CARC 35: Lifetime benefit maximum has been reached
Your plan's lifetime coverage cap for this type of service has been exhausted.
What this means for your claim
For most services on ACA-compliant plans, lifetime limits are banned. However, short-term plans or grandfathered plans may still have them. This code may also apply to specific benefit categories like mental health visits.
What to do next
- 1
Check your plan documents to confirm whether a lifetime limit applies and whether your plan is ACA-compliant.
- 2
If your plan is subject to the Mental Health Parity Act or ACA, a lifetime dollar limit on mental health or medical benefits may be illegal — file a complaint with your state insurance commissioner.
- 3
Contact your insurer in writing to request the full lifetime benefit tracking to verify the calculation.
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