How to Determine Maximum Annual Health Insurance Caps

A "maximum annual cap" on a health insurance policy is actually the total amount that the insurer will pay during a year. If you see this on your policy benefits sheet, you'll want to pay attention; a low maximum annual cap makes the policy nearly worthless. After all, the idea of insurance is to protect someone from high medical costs. It's very important that a policy holder know what the maximum annual cap on a policy is to avoid a sense of false comfort as a policy holder.

Instructions

• 1

  Inspect your policy carefully. Take a look at the "explanation of benefits" chart where copays and deductibles are laid out. If you don't see maximum cap information there, look in the fine print section. Not all policies have annual caps, but some are hidden in the paperwork.

• 2

  Ask your broker. It's not infrequent for small companies to line individuals up with policies from large insurers. If there was an "agent" who made the deal with your policy, pick their brain for information on the maximum annual caps. They should be able to tell you what the deal is.

• 3

  Contact your health insurance company. Most of the big ones have email centers for convenience, but to take on the following steps, you'll have to call in. You should have an 800 number on the back of your insurance card that you can call to ask questions or resolve issues.

• 4

  Ask about an unclear benefits chart, or no maximum cap information. Some charts have the maximum cap printed in the "Non-Preferred Provider" column; ask the rep to specify whether there are DIFFERENT max annual caps for preferred or non-preferred providers (as there are sometimes different copays, etc). Make sure the company is responsive to your questions; it is their responsibility to provide you with accurate max cap information.

• 5

  Get it in writing. If a rep tells you something that isn't clearly written on your plan explanation, ask them to send another document specifying the answer to the question you ask. Unclear or missing paperwork is a boon to insurance companies when it comes time to avoid paying claims. Don't let a bad maximum cap sink your claims if they do occur.