Per-Visit Cap (Paramedical)

The per-visit cap is the maximum amount your insurance plan will reimburse for a single visit to a paramedical provider, such as a physiotherapist, chiropractor, or massage therapist. If the provider charges more than the cap, you are responsible for the difference. This cap ensures fairness and cost control by aligning payments with typical local pricing.

For example, your plan might pay up to $40 per visit for massage therapy, regardless of the therapist’s actual fee. The cap may apply before coinsurance is calculated, meaning the insurer reimburses a portion of that capped amount.

Example:

If your massage therapist charges $75 and your plan’s per-visit cap is $40 with 80 percent coinsurance, the plan pays $32 (80 percent of $40) and you pay $43.

What to Watch For:

Ask your provider about their fees before treatment. Some plans set different per-visit caps for various practitioners, and higher charges are always your responsibility.

Related Terms

Paramedical Disciplines

Paramedical disciplines refer to regulated health professionals who provide therapy or rehabilitation services outside of hospital settings. Common examples include physiotherapists, chiropractors, massage therapists, acupuncturists, naturopaths, osteopaths, psychologists, and speech-language pathologists.

Pay-Direct card / Drug card

A pay-direct card, also known as a drug card, is a plastic or digital card issued by your health insurance provider that allows pharmacies to bill your insurer directly for eligible prescription drugs. Instead of paying the full cost upfront and submitting a claim later, you pay only your portion - such as a deductible or coinsurance - at the point of sale.

Per Incident

Per incident refers to the way certain insurance benefits are calculated or limited based on each separate event, illness, or accident rather than by year or lifetime. When a benefit is paid “per incident,” it means you are eligible for reimbursement each time a new, distinct occurrence happens, up to the maximum amount specified for that type of claim.

Per Person / Per Family

Per person and per family describe how benefit limits, deductibles, or maximums are applied within a health or dental insurance plan. A per person limit means the specified amount applies individually to each insured member, while a per family limit represents the total combined coverage for all members under one policy.

Per-Practitioner Annual Maximum (Paramedical)

The per-practitioner annual maximum is the total amount your plan will reimburse for services from one specific type of provider in a single benefit year. For example, if your plan pays up to $500 for massage therapy annually, once that amount is reached, additional treatments from that provider type are no longer covered until the next year.

Have questions about your insurance coverage?

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