The Out-of-Pocket Maximum (OOPM) limit is the most a plan member will pay during a plan year for their in-network services. Deductibles, copayments, and coinsurance are included in the OOPM.
The OOPM limit went into effect with plan years on or after January 1, 2014. The OOPM does not include premiums and balanced billing amounts for non-network providers, and other out-of-network cost-sharing. OOPM limits apply to non-grandfathered group plans (self-funded and fully insured).