The catastrophic out-of-pocket maximum or limitation does not indicate any single illness or condition. The catastrophic limitation is the maximum amount of coinsurance that a member has to pay out of their own pocket before the Health Plan pays covered charges at 100% for the balance of the calendar year.
Most conditions that the Health Plan pays on your behalf for the High Option, at a percentage amount, will have your portion of the fee (the coinsurance) apply toward a maximum out-of-pocket amount. Once a member meets the maximum amount (the catastrophic limit), the Plan pays covered charges for the remainder of the calendar year at 100% of the Plan allowance, or the PPO negotiated rate if you us a preferred provider.
See the postal brochure or federal brochure for complete details.