Copayments, deductibles or other fees that a member is required to pay outside of his or her health benefits plan.

The maximum dollar amount of shared expenses (coinsurance) you will pay in a year before the insurance company or health plan begins paying at the 100% level of benefits. This is usually in addition to a deductible you may have paid prior to sharing expenses.

Includes the 20% coinsurance payable by the claimant and any co-payments paid by the claimant. Out of Pocket does not include any excluded amounts ( including but not limited to amounts over Reasonable and Customary or Usual and Customary and charges not covered by the policy) or amounts that exceed the maximum benefit allocation as listed in the Schedule of Benefits.

Payments you must make if you visit an out-of-plan provider or if you obtain a service not covered by your policy.

The amount of money you—the insured—are responsible for in payment of medical bills.