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Combined Maximum

A combined maximum is a shared limit that applies across multiple services or benefit types. Instead of separate dollar caps for each category, one total amount covers several related expenses. For instance, physiotherapy, chiropractic, and massage therapy might share a $700 combined maximum, meaning any combination of those services counts toward the same pool.

This arrangement simplifies plan design and controls overall costs while giving flexibility to allocate benefits where needed.

Example:

If you use $300 for physiotherapy and $400 for massage, you have reached the $700 combined maximum for that group.

What to Watch For:

Check whether your combined maximum resets annually and which practitioners or benefits are grouped together.

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.

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.

Per-Visit Cap (Paramedical)

The per-visit cap is the maximum amount your insurance plan will reimburse for a single visit to a paramedical provider, such as a physiotherapist, chiropractor, or massage therapist. If the provider charges more than the cap, you are responsible for the difference. This cap ensures fairness and cost control by aligning payments with typical local pricing.

Per-Visit Maximum

A per-visit maximum is the highest dollar amount your insurance plan will reimburse for a single appointment or treatment with a healthcare provider. If the provider charges more than this set amount, you are responsible for paying the difference. This type of limit is most common in extended health plans for paramedical services, such as physiotherapy, chiropractic care, massage therapy, or acupuncture.

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