Overview
Your benefits summary shows your coverage limits and how much you've used. Understanding these limits helps you make the most of your Soda benefits and plan your healthcare visits throughout the year.
What you'll learn:
- How to read your benefits summary
- Understanding annual limits
- Checking remaining balance
- Per-visit limits and co-payments
- What happens when limits are reached
- How limits reset
What is a benefits summary?
You can find your policy limits and benefits under the section "Coverage"
Your benefits summary shows:
- Your annual limit (total amount available for the year) - if applicable
- Amount used so far
- Remaining balance
- Per-visit limits (if applicable)
- Co-payment amounts (if applicable)
- Service categories covered
Where to find it:
- In the Doctor Anywhere app, all your policy-related features are under the section "Coverage"
- Real-time updates after each visit
- View anytime to check your balance
- See your claim history
Why it matters:
- Plan your healthcare visits
- Know how much you have left
- Avoid unexpected out-of-pocket costs
- Track your usage throughout the year
Understanding annual limits
What is an overall limit?
- Maximum amount you can claim in a policy year
- Set by your company
- Applies to all covered services (benefits)
- Resets at policy renewal date
How it works:
- You can use up to your limit amount
- All claims count toward your limit
- Unused amount doesn't carry over
- Limit resets on your policy anniversary
If your policy has an overall limit, you will see it under the tile "Overall limit: all benefits"
Shared (group limits) vs. separate limits
Shared limit (sometimes also called group limit):
- One limit covers multiple services (benefits)
- Example: $1,000 = use for GP, dental, specialist, etc.
- More flexibility in how you use benefits
Separate limits:
- Different limits for different service categories
- More control over specific service spending
- Each category has its own limit
How to know which you have:
- Check your benefits summary - if you have group limits, you will see a label "Group limit" - after tapping on it, you can view all limits that belong to this group
- Shared limit shows one total amount
- Separate limits show multiple categories
- If you are unsure - ask DA Assistant (it's available on the policy details page) - in the bottom right corner
Per-visit limits
What is a per-visit limit?
- Maximum amount covered per single visit
- Protects against high-cost single visits
- You pay excess if visit exceeds limit
- Remaining annual limit still available
Co-payments
What is co-payment?
- Fixed amount you pay per visit
- Company pays the remainder
- Example: $5 co-pay per GP visit
How it works:
- Doctor visit: $50
- Co-payment: $5
- You pay: $5
- Company pays: $45
- $45 counts toward your annual limit
Where to see it:
- Shown in benefits summary
- Check your plan details
What happens when you reach your limit?
When limit is reached:
- You can still visit clinics
- You pay out-of-pocket for additional visits
- Benefits stop until renewal
After limit reached:
- No more benefits until renewal
- All visits are out-of-pocket
- Limit resets at policy renewal
- New limit available on renewal date
Important:
- Limit resets on policy anniversary
- Not calendar year (unless policy starts Jan 1)
- Check your renewal date in the app (Go to e-card details page, and look for the effective day)
- New limit available on renewal
Common questions
Q: How do I check my remaining balance?
A: Open your Soda app or employee dashboard, go to the "Coverage" section, and view your benefits summary. Your remaining balance is shown in real-time.
Q: What happens when I reach my limit?
A: You can still visit clinics, but you'll pay out-of-pocket for additional visits. Your benefits resume when your limit resets at policy renewal.
Q: Do unused limits carry over to next year?
A: No, unused limits don't carry over. Your limit resets to the full amount on your policy renewal date.
Q: What is a per-visit limit?
A: A per-visit limit is the maximum amount covered per single visit. If a visit costs more, you pay the excess.
Q: What is co-payment?
A: Co-payment is a fixed amount you pay per visit (e.g., $5). The company pays the remainder, and the company's portion counts toward your annual limit.
Q: How do I know if I have shared or separate limits?
A: Check your benefits summary. Shared limits show one total amount - and they are labelled "Group limits" or "Overall limits", while separate limits show individual amounts per service (benefit).
Q: When does my limit reset?
A: Your limit resets on your policy anniversary date (renewal date), not the calendar year. Check your benefits summary for your specific renewal date (effective date)
Q: What if I join mid-year? Do I get a full limit?
A: If you join mid-year, your limit is prorated based on remaining months. For example, if you join with 6 months remaining, you get half the annual limit. Full limit available next year.
Q: Can I see my claim history?
A: Yes! Your benefits summary includes your claim history, showing all visits, dates, amounts, and services used - you will find it under the section "Coverage" in the Doctor Anywhere app.