Maximum out-of-pocket expense - The maximum dollar amount a group member is
required to pay out of pocket during a year. Until this maximum is met, the plan and
group member shares in the cost of covered expenses. After the maximum is reached, the
insurance carrier pays all covered expenses, often up to a lifetime maximum. (See
previous definition.)
required to pay out of pocket during a year. Until this maximum is met, the plan and
group member shares in the cost of covered expenses. After the maximum is reached, the
insurance carrier pays all covered expenses, often up to a lifetime maximum. (See
previous definition.)
Maximum plan dollar limit
The maximum amount payable by the insurer for coveredexpenses for the insured and each covered dependent while covered under the health
plan.
¨ Plans can have a yearly and/or a lifetime maximum dollar limit.
¨ The most typical of maximums is a lifetime amount of $1 million per individual.