What is a benefit maximum?
A benefit maximum is a limit on a covered service or supply. A service or supply may be limited by dollar amount, duration, or number of visits.
Here are examples of benefit maximums:
- Well-woman exams are limited to one per calendar year.
- A lifetime maximum is the maximum dollar amount which will be paid on your behalf under any HMSA plan which is sponsored by the same employer or contract holder for the same group health plan. See your Guide to Benefits for more information and the dollar amount applicable to your plan.
See your Guide to Benefits to find out if a service has a benefit maximum.
For additional important information, we encourage you to read: