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.
How It Works
Under a combined maximum, any combination of the grouped services draws from the same pool of coverage rather than each category carrying its own separate cap. A combined paramedical maximum, for example, applies one shared annual limit collectively to several types of paramedical services, pooling them under a single total instead of assigning a maximum to each practitioner. The disciplines pooled this way typically include physiotherapists, chiropractors, massage therapists, acupuncturists, naturopaths, osteopaths, and psychologists, though each insurer defines the grouped disciplines differently. A combined dental maximum works the same way, grouping multiple categories of dental services, such as preventive, basic, and restorative care, under one total. Once a combined maximum is reached, no further claims are reimbursed for any of the included services until the plan renews. These arrangements are most common in personal health and dental plans or guaranteed-issue policies, where flexibility and simplicity are emphasized over unlimited coverage.
Example:
Imagine a Canadian personal health plan that groups physiotherapy, chiropractic, and massage therapy under one shared paramedical combined maximum for the benefit year. A member might use part of that pool on massage therapy and the rest on chiropractic care. Once those visits add up to the combined annual total, the member cannot claim any further paramedical reimbursement until the plan renews, even though no single discipline was capped on its own.
What to Watch For:
Because each insurer defines the grouped disciplines differently, check which practitioners or benefits fall under your combined maximum before relying on it, and confirm when it resets for a new policy year. Keep in mind that an annual maximum works alongside other cost-sharing mechanisms, such as coinsurance, deductibles, reasonable and customary limits, and per-visit caps, so it is worth understanding how those apply to your claims. It also helps to remember that a single plan's combined service maximum is a distinct concept from coordination of benefits, the rule that limits the combined payment from all of your group plans for a particular item to no more than the full eligible expense.
