Maximum Benefit

What Does Maximum Benefit Mean?

The maximum benefit is the highest amount of insurance money that an insurer can pay to an insured during a specific period. Once this limit is reached, the insured is responsible for covering any additional costs for a product or service.

Insuranceopedia Explains Maximum Benefit

A maximum benefit is commonly applied to health insurance, where there is a limit on the amount the insurer will pay for certain benefits, such as non-essential services like dental and oral care.

The passage of the Affordable Care Act in September 2010 exempted essential services from being subject to a maximum benefit. Essential services, including medical emergencies, hospitalization, and pregnancy, are required by law to be fully covered by insurance, regardless of any maximum benefit limits.