In plain English
This is a shared spending cap for everyone covered under a family health plan. It combines what covered family members pay for covered health care during one plan year. After that combined total reaches the cap, the plan pays all further covered costs.
In context
Here, the term labels the maximum combined amount that all covered members of the family on the plan must pay for covered health care during the plan year before the plan pays all further covered costs.
- Situation
- Reading premium, deductible, excess, copay, limit, and out-of-pocket fields
- What it communicates
- labels the family-level out-of-pocket maximum on a family plan
Meaning limits
By itself, the term does not state the amount of that maximum or which health care the plan treats as covered.
Examples
“When the covered members' payments for covered health care during the plan year reached the family out-of-pocket maximum, the plan paid all further covered costs.”
“Keep a running total of what each covered family member pays for covered care so you can see when the family out-of-pocket maximum is near.”