Out of Pocket Limit

An Out-of-Pocket Limit is the most you pay during a policy period (usually a year) before your traditional health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn’t cover. NOTE: Most traditional health insurance or plans don’t count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit, so what you pay out of pocket, in addition to your premium, will usually be much higher than the stated out of pocket limit.