Health insurance plan is the way to arrange fiscal help for the medical treatment as well as to ensure that you are safe in case of any health emergency. In any plan whether it is a private or government health insurance, there is a fixed amount of money to be provided within a certain duration which is known as upper limit. It is the total amount of money that is paid by the insurance plan as reimbursement for a specific time period. Let’s understand it with the help of an example. Assume that you are purchasing a government health insurance plan with an upper limit of $20,000 for one year. It means that you will be paid only up to $20,000 for medical costs of a year by the insurance company. If your bills exceed this limit, then you have to pay rest of the amount at your own.
If you reached that upper limit in the middle of fixed time period, the insurance plan will not pay you anymore. However, you can continue to get the reimbursement after the renewal of the plan which can be done after the time period of plan is over. This upper limit varies from policy to policy, but generally it remains between the range of 1 to 5 million dollars. Though, there are some government health insurance policies that provide less than 1 million dollar as the upper limit for a fixed period plan but those are very rare.
Some people go for the unnecessary medical checkups or treatment if they are enrolled in a kind of plan which gives them 100% indemnification. The upper limit is fixed to maintain a minimum potential liability to avoid the misuse of the insurance plan. However, sometimes that upper limit is not sufficient to reimburse the expenses of chronic diseases like open heart surgery, cancer or organ transplantation. In such situation, one needs a policy with greater duration or upper limit that provides bigger amount to meet the expenses of such sudden emergencies. Even there are some government health insurance policies in which there is no upper limit. For such plans you need to pay higher annual deductibles as compared to the policies with fixed upper limit.