What is an insurance cap?
An insurance cap is the maximum dollar amount that a health insurance plan will pay for covered health care benefits in a specified period outlined within your insurance policy. If you reach your insurance plan maximum (amount is plan dependent), the plan will no longer provide coverage and you are responsible to pay out-of-pocket for future claims.
Typically, an insurance cap is an annual (yearly) maximum, however, in some insurance policies, a lifetime maximum may apply. A lifetime maximum applies to all periods combined in which an insured person is covered by their insurance provider.
Do all insurance plans have the same insurance cap?
Insurance cap details may vary from plan to plan. Additionally, not all insurance plans include an insurance cap (unlimited maximum).
Why are insurance caps important?
An insurance cap may influence your eligibility to affordably access PrEP depending on the amount and the province you live in. We encourage you to speak with your insurance provider to learn if you have an insurance cap and subsequently, how it may affect your benefits.