The most a plan member will pay per year for covered health expenses before the plan pays 100% of covered health expenses for the rest of that year.
The most you will have to pay in any given year for all services received under an insurance policy. This amount includes copayments, coinsurance and deductibles. If you exceed this amount, the insurance company will pay all other expenses for the remainder for that year.
The maximum amount of coinsurance you pay for covered PPO medical expenses in any single calendar year. Once you have paid the out-of-pocket maximum, the PPO pays 100% of expenses (except for plan co-payments, which are still required). Prescription co-pays do not count toward your out-of pocket maximum.