What is an out-of-pocket (OOP) maximum?

This is the total amount you’ll have to pay during a policy period, typically a year, before your health insurance starts to pay 100% for covered essential health benefits. Costs that contribute to your out-of-pocket maximum limit must include deductibles, coinsurance, copayments or similar charges and any other expenditure required of an individual that is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost sharing, or spending for non-essential health benefits.
 
#118 R11-13-17