What are annual maximum benefits?

Annual maximum benefits differ from out-of-pocket maximums, which limit how much you will pay over a year for healthcare services. Maximum benefits are common in adult dental insurance, vision insurance, short-term health insurance, and other types of supplemental insurance.

What is a maximum benefit for health insurance?

Depending on your insurance coverage, a maximum benefit may be based on the service provided or the policy length. For instance, a maximum benefit for short-term health insurance is usually for the policy term or period. For dental insurance, it’s a calendar year. In those cases, your maximum resets at the start of a new plan year or term.

What happens if I reach a maximum annual benefit?

If you reach a maximum annual benefit or a maximum benefit, you pay any additional covered service costs for the rest of the term or year. If you reach an out-of-pocket maximum (or OOP), the insurance company pays additional covered service costs for the term or the year.