For plans with a non-embedded maximum out-of-pocket limit, the individual maximum out-of-pocket limit only applies for those with single coverage. Those with covered dependents must satisfy the family maximum out-of-pocket limit before the health plan will cover all eligible in-network health care expenses at 100%. For family coverage, no individual family member can contribute more than the individual IRS limit.

 For plans with an embedded maximum out-of-pocket limit, all eligible in-network individual health care expenses will be covered at 100% once the individual maximum out-of-pocket limit has been satisfied. For family coverage, if the family maximum out-of-pocket limit has been satisfied prior to the individual amount being satisfied, all eligible in-network health care expenses for covered participants will be paid at 100%.