Common use of Benefit Maximums Clause in Contracts

Benefit Maximums. Some of the Authorized Benefits and Services described in this Certificate are covered for a limited number of days or visits per Contract Year. This is known as a benefit maximum. The Schedule of Out-of-Pocket Expense attached to this Certificate lists the maximums that apply to certain benefits. Once you have reached a maximum for a Covered Service, you will be responsible for the cost of additional services received during that Contract Year even when continued care is Medically/Clinically Necessary.

Benefit Maximums. Some of the Authorized Benefits and Services described in this Certificate are covered for a limited number of days or visits per Contract Year. This is known as a benefit maximum. The Schedule of Out-of-Pocket Expense Expenses attached to this Certificate lists the maximums that apply to certain benefits. Once you have reached a maximum for a Covered Service, you will be responsible for the cost of additional services received during that Contract Year even when continued care is Medically/Clinically Necessary.