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coverage limits of medical insurance

28 July 2023

If you're wondering how do I know my medical insurance coverage and the maximum you can reach? Here are the full details about the coverage limits in medical insurance.

Of course, if a person falls under a list of medical insurance, he may be exposed to different situations to obtain approvals for the medical procedures he performs, and most of the procedures fall under the list of accepted medical approvals, but can the approval be under the list of acceptance, but despite that the insurance company cannot cover it? In what cases does the medical insurance company not be able to cover medical procedures? Let's move on to the details.

Like the nature of any insurance company, the company sets a credit limit (also known as coverage limits), as coverage is the insurance company covers the costs of the procedure, and the coverage limit is common in insurance, but it is often associated with different conditions.

The medical insurance coverage limits for a policy mean the maximum amount that the insurance company will be willing to pay for a covered claim, and once this limit is reached, the insured must pay all health expenses for the rest of the contract period, and most likely the more comprehensive the medical insurance policy, the higher the permissible coverage limit, but unfortunately it is not always that simple.

What are the coverage limits of medical insurance?

The term coverage limit is used in medical insurance in a variety of ways, as it can refer to the maximum amount that a person will have to pay from their own costs when they need medical care.

The concept of annual coverage limit in medical insurance can also refer to the maximum amount that the medical insurance company can bear according to the health insurance plan agreed with the insured during a given year of medical insurance.

If the insured reaches the annual coverage limit, he will be responsible for bearing the material costs of other procedures during the remainder of the year and paying them for further medical care.

Most medical insurance policies have an annual coverage limit, and short-term insurance plans can have an annual limit, but in most cases, patients do not reach this limit, and the year may end and they still have enough balance to cover more procedures.

Fixed compensation plans also include annual limits on how much the plan will pay, as well as limits for each accident or per service.

Are there different types of coverage limits in medical insurance?

There is more than one coverage limit that can be set for medical insurance policies, hence we can divide them as follows:

  • The first and most important limit is the annual coverage limit:

According to the general definition of the annual coverage limit, this annual limit will be responsible for determining the amount that the insurance will pay for one year of registration, and any amount that exceeds this limit, the insured will pay in the event that they try to obtain more medical procedures, and this limit is determined by setting a certain amount of money, or the number of visits to the health care provider, and once the limits are reached, all overtaken costs will be paid by the insurance company until the end of registration.

  • Age limit:

The age limit follows the same logic as before, however, there is no time limit for coverage, which means that the insurance company will spend for covered benefits throughout the time of registration (which can sometimes be a lifetime).

Please note that the annual coverage limit applies to most health insurance plans, and all people should make sure to have the correct information about the total limit before contracting, and the maximum policy limit.

  • Some coverage limits in health plans:

Health insurance policies cover different types of treatments under different terms, which means that there are basically multiple coverage limits in one policy, so a medical insurance policy that falls under can be a certain annual limit to cover a specific medical service.

It should also be borne in mind that certain treatments can be grouped into one category (e.g. all dental treatments) which by themselves are subject to an annual limit.

For example, if during the registration period, you receive multiple dental treatments – for example, general and major treatments – you may find yourself liable for excess expenses if you reach the combined annual limit for dental treatments.

To shorten the long story, as long as no indication of coverage limits is applied to a specific covered treatment, there is no limit to the specific treatment.

Besides the coverage limits, you will also find all the necessary information about waiting periods that apply to treatments not covered by the insured.

Are there disadvantages to the health insurance policy?

One of the main drawbacks of getting health insurance is the large cost if you are not under a private company, the pre-existing exclusion of certain medical approvals, the long waiting period, increased premiums, and copayment.

If you have questions about Brokerage Insurance Medical Insurance policies, please do not hesitate to contact us, read our blog articles, or speak with customer service representatives directly for medical assistance.