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Overall Plan Maximum

An overall plan maximum is the total amount your health and dental plan will pay for all combined benefits within a single policy year. Once the limit is reached, you must pay any additional expenses out of pocket until the next renewal period.

This type of maximum is often used in guaranteed-issue or conversion plans where coverage cannot be declined based on health. It helps insurers manage risk while still providing a wide range of benefits.

Example:

If your plan has a $10,000 overall plan maximum and you claim $6,000 in health and $4,000 in dental expenses, no further claims are reimbursed for the rest of the year.

What to Watch For:

Monitor your total claims, since reaching the overall maximum stops reimbursement for all covered categories until reset.

Related Terms

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.

Benefit Period (Vision)

The benefit period for vision refers to how often your vision care coverage renews and allows you to make new claims for eligible expenses such as glasses, contact lenses, or eye exams. Unlike other benefits that reset each year, vision care often renews every two benefit periods, which can mean every 24 consecutive months rather than every calendar year.

Anniversary Year

An anniversary year is a 12-month benefit period that begins on the date your insurance coverage takes effect rather than on a standard calendar year. This means your plan’s annual maximums, deductibles, and claim resets follow your personal enrollment date instead of January 1 to December 31.

Policy (Contract)

A policy, also referred to as a contract, is the legally binding agreement between an insurance company (the insurer) and the policyholder that defines the terms, conditions, and obligations of coverage. It outlines what is insured, the benefits provided, the premium amount, exclusions, and the responsibilities of both parties. Once the insurer accepts the application and the first premium is paid, the policy becomes active and enforceable.

Annual Maximum (Overall Plan)

The annual maximum is the most your insurance plan will pay for a specific benefit within a 12-month period (calendar year or benefit year). Once you reach this limit, additional expenses for that category become your responsibility until the next year.

Learn More About Overall Plan Maximum

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Relevant Plans

Plans that relate to Overall Plan 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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