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.

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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.

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Example:

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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.

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What to Watch For:

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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.