Maximum Benefit

Updated: 11 March 2024

What Does Maximum Benefit Mean?

Maximum benefit is the highest amount of insurance money that an insurance company can pay to an insured for a specific period. Beyond this amount, the insured pays for the cost of a product or a service.

Insuranceopedia Explains Maximum Benefit

A maximum benefit is usually applied to health insurance. There is a limited insurance amount for certain benefits deemed as non-essential, including dental and oral care.

The passing of the Affordable Care Act in September 2010 exempted essential services from being subject to a maximum benefit. The services deemed essential include medical emergencies, hospitalization, and pregnancy. By law, services like these will always be covered by insurance.

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