What happens when an insured reaches their 'Lifetime Maximum'?

When an insured reaches their 'Lifetime Maximum,' all coverage for that benefit ceases. This term refers to the maximum amount that an insurance company will pay for a particular benefit or service over the lifetime of a policyholder. Once this limit is reached, the insurer is no longer obligated to provide coverage for that specific benefit, meaning the insured must pay out of pocket for any further medical expenses related to that benefit.

The concept of a Lifetime Maximum is designed to manage the insurer's financial risk and can vary significantly from one policy to another. It is especially relevant in the context of high-cost therapies or treatments, where individuals can quickly accumulate expenses that might exceed the insurer’s limit. Understanding this provision is crucial for policyholders, as it impacts their long-term health care planning and financial obligations.