Back to all terms

Claim Submission Deadline

The claim submission deadline is the final date by which an insured person must submit a claim to their insurance company for reimbursement of eligible expenses. After this date, the insurer is not obligated to pay the claim, even if the expense itself would have been covered. This deadline ensures timely processing, accurate recordkeeping, and proper financial reporting for both the insurer and the policyholder.

Deadlines vary by insurer and policy type. For most health and dental insurance plans, claims must be submitted within a specific period - commonly within 90 days to one year from the date the service was provided or from the end of the benefit year. In group insurance, employers often define the deadline in coordination with the insurer, and any late submissions are typically denied.

Example:

If your dental cleaning took place on June 1 and your plan requires that all claims be submitted within 90 days, you must file your claim by August 30 to receive reimbursement. Claims submitted after this date will not be eligible for payment.

What to Watch For:

Keep track of claim deadlines, especially at year-end or when leaving a job, as benefits usually end with your employment. Submit claims as soon as possible after receiving services and retain copies of receipts and submission confirmations. Some insurers allow online submissions, which provide faster processing and electronic proof of submission date.

Related Terms

Calendar Year

The calendar year defines a benefit period that runs from January 1 to December 31. Many annual maximums, deductibles, and claim resets follow this schedule. It provides a consistent framework across most insurers and simplifies tax reporting for medical expenses.

Certificate of Insurance

A certificate of insurance is an official document issued by an insurance company that summarizes the key details of your coverage. It serves as proof that you are insured and outlines the essential terms of your policy, including the type of coverage, effective dates, benefit limits, exclusions, and any dependents or beneficiaries listed under the plan.

Claim

A claim is a formal request you or your healthcare provider submit to your insurance company to receive reimbursement or direct payment for eligible medical or dental expenses covered under your plan. Submitting a claim provides the insurer with the necessary information - such as receipts, treatment details, and provider information - to verify the service and determine the amount payable according to your policy’s terms.

Claimant

A claimant is the person who submits a request for reimbursement or payment under an insurance policy. In health and dental insurance, the claimant is usually the insured individual who received the service, such as a medical treatment, prescription, or dental procedure. However, a claimant can also be a parent, spouse, or legal guardian submitting a claim on behalf of a covered dependent.

Coinsurance

Coinsurance -sometimes called the *reimbursement rate* - is the percentage of eligible health or dental expenses your plan will pay after any deductible. It’s the insurer’s share of the bill, with the remainder paid by you. Typical plans cover 70–100% of eligible costs; the rest is your out-of-pocket portion.

Have questions about your insurance coverage?

Our licensed advisors can help you understand your options and find the right plan for your needs.

Contact Us