The maximum dollar amount per calendar year of co-insurance expenses payable by you for covered medical services rendered by out-of-network providers.
A provision in a health insurance policy that sets a limitation on the most the insured will have to pay toward their share of covered medical expenses in a calendar year. This amount is in addition to the deductible, and is subject to the maximum lifetime benefit.
Amount you pay (in co-insurance and in some plans, deductible also) after which the insurance will generally cover 100% of Reasonable and Customary charges, up to a lifetime (or annual) maximum.
The most you will have to pay for covered expenses in any calendar year before the plan pays 100 percent.
The limit on your total copayments, deductibles and coinsurance under a benefit plan option.
The maximum amount you must pay for eligible expenses each year before the health plan begins paying 100 percent of subsequent eligible expenses in that year. For all health plans, the OPM per person is $1,000 or $2,000 for a family (except the Ohio Med non-network OPM is $2,000 for single and $4,000 for family).
a safety net to limit your out-of-pocket liability
The maximum amount that a health plan member will have to pay for covered expenses under the plan. When the OOP max is met, the health plan pays for covered expenses at 100%.
The maximum dollar amount -including deductibles and copayments that you pay in any calendar year toward the cost of covered medical care. Once you reach your individual or family out-of pocket maximum, the health plan will cover your eligible services at 100% for the remainder of the calendar year. Prescription Drug copayments are not included in your out-of-pocket maximum dollar amount.
The maximum amount of coinsurance an insured is required to pay before the plan will pay 100% .
The total amount of money that the consumer will be obligated to personally incur each year in copayments and deductibles. For instance, the health plan may have a $3,000 annual out-of-pocket maximum which means that after the deductible and copay costs reach $3,000, the enrollee has full coverage. PARTICIPATING PROVIDER A physician who has a contract with the health plan to provide treatment to the health plan's patients.
The maximum amount of money a person will pay in addition to premium payments and co-payments where applicable. The out-of-pocket maximum includes the co-insurance payments and sometimes the deductible.
The maximum amount that a Member will have to pay for Covered Services under the Health Benefit Plan. The maximum is typically the sum of all Deductible and Co-payment or Coinsurance amounts paid by the Member.
Refers to the maximum amount that an enrollee will have to pay for expenses covered under the health plan. The maximum is a sum of all paid deductible and co-payment or coinsurance amounts.
The total amount of the calendar year deductible plus the amount of any coinsurance and/or copays a covered person must pay each calendar year for covered services before benefits will be paid at 100%; some services may not apply to the out-of-pocket maximum.
The maximum amount you will pay for covered medical services in any calendar year. The plan pays 100% of reasonable and customary expenses after you have met the out-of-pocket maximum.
The most money you will pay in a year for deductibles and co-insurance. Co-pays for Dr. office visits and prescriptions are in addition to this maximum amount.
The amount of co-insurance a member must pay before out-of-network claims will be paid at 100% of the allowed amount.
Dollar amount set by the insurer that limits the amount members have to pay out of their own pocket for particular covered healthcare services during a specified time period.
The total amount the member must pay for coinsurance and/or copayments in a calendar year before the plan covers the full cost (100%) of eligible expenses.
Preset dollar amounts that limit the amount a health plan member must pay out of his or her own pocket for certain health care services during a specific period (usually annually).
A cap placed on out-of-pocket costs, after which benefits increase to provide for full coverage for the rest of the benefit year; also known as an out-of-pocket maximum (OOP).
The amount an enrollee must pay for coinsurance in a calendar year before the plan covers remaining expenses for that year at 100%.
A specified amount that the enrollee must pay out-of-pocket for covered services in a benefit period.
means a specified dollar amount of covered services received in a calendar year that is the Member's responsibility. For PCP-Coordinated Care, this amount includes only the copayments and coinsurance for PCP-Coordinated services.
The total dollar amount paid by the patient for covered medical services during a specified period of time, such as 1 year. The stop-loss limit may also be called the maximum out-of-pocket cost or catastrophic expense limit.
fixed sum of money that any single insured person must pay using their own money or funds, prior to a national health insurance company covering a consumers' health care bills in full.
A cap on the amount a health plan member is required to pay outside of his or her benefits plan for covered services.
is a predetermined amount of money that a plan member must personally pay in a calendar year before the insurance company will pay 100% of the plan member's additional health care expenses.
The total payments that must be paid by a covered person (i.e. deductibles and coinsurance).
The maximum amount of money you are required to pay in a year, in deductibles and coinsurance.
The maximum dollar amount that you have to pay in a calendar year for Covered Services. Only certain expenses you pay count toward meeting the Out-of-Pocket Maximums and they generally include the Deductible(s) and Coinsurance payments you make for Covered Services.
The maximum out of pocket that member will have to pay for expenses covered under the health plan. The maximum may be a coinsurance maximum or a copayment maximum. Generally the OOP amount is calculated by the sum of all paid deductible and copayment or coinsurance amounts. Some POS plans may have two types of OOP maximums for services in and out of the network. Once the member reaches the OOP maximum(s) the plan pays 100% of expenses for covered services. Note: A family OOP is 2 or 3 times an individual member's amount.
CLOSE Your Out-of-Pocket Maximum is a limit on the health care costs that you pay. After you reach the limit, plans generally pay all covered costs for the rest of the year. Typically the amount you pay toward deductibles and coinsurance counts towards your out-of-pocket maximum. Most plans do not include copays or what you pay for prescription drugs in your out-of-pocket maximum. The individual out-of-pocket maximum is the limit on what you pay for one person in your family. With the family maximum, when one person meets the individual maximum, you can combine the costs for other family members to meet the rest of the family limit.
the most a participant will pay for covered medical expenses in copayments or coinsurance. Some charges do not count toward this maximum.
The highest dollar amount a member or family must pay in combined copayments and deductibles during any given year.
The maximum amount you have to pay for expenses covered under your health care plan, after any deductible is met, during a defined benefit period.
the most you pay in coinsurance during a benefit plan year. After you reach your out-of-pocket maximum, your medical plan option pays 100 percent of eligible expenses for the remainder of the benefit plan year. The Albertsons health care plan consists of in-network and out-of-network out-of-pocket maximums.
A limit on all of the insured's out-of-pocket expenses (including deductibles and co-payments) for treatment of illness or injury. At this point, the insurance company will begin covering 100 percent of the charges. If you use non-network providers, the out-of-pocket maximum could be as high as $10,000.
A fixed dollar limit on a member's out-of-pocket expenses. After reaching this set limit, prescriptions can be filled at a reduced cost or at zero cost to the member (dependent upon benefit structure). All prescriptions or only certain types of prescriptions a member receives may accumulate toward the out-of-pocket maximum. Example: All copayments/coinsurance may accumulate to an out of pocket maximum of $200 for an individual and $400 for a family, after which all prescriptions may be obtained at zero cost to the member.
A predetermined limited amount of money that an individual must pay out of their own savings, before an insurance company or (self-insured employer) will pay 100 percent for an individual's health care expenses.
The maximum amount of money an enrolled employee must pay under his or her insurance program. Once this limit is reached, members do not have to pay coinsurance or co-payments for services that accumulate to the out-of-pocket maximum.
The maximum amount of money you will be required to pay per year for your health insurance plan's deductibles and coinsurance. This maximum may apply to each family member, or to an entire family. The maximum amount is in addition to your premiums.
The amount which a covered person must pay for deductibles, coinsurance and copays in a defined time period (generally calendar year) before the health plan covers all remaining covered services at 100 percent up to the plan benefit maximum.
The highest amount of money you will pay in a year for deductibles and coinsurance plus regular premiums.
The amount you must pay toward eligible expenses before the plan pays in full. This puts an annual limit on how much an enrollee would pay before the plan starts paying 100 percent. For example, as enrollees make co-payments of their 10 percent of the bill, the co-payments are added up. Once the enrollee reaches the OPM, the enrollee will not have to pay the 10 percent co-payments. Office visit co-payments are not counted toward the OPM.
The most money you pay for covered expenses during the year before the plan begins paying 100% of covered expenses for the remainder of the year. Only covered expenses count toward the maximum. For example, any charges above the limited fee schedule for out of network doctor's services do not count.
The most a member will be required to pay out-of-pocket in a benefit year, including co-payments, coinsurance, and deductibles.
The most money you will be required to pay in a year for deductibles and coinsurance. It is a stated dollar amount set by the insurance company, in addition to regular premiums.
The maximum amount that an insured is required to pay under a plan or insurance contract.