The part of the costs which are the patient’s responsibility. Charges for services and supplies not covered under your plan including deductibles, coinsurance and charges which exceed the allowed charges or the maximum benefits of your plan.

This phrase usually refers to physicians, hospitals or other health care providers who are considered non-participants in an insurance plan. Depending on an individual’s health insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered, or covered only in part by an individual’s insurance company.

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.

An individual (patient) who receives health care services (such as surgery) on an outpatient basis, meaning they do not stay overnight in a hospital or inpatient facility. Many insurance companies have identified a list of tests and procedures (including surgery) that will not be covered (paid for) unless they are performed on an outpatient basis. The term outpatient is also used synonymously with ambulatory, to describe health care facilities where procedures are performed.