What is a common term for the limit on the amount of money an insurer will pay for a specific service?

The concept of a maximum benefit limit refers to the cap imposed by an insurance policy on the total amount the insurer will pay for specific services or treatments during a specified timeframe, such as a year. This limit is essential in helping insurers manage their exposure to high-cost claims.

For instance, if a health insurance policy has a maximum benefit limit of $100,000 for surgical procedures, once the insured has accumulated costs that reach this threshold, the insurer will not cover any additional expenses beyond that limit for those specific services. This protective feature helps insurers maintain financial sustainability while balancing the benefits provided to policyholders.

In contrast, terms like deductible, copayment, and coinsurance relate to the cost-sharing measures between the insured and the insurer but do not set a ceiling on the total reimbursement amount for a specific service, making them different in function and purpose from the maximum benefit limit.