat:2 }}

Prior Authorization: {% if eligibility.prior_authorization_required %}Required{% else %}Not Required{% endif %}

{% if eligibility.status == 'active' %}

{% with deductible_percentage=eligibility.deductible_remaining|floatformat:0|add:0 %} {% with progress_value=100|add:deductible_percentage|floatformat:0 %}

Deductible Progress

{% endwith %} {% endwith %}

Deductible utilization this year

{% endif %}

Coverage Types

{% if eligibility.coverage_types %}

{% for coverage in eligibility.coverage_types %}

{% if coverage == 'medical' %} {% elif coverage == 'dental' %} {% elif coverage == 'vision' %} {% elif coverage == 'prescription' %} {% else %} {% endif %}

Covered

{% endfor %}

{% else %}

No Coverage Information Available

Unable to retrieve coverage details at this time.

{% endif %}

Patient & Policy Information

Patient Details

Name: {{ insurance.patient.get_full_name }}

Date of Birth: {{ insurance.patient.date_of_birth|date:"M d, Y" }}

Patient ID: {{ insurance.patient.patient_id }}

Policy Details

Provider: {{ insurance.insurance_provider }}

Policy Number: {{ insurance.policy_number }}

Member ID: {{ insurance.member_id }}

This eligibility verification is valid for 24 hours from the check time.