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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.

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.

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.

Example:

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.

What to Watch For:

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.

Related Terms

Paramedical Disciplines

Paramedical disciplines refer to regulated health professionals who provide therapy or rehabilitation services outside of hospital settings. Common examples include physiotherapists, chiropractors, massage therapists, acupuncturists, naturopaths, osteopaths, psychologists, and speech-language pathologists.

Pay-Direct card / Drug card

A pay-direct card, also known as a drug card, is a plastic or digital card issued by your health insurance provider that allows pharmacies to bill your insurer directly for eligible prescription drugs. Instead of paying the full cost upfront and submitting a claim later, you pay only your portion - such as a deductible or coinsurance - at the point of sale.

Per Incident

Per incident refers to the way certain insurance benefits are calculated or limited based on each separate event, illness, or accident rather than by year or lifetime. When a benefit is paid “per incident,” it means you are eligible for reimbursement each time a new, distinct occurrence happens, up to the maximum amount specified for that type of claim.

Per-Practitioner Annual Maximum (Paramedical)

The per-practitioner annual maximum is the total amount your plan will reimburse for services from one specific type of provider in a single benefit year. For example, if your plan pays up to $500 for massage therapy annually, once that amount is reached, additional treatments from that provider type are no longer covered until the next year.

Per-Visit Cap (Paramedical)

The per-visit cap is the maximum amount your insurance plan will reimburse for a single visit to a paramedical provider, such as a physiotherapist, chiropractor, or massage therapist. If the provider charges more than the cap, you are responsible for the difference. This cap ensures fairness and cost control by aligning payments with typical local pricing.

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