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.

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For example, if a plan offers a $500 per person annual maximum, each covered individual can claim up to $500 in eligible expenses. If the plan instead has a $1,000 per family annual maximum, the entire family shares that $1,000, 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.

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Understanding whether your plan uses per person or per family limits helps you plan expenses and avoid exceeding shared maximums early in the benefit year.

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Example:

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If your plan has a $1,000 per family dental maximum and you and your spouse each claim $500 for cleanings and fillings, the full family maximum is reached and no further dental expenses are reimbursed until renewal.

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What to Watch For:

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Review your policy details carefully to see how deductibles and maximums are applied. Some plans use per person limits for certain benefits, like vision care, but per family limits for others, such as major dental or travel coverage. Always track cumulative family claims if you share a combined limit.