Per Incident

Per incident refers to the way certain insurance benefits are calculated or limited based on each separate event, illness, or accident rather than by year or lifetime. When a benefit is paid “per incident,” it means you are eligible for reimbursement each time a new, distinct occurrence happens, up to the maximum amount specified for that type of claim.

How It Works

The per-incident structure is most common in emergency medical, travel, accidental dental, or hospital coverage. Under it, the insured is eligible for reimbursement each time a new, distinct occurrence happens, up to the maximum amount specified for that type of claim. Multiple unrelated events can each qualify for full reimbursement, as long as each is considered a separate incident by the insurer. Repeated treatments or complications arising from the same original cause, however, are usually treated as one incident rather than several. For example, Sun Life's Personal Health Insurance Standard plan reimburses accidental dental at 100 percent limited per fracture or injury, a per-incident limit applied to each separate accident, while under TD's Accident and Sickness Hospitalization coverage any recurrent hospitalization due to the same or related cause within 180 days of another is considered a continuation of the initial period rather than a new incident.

Example:

Suppose your Canadian extended health plan covers accidental dental repair to natural teeth on a per-incident basis. If you chip a tooth in a fall in January and later break a different tooth in a separate accident in July, each accident is treated as its own incident, so the per-incident maximum applies fresh to each. If instead you needed follow-up treatment on the same January tooth months later, the insurer would likely group it under the original incident rather than resetting the limit.

What to Watch For:

Because some insurers group related medical visits or follow-up treatments under a single event, you should check your policy's definition of incident and confirm whether the limits are per incident, per year, or per lifetime. That distinction matters, since repeated treatments or complications arising from the same original cause are usually treated as one incident rather than multiple separate ones, which affects how often you can claim for the same type of expense.