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Combined Paramedical Maximum

A combined paramedical maximum is a shared annual limit that applies collectively to several types of paramedical services under your health insurance plan. Instead of assigning a separate reimbursement maximum for each practitioner, the plan pools multiple services together under one total dollar amount. Once that combined limit is reached, no further claims are reimbursed for any of the included disciplines until the plan renews.

Paramedical services typically include treatments from physiotherapists, chiropractors, massage therapists, acupuncturists, naturopaths, osteopaths, and psychologists. For example, your plan might provide a $700 combined annual maximum for all paramedical services. You can use that amount across any mix of providers, offering flexibility but requiring you to monitor usage carefully.

Combined maximums are common in simplified or guaranteed-issue health plans, where coverage is streamlined for ease of administration and to control overall claim costs.

Example:

If your plan offers a $700 combined paramedical maximum and you claim $400 for massage therapy and $300 for chiropractic care, you will have reached the $700 annual total and cannot claim for additional paramedical services until the next benefit year.

What to Watch For:

Check which disciplines are grouped under the combined maximum, as each insurer defines it differently. If you frequently use multiple therapists, consider a plan that provides individual maximums per practitioner instead of a shared total. Always confirm whether per-visit caps or coinsurance apply before reimbursement is calculated.

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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