In the calculation of premium, it is the rate of return on the company’s investment of premium dollars over the lifetime of the policy. Insurance company investment experience will affect life insurance cost.
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Out-of-Pocket (OOP) Limit
Also called “co-insurance limit” or “stop-loss limit”: the most you may have to pay during a benefit period (usually a calendar year) before your health insurance or plan begins to pay 100% of the allowed amounts. This limit never includes your premiums or non-covered services. Plans vary as to which coinsurance sums count towards your OOP limits: hospital, surgical, chemo & radiation coinsurance usually always count. Prescription and dental coinsurance & co-pays never count. Medical visits and diagnostics coinsurance may count on some policies. Deductibles and out-of-network coinsurance very rarely count. Always check to determine the definitions and OOP provisions in your Policy.