Insurance Glossary

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Insurance Term - Maximum Out-of-pocket Expense

It is the maximum amount a group member is required to pay out of pocket during a year for deductibles and co-insurance. Until this maximum is met, the plan and group member shares in the cost of covered expenses. After the maximum is reached, the insurance carrier pays all covered expenses, often up to a lifetime maximum. It is a stated currency amount set by the health insurance company, in addition to regular premiums.

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