Annual Maximum (Overall Plan)

The annual maximum is the most your insurance plan will pay for a specific benefit within a 12-month period (calendar year or benefit year). Once you reach this limit, additional expenses for that category become your responsibility until the next year.

For instance, a plan might cover up to $300 per year for massage therapy or $1,000 for dental care. Annual maximums help control claims costs and encourage sustainable use of benefits. They can apply per person or per family and often increase with higher-tier plans.

Example:

If your dental annual maximum is $1,000 and you’ve claimed $850, only $150 remains for the rest of the year.

What to Watch For:

Some carriers use a combined annual maximum across multiple services.
Unused amounts rarely carry forward.
Check if your plan uses calendar year or anniversary year resets.

Related Terms

Accident

An accident is an unexpected, sudden, and external event that causes bodily injury, occurring independently of any illness or pre-existing condition. In the context of health and dental insurance, an accident typically refers to physical harm resulting from an unforeseen incident such as a fall, collision, or blow to the body. Accidents are distinct from sickness or degenerative conditions because they are caused by an identifiable event rather than a gradual process.

Accidental Death and Dismemberment Insurance (AD&D)

Accidental Death and Dismemberment Insurance (AD&D) provides a tax-free lump-sum payment if you die or suffer a severe injury as the direct result of an accident. It is designed to offer financial protection for you and your family in the event of an unexpected, accidental injury or loss that causes death, dismemberment, or permanent disability.

Accidental Dental

Accidental dental coverage pays for the repair or replacement of natural teeth damaged due to an accidental blow to the mouth or jaw. This benefit is distinct from routine dental coverage because it applies to emergencies caused by external physical impact, not decay or normal wear.

Actuary

An actuary is a professional who specializes in analyzing financial risk and uncertainty, particularly in the fields of insurance, pensions, and investments. Actuaries use mathematics, statistics, and financial theory to calculate premiums, reserves, and probabilities of future events such as illness, disability, or death. Their work ensures that insurance plans remain financially stable and that companies can meet future claim obligations while staying competitively priced.

Advisor/Agent

An advisor or agent is a licensed professional who helps individuals and businesses understand, choose, and manage insurance and financial products. In the context of health, dental, life, and disability insurance, an advisor’s role is to assess a client’s needs, explain plan options, and recommend solutions that provide appropriate protection within their budget.

Have questions about your insurance coverage?

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