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.