Insurance Glossary

Out-of-Pocket Maximum

Health

Definition

The most you have to pay for covered services in a plan year. After you reach this amount, the insurance pays 100% of covered services.

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Related Terms

Deductible
The amount you must pay out-of-pocket before your insurance coverage begins to pay for covered losses.
Coinsurance
A cost-sharing arrangement where the insured pays a specified percentage of covered expenses after the deductible is met.
Copayment
A fixed amount you pay for a covered health care service, usually when you receive the service.
Accident Insurance
Insurance coverage for unforeseen bodily injury resulting from an accident.
Pre-existing Condition
A health condition that existed before the start date of a new insurance policy.
Disability Insurance
Insurance that provides income replacement if you become unable to work due to illness or injury.
Long-Term Care Insurance
Insurance that covers the cost of long-term care services, such as nursing home care or in-home assistance.
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