Out-of-Plan – Physicians, hospitals or other health care providers who are considered nonparticipants in an insurance plan (usually and HMO or PPO). Depending on an individual’s health insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered or may be covered only in part.
Out-of-Pocket Maximum – A predetermined limited amount of money an individual must pay out of their own sources, before an insurance company or (self-insured employer) will pay 100 percent for an individual’s health care expenses.
Outpatient – An individual (patient) who receives health care services (such as surgery) without an overnight stay 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. "Outpatient" is also used synonymously with "ambulatory" to describe health care facilities where procedures are performed.