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.
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Out-of-pocket maximum or "maximum out-of-pocket" means the
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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.
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Examples of Out-of-pocket maximum in a sentence

  • What We pay is based on all the terms of this Contract.] (Use the above text if the Tier 1 deductible can be satisfied separately and allows a Member to be in benefit for further Tier 1 Covered Services and Supplies and is also applied toward the satisfaction of the Tier 2 deductible.) [Maximum Out of Pocket Maximum out of pocket means the annual maximum dollar amount that a Member must pay as Copayment, Deductible and Coinsurance for all Covered Services or Supplies in a [Calendar] [Plan] Year.

  • Your Out of Pocket Maximum is determined by the number of Members enrolled in this Plan.

  • If only one (1) Member is enrolled in this Plan, then only the Individual Out of Pocket Maximum applies.

  • If more than one (1) Member is enrolled in this Plan, then both the Individual Out of Pocket Maximum and the Family Out of Pocket Maximum are applicable.

  • Out of Pocket Maximum The Out of Pocket Maximum includes all payments, including Deductibles, Coinsurance and Copayments, which You pay during a Benefit Period for all Essential Health Benefits, medical services, child dental and vision services and Prescription Drug services combined.


More Definitions of Out-of-pocket maximum

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.
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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.
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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.
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Out-of-pocket maximum means the maximum amount you will have to pay for allowable covered expenses under a health plan.
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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.
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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 deductibles and copayments, depending on the contract for that plan. The specific deductibles and copayments included in the out-of-pocket maximum may vary by policy.
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Out-of-pocket maximum or "maximum out-of-pocket" means the maximum amount an enrollee is
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