In plain English
It is the spending cap for one covered person, not for the whole family. It means the most that person has to pay from their own money for covered health care during one plan period. Once that ceiling is reached, the plan pays all remaining covered costs for that person for the rest of that period.
In context
Here, the expression labels the highest total amount that one person on the family plan must pay out of pocket for covered health care during the plan period before the plan pays all remaining covered costs for that person.
- Situation
- Reading premium, deductible, excess, copay, limit, and out-of-pocket fields
- What it communicates
- labels the per-person out-of-pocket maximum on a family plan
Meaning limits
The term by itself does not say what the family-wide out-of-pocket maximum is or which health care costs count as covered.
Examples
“After Maya reached her individual out-of-pocket maximum, the plan paid the remaining covered costs for her surgery, but her brother on the same family plan still owed his own share.”
“On the family plan, Nora's individual out-of-pocket maximum applied only to her covered care, not to her parents' bills.”