The deductible is the amount you are responsible for paying for covered services before the insurance company begins paying its portion.
The out-of-pocket maximum is the maximum amount you will pay for covered medical services within a given plan year. Once you hit this threshold for deductibles, coinsurance and copayments, your health plan pays 100% for covered services from in-network providers. Premium payments are not included in your out-of-pocket maximum/limit.
Your health plan has a $3,000 deductible and $7,000 out-of-pocket maximum.
If you break your arm and the treatment costs $4,000, you will have hit your $3,000 deductible and the insurance will now pay a larger portion of the medical costs.
If you later find that you need surgery for that arm that costs $15,000, your will hit your $7,000 out-of-pocket maximum and will not pay for any more medical expenses for the year outside of your monthly premiums.
You can confirm your deductible and other health plan details using this article:
If you have any other questions about your health insurance plan and benefits, please submit a request to our customer care team at the link below: