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.