Overall Plan Maximum

An overall plan maximum is the total amount your health and dental plan will pay for all combined benefits within a single policy year. Once the limit is reached, you must pay any additional expenses out of pocket until the next renewal period.

This type of maximum is often used in guaranteed-issue or conversion plans where coverage cannot be declined based on health. It helps insurers manage risk while still providing a wide range of benefits.

Example:

If your plan has a $10,000 overall plan maximum and you claim $6,000 in health and $4,000 in dental expenses, no further claims are reimbursed for the rest of the year.

What to Watch For:

Monitor your total claims, since reaching the overall maximum stops reimbursement for all covered categories until reset.

Related Terms

Occupational Class

Occupational class is the category assigned to an individual based on the type of work they perform and the level of risk associated with their job. Insurers use occupational classes to help determine eligibility, premium rates, and benefit levels for life, disability, and accident insurance. The classification reflects how likely a person is to experience injury, illness, or death related to their occupation.

Optional Benefit / Rider / Add-On

An optional benefit, also called a rider or add-on, is an additional feature that can be purchased to enhance your existing health, dental, life, or disability insurance plan. Optional benefits allow you to customize coverage by adding protection that suits your personal needs, rather than relying only on the base plan design.

Oral Surgery

Oral surgery refers to surgical procedures performed in or around the mouth and jaw by a licensed dentist, oral surgeon, or maxillofacial specialist. It includes both minor procedures, such as tooth extractions, and more complex surgeries involving the jawbone, soft tissue, or dental implants.

Orthodontics

Orthodontics covers the cost of correcting tooth alignment and jaw positioning using braces or aligners. In individual and group dental plans, orthodontic benefits are usually separate from preventive and restorative coverage. Most plans apply a lifetime maximum and a waiting period before orthodontic treatment is eligible.

Orthopedic Shoes / Custom Orthotics

Orthopedic shoes and custom orthotics are specialized footwear and inserts designed to support proper alignment, relieve pain, and improve mobility for individuals with foot, leg, or posture-related conditions. These items are often prescribed to correct biomechanical issues, provide additional cushioning, or accommodate deformities caused by medical conditions such as arthritis, diabetes, or plantar fasciitis.

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