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.
How It Works
A per person limit means the specified amount applies individually to each insured member of the plan. A per family limit instead represents the total combined coverage shared by all members under one policy, regardless of how many members are insured. This structure is used in both group and individual plans to manage claim costs and ensure fairness between smaller and larger households. In a Canadian family health insurance plan, multiple members of a household are covered under one policy rather than each holding a separate individual policy. Some plans apply per person limits to certain benefits, such as vision care, while applying per family limits to others, such as major dental or travel coverage. In a Sun Life Personal Health Insurance plan, coverage maximums are stated for each insured person and per calendar year unless otherwise stated, which illustrates how per person maximums are applied.
Example:
Suppose a Canadian extended health and dental plan sets a per family annual dental maximum that the whole household shares. If you and your spouse each claim cleanings and fillings early in the year, your combined claims can reach the shared family maximum, after which no further dental expenses are reimbursed until the plan renews. By contrast, if vision care on the same plan carries a per person limit, each insured member still has their own separate vision allowance regardless of what the others have claimed.
What to Watch For:
When members share a combined family limit, cumulative family claims should be tracked because the maximum can be reached before the benefit year ends. Whether a limit is applied per insured person or across the whole family should be verified for each benefit, since some maximums, such as lifetime limits, may apply differently per person versus per family.
