In plain English
This is the yearly spending cap on what a covered person has to pay themselves for covered health care costs. Premium payments are not part of this total. Once the cap is reached, the plan pays the full covered cost of further covered care for the rest of the plan year.
In context
Here, the expression labels the highest total amount a covered person must pay in a plan year for covered health care costs, excluding premiums, before the plan pays the full covered cost of further covered care for the rest of that year.
- Situation
- Reading premium, deductible, excess, copay, limit, and out-of-pocket fields
- What it communicates
- labels the out-of-pocket maximum entry in the comparison table
Meaning limits
The term by itself does not tell you what that maximum amount is for a particular plan.
Examples
“Once Amir's covered bills reached the out-of-pocket maximum, he still paid his premiums, but the plan covered the full cost of his further covered care for the rest of the year.”
“Before the operation, they checked whether Rosa had already met her out-of-pocket maximum for the year.”