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Small Business Employee Benefits and HR Blog

Out-of-Pocket Limit

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