What does “coverage year” refer to?

The term “coverage year” specifically refers to the time period during which the insurance plan provides active benefits to the insured. This is critical for understanding how health insurance plans operate, as it defines when members can access their benefits, what limitations may apply, and how costs, such as deductibles and out-of-pocket maximums, reset annually.

While the period may align with a calendar year or start from the enrollment date, the defining aspect is that it is the duration when the plan is effective and claims can be filed. This distinguishes a coverage year from other concepts like premium payment schedules or benefit limits, providing clarity on how long insured individuals can expect their coverage to be effective.