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Lifetime Maximum

A lifetime maximum is the total amount your insurance plan will pay for a specific benefit over the course of your life. Once the limit is reached, no further reimbursement is available for that benefit. Lifetime maximums commonly apply to orthodontics, medical equipment, or travel emergency medical coverage.

For example, an orthodontic lifetime maximum might be $2,000, while a travel emergency lifetime maximum could be $5 million. Lifetime limits protect insurers from unlimited long-term exposure while allowing members to plan major expenses realistically.

Example:

If your orthodontic lifetime maximum is $2,000 and you have already received that amount in claim reimbursements, additional orthodontic costs will not be covered in the future.

What to Watch For:

Unlike annual limits, lifetime maximums do not reset. Always verify whether lifetime limits apply per insured person or across your family. Keeping receipts helps track cumulative usage.

Related Terms

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 Person / Per Family

Per person and per family describe how benefit limits, deductibles, or maximums are applied within a health or dental insurance plan. A per person limit means the specified amount applies individually to each insured member, while a per family limit represents the total combined coverage for all members under one policy.

Pre-Determination of Benefits

Pre-determination of benefits is the process of submitting a treatment plan or cost estimate to your insurance provider before receiving care to confirm how much of the expense will be covered. This step helps you understand your expected reimbursement and out-of-pocket cost before proceeding with services that may be costly or complex.

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.

Healthcare Spending Account (HCSA)

A Healthcare Spending Account (HCSA) is a flexible, employer-funded benefit that reimburses employees for a wide range of eligible healthcare expenses not fully covered by their group insurance plan or a government health plan. It allows employees to use allocated funds toward medical, dental, and vision expenses based on their personal needs. The Canada Revenue Agency (CRA) regulates which expenses qualify under the Income Tax Act, and reimbursements from an HCSA are received tax-free.

Relevant Plans

Plans that relate to Lifetime Maximum

Alberta Blue Cross - Blue Assured - Basic

Alberta Blue Cross - Blue Assured - Basic

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Enhanced

Alberta Blue Cross - Blue Assured - Enhanced

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Enhanced+

Alberta Blue Cross - Blue Assured - Enhanced+

Can apply at anytime, at any age.

Alberta Blue Cross - Blue Assured - Premium

Alberta Blue Cross - Blue Assured - Premium

Can apply at anytime, at any age.

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