Individual and Family Plan Out-of-Pocket Maximums

Out-of-Pocket Maximum

The maximum out-of-pocket expense is the most you're required to pay for covered services in a plan year. After you spend this amount on deductibles, copays, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits for the rest of the plan year.

Family Out-of-Pocket Maximums

Any expenses paid by individuals go toward the family’s out-of-pocket maximum. When the family out-of-pocket maximum is met, the plan pays 100% of each individual’s out-of-pocket costs for covered services for the rest of the plan year.

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Individual and Family Plan Express Reimbursement