What is an out-of-pocket maximum?

This is the maximum amount you can expect to pay in a year for healthcare services. This amount resets every year, and there are two types of OOP Maximums: Family and Individual. Your Family OOP Maximum is the total amount you will be expected to cover for everyone covered under your policy. Your Individual OOP Maximum is the amount you will be expected to cover for a single individual covered under your plan. If your child meets their Individual OOP Maximum, or you and other members of your family meet your Family OOP Maximum in a given calendar year, your child’s services will be covered at 100%.