What does the term “out-of-pocket” mean?
A. The term “out-of-pocket” refers to an amount of eligible medical expenses to be paid by either the employee or the employer. Out-of-pocket expenses are typically the sum of the deductible amount plus the co-insurance amount (co-Insurance rate or co-Insurance corridor). The out-of-pocket expense can also include specific types of employee pay or employee or employer expenses that may be itemized on the plan’s Annual Benefit Summary. Amount due for eligible medical expense — only that you have incurred the expense, that you have submitted it to, that it has been processed and reported by them via the EOB, and that it is not being paid for or reimbursed from any other source.
