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Combined Dental Maximum

A combined dental maximum is the shared annual limit your insurance plan will pay for multiple categories of dental services grouped together under one total. Instead of assigning separate dollar caps to preventive, basic, and restorative care, the insurer combines them into a single yearly maximum. Once that combined amount is reached, no further reimbursement is available for any of those services until the next benefit period.

This approach simplifies plan administration while helping control overall costs. For example, a plan might offer a $1,500 combined maximum that applies to cleanings, fillings, and crowns. How you use that total is flexible - you can apply it entirely to one type of service or spread it across several, as long as you stay within the combined limit.

Combined maximums are most common in personal health and dental plans or guaranteed-issue policies where flexibility and simplicity are emphasized over unlimited coverage.

Example:

If your plan has a $1,500 combined dental maximum and you claim $300 for cleanings, $700 for fillings, and $500 for a crown, you will have reached your $1,500 limit for the year. Any additional dental costs will not be reimbursed until the plan renews.

What to Watch For:

Track your cumulative dental claims throughout the year. Even if your coinsurance applies, the plan stops paying once you reach the combined total. Also check whether orthodontic services have their own separate lifetime maximum or fall within the same combined pool.

See also Combined Maximum

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.

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.

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.

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