Maximum amount an insured will be required to pay for covered services during a specified time period. Also called stop-loss limit or catastrophic expense limit.
The maximum amount of money you will be required to pay in a calendar year for deductibles and coinsurance. It is a stated dollar amount set by the insurance company. Regular premiums and charges in excess of usual and customary rates do not count toward the maximum out-of-pocket amount.----------[ Back
also OPM. The out-of-pocket maximum is the most a member generally pays for covered services during a benefit period. The deductible and coinsurance apply toward meeting the out-of-pocket maximum. Copayments do not apply toward the OPM.