Basics

• Individual insurance policies are those that cover an individual. With family protection, each individual usually has a policy limit, as does the entire family. Your insurance binder explains total policy limits for the coverage period (generally calendar years) as well as maximum payouts for specific types of claims.
  
  

Payout Process

• Amounts paid by your insurer to the provider apply toward your payout limits. If you have an unmet deductible for a covered event, you pay this amount plus any co-insurance or co-payments. The remainder is paid by the insurer, up to your maximum payout limit.
  
  

Examples

• Health plans often have no maximum payouts on total claims, though you can find lower premiums with policies that do have a maximum. Health plans do often have limits on certain events like routine wellness check-ups. Dental plans typically have maximum annual payouts, as well as maximum payouts for various types of events (eg. orthodontics).