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.
Sample 1Sample 2Sample 3
Out-of-pocket maximum or "maximum out-of-pocket" means the
Sample 1Sample 2Sample 3
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.
Sample 1Sample 2Sample 3

Examples of Out-of-pocket maximum in a sentence

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

  • Credit may be given for prior amounts applied toward the Deductible and Out-of-Pocket Maximum for the same Benefit Period during which renewed eligibility occurs.

  • See “Dependent Verification of Eligibility Requirements” within ELIGIBILITY PROVISIONS for required documentation.JOINT CORE COVERAGE Under Joint Core, the family is subject to only one Out-of-Pocket Maximum.

  • Once you reach your Out-of-Pocket Maximum, the Claims Administrator will pay 100% of the Allowable Amount for Covered Services for the rest of the Calendar Year.Your payment after you reach the Calendar Year OOPM.

  • Medications that are approved through the Prior Authorization or exception request process will be treated as an Essential Health Benefit with member’s cost share applying to the Out-of-Pocket Maximum.


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.
Sample 1Sample 2Sample 3
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.
Sample 1Sample 2Sample 3
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.
Sample 1Sample 2Sample 3
Out-of-pocket maximum means the maximum amount you will have to pay for allowable covered expenses under a health plan.
Sample 1Sample 2Sample 3
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.
Sample 1Sample 2Sample 3
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.
Sample 1Sample 2Sample 3
Out-of-pocket maximum or "maximum out-of-pocket" means the maximum amount an enrollee is
Sample 1Sample 2Sample 3