Out-of-pocket maximum or limit - The total payments that must be paid by a covered person (i.e., deductibles and coinsurance) as defined by the contract. Once this limit is reached, covered health services are paid at 100% for health services received during the rest of that calendar year.

Outpatient benefits - Benefits paid for services provided outside a hospital by physicians, laboratories, clinics, emergency rooms, hospital outpatient departments, and providers of medical equipment and supplies.