Combined Maximum

A combined maximum is a shared limit that applies across multiple services or benefit types. Instead of separate dollar caps for each category, one total amount covers several related expenses. For instance, physiotherapy, chiropractic, and massage therapy might share a $700 combined maximum, meaning any combination of those services counts toward the same pool.

This arrangement simplifies plan design and controls overall costs while giving flexibility to allocate benefits where needed.

Example:

If you use $300 for physiotherapy and $400 for massage, you have reached the $700 combined maximum for that group.

What to Watch For:

Check whether your combined maximum resets annually and which practitioners or benefits are grouped together.

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?

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