Tip: The individual out-of-pocket limit is the maximum that you will be required to pay in copayments and other cost sharing for covered services. The family out-of-pocket limit is the maximum that your family will have to pay for copayments or coinsurance. Once you or your family reaches the out-of-pocket limit, the health plan will pay 100% of the costs of covered services.

Tip: Some health plans have lifetime limits, which is the maximum amount they will pay for health care services for the lifetime of the individual. Other plans have annual lifetime limits or limits for specific services. It is important to find out if the health plan has any maximum limit on covered services.