Benefit
A benefit is the specific financial protection or coverage provided under an insurance policy. In health and dental insurance, a benefit refers to the payment or reimbursement made by the insurer for eligible medical, dental, or wellness expenses. Each benefit category - such as prescription drugs, dental services, vision care, or physiotherapy - outlines what is covered, how much the insurer will pay, and any applicable limits or conditions.
Benefits are the core of an insurance plan, representing the tangible value you receive in exchange for paying premiums. They may include lump-sum payments (as in critical illness or accident coverage) or ongoing reimbursement for routine healthcare needs. Some plans offer fixed benefit amounts, while others calculate payment as a percentage of the total eligible expense based on coinsurance.
Example:
If your plan includes a dental benefit covering 80 percent of basic services, and you receive a $200 filling, the insurer reimburses $160 while you pay $40.
What to Watch For:
Review your policy’s summary of benefits to understand what is covered and what exclusions apply. Each benefit may have its own annual or lifetime maximum and may require pre-authorization for certain procedures. Keep track of benefit renewals, as unused amounts usually do not carry over to the next year.
