Per-X-Years Limit

A per-X-years limit means a benefit can only be claimed once during a specified number of years. This rule applies to items or treatments that are not needed annually, such as hearing aids, orthotics, or major dental appliances.

Plans use these limits to manage costs for high-value or long-lasting services. The time frame varies by benefit - common examples include every two, three, or five years.

Example:

If your plan covers hearing aids up to $600 every four years, you can only make another claim after four full years have passed since the last reimbursement.

What to Watch For:

Track your purchase dates carefully. Submitting a claim too early, even by a few days, can result in denial.

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.