Out-of-pocket maximum definition

Out-of-pocket maximum means the maximum amount you will have to pay for allowable covered expenses under a health plan, which may or may not include the deductibles or copayments, depending on the contract for that plan. The specific deductibles or copayments included in the out-of-pocket maximum may vary by policy. Expenses that are applied toward the out-of-pocket maximum should be noted in boxes 8 through 31.
Out-of-pocket maximum means the maximum dollar amount, as stated in the Schedule of Medical Benefits or Pharmacy Benefit, that any Covered Person or Family will pay in any Benefit Period for covered services, treatments or supplies.
Out-of-pocket maximum or "maximum out-of-pocket" means the

Examples of Out-of-pocket maximum in a sentence

  • Once you have paid the Out-of-Pocket Maximum for Services received within the contract year, no additional Copayments, Coinsurance or Deductibles will be charged by the Health Plan for the remainder of the contract year.

  • There is an individual Out-of-Pocket Maxi- mum within the Family Out-of-Pocket Maximum.

  • There are individual and Family Calendar Year Out-of-Pocket Maximum amounts for both Partic- ipating Providers and Non-Participating Providers.

  • Calendar Year Out of Pocket Maximum The Calendar Year Out-of-Pocket Maximum is the highest Deductible, Copayment, and Coinsurance amount an individual or Family is required to pay for designated Covered Services each year.

  • The Out-of-Pocket Maximum is the most you are required to pay for Covered Services in a Calendar Year.


More Definitions of Out-of-pocket maximum

Out-of-pocket maximum. There is an annual maximum eligible out-of-pocket expense limit for prescription drugs of one thousand and fifty dollars ($1,050) per person or two thousand one hundred dollars ($2,100) per family.
Out-of-pocket maximum means the maximum amount a Member will pay in deductible and coinsurance for allowable expenses in any Benefit Year. Please refer to the Benefit Schedule for applicable Out-of-Pocket amounts.
Out-of-pocket maximum means the maximum liability that may be incurred by a Covered Person in a Benefit Period before benefits are payable at 100% of the Allowable Amount.
Out-of-pocket maximum or "maximum out-of-pocket" means the maximum amount an enrollee is required to pay in the form of cost-sharing for covered benefits in a plan year, after which the carrier covers the entirety of the allowed amount of covered benefits under the contract of coverage.
Out-of-pocket maximum means the maximum amount you will have to pay for allowable covered expenses under a health plan.
Out-of-pocket maximum means the maximum amount an enrollee
Out-of-pocket maximum means the annual aggregate amount for which a Participant will be financially responsible for during the Calendar Year. If applicable, the Out-of-Pocket Maximums are listed in the applicable Schedule of Benefits.