How do plans calculate what constitutes a “day” or a “visit” when applying the benefit limits?
Only the days or visits actually paid as benefits under the plan count toward the limits. Many plans include deductible provisions which mean the covered person must pay for covered services out of pocket until the deductible has been met If a person pays for services while meeting the deductible those services do not count against the limited number of days or visits under the plan. For example, if a person goes for 6 physical therapy visits in January and the cost for those visits is applied toward a $1,000 deductible, those 6 visits do not reduce the 30 physical therapy visits covered under the plan. Once the $1,000 deductible is satisfied the person would be eligible for 30 visits for which the plan would pay benefits.
