Maximum Deductibles & Out of Pocket Limits

The most a participant pays during a policy period (usually a year) before the participant's health insurance or plan begins to pay 100% of the allowed amount. This limit never includes a participant's premium, balance-billed charges or health care the health insurance or plan doesn’t cover. Some health insurance or plans don’t count all of a participant's co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit. In Medicaid and CHIP, the limit includes premiums.