Insurance term
Annual Maximum
Definition
The annual maximum is the most a dental plan will pay toward a patient's care in one benefit year.
Why it matters for the front desk
Once a patient reaches the maximum, they pay for everything else until the benefit year resets, which may not be January 1. The remaining amount changes with every claim, including claims from other offices, so the figure from last month's check can already be out of date. Checking the remaining maximum before a large treatment plan lets you phase treatment across benefit years when it makes sense for the patient.
Related reading
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What Actually Happens During Dental Insurance Eligibility Verification
Related terms
- Deductible A deductible is the amount a patient must pay out of pocket each benefit year before the plan starts paying for covered services.
- Coinsurance Coinsurance is the percentage of a covered procedure's cost that the patient pays after the deductible, with the plan paying the rest.
- Eligibility Verification Eligibility verification is the process of confirming, before an appointment, that a patient's dental coverage is active and what it will pay for.