Lifetime Maximum (Multi-Benefit)

A combined lifetime maximum (multi-benefit) is a single limit that applies to multiple benefit categories over your lifetime. Instead of each service having its own separate lifetime maximum, this approach creates one shared total for several types of expenses, such as health, vision, and dental.

This structure is common in guaranteed-issue and simplified health plans, where insurers control long-term risk while still offering broad coverage. Once the combined lifetime maximum is reached, no additional reimbursements are provided for any benefit included in that grouping.

Example:

If your plan has a $250,000 combined lifetime maximum for all health benefits, once you reach that total, future claims for any included services are not reimbursed.

What to Watch For:

Confirm which benefits are counted toward the shared total and track large claims over time to avoid reaching the lifetime cap unexpectedly.

Related Terms

Combined Paramedical Maximum

A combined paramedical maximum is a shared annual limit that applies collectively to several types of paramedical services under your health insurance plan. Instead of assigning a separate reimbursement maximum for each practitioner, the plan pools multiple services together under one total dollar amount. Once that combined limit is reached, no further claims are reimbursed for any of the included disciplines until the plan renews.

Coverage / Benefit

Coverage, sometimes referred to as a benefit, is the range of health or dental services, supplies, or treatments that your insurance plan agrees to pay for under its terms and conditions. Each benefit represents a category of care, such as prescription drugs, dental services, vision care, or paramedical treatments.

Coordination of Benefits

Coordination of benefits (COB) is the process used by insurance companies to determine the order in which multiple plans will pay for the same claim when a person is covered under more than one policy. The goal is to ensure that combined reimbursements do not exceed 100 percent of the eligible expense, while allowing the insured to receive the maximum possible coverage across all plans.

Claimant

A claimant is the person who submits a request for reimbursement or payment under an insurance policy. In health and dental insurance, the claimant is usually the insured individual who received the service, such as a medical treatment, prescription, or dental procedure. However, a claimant can also be a parent, spouse, or legal guardian submitting a claim on behalf of a covered dependent.