Out-of-Pocket Maximum/Limit

The most you’d ever have to pay for covered services and prescriptions in a plan year. After you spend this amount on deductibles, copays and coinsurance, your health insurance company pays 100% of the costs of covered benefits for the rest of the year. Your monthly premium or anything you spend for services your plan doesn’t cover (out-of-network) do not count toward this limit. This limit resets each year.

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