Lifetime Maximum (Multi-Benefit)

A combined lifetime maximum (multi-benefit) is a single limit that applies to multiple benefit categories over your lifetime. Instead of each service having its own separate lifetime maximum, this approach creates one shared total for several types of expenses, such as health, vision, and dental.

This structure is common in guaranteed-issue and simplified health plans, where insurers control long-term risk while still offering broad coverage. Once the combined lifetime maximum is reached, no additional reimbursements are provided for any benefit included in that grouping.

Example:

If your plan has a $250,000 combined lifetime maximum for all health benefits, once you reach that total, future claims for any included services are not reimbursed.

What to Watch For:

Confirm which benefits are counted toward the shared total and track large claims over time to avoid reaching the lifetime cap unexpectedly.

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.

Have questions about your insurance coverage?

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