What term refers to the specified dollar amount beyond which the insured no longer participates in expense sharing?

The term that refers to the specified dollar amount beyond which the insured no longer participates in expense sharing is known as the stop-loss limit. This limit is essentially a threshold that, once reached, protects the insured from further expenses related to covered healthcare costs for the remainder of the policy period.

When individuals incur healthcare expenses, they typically share in those costs through various mechanisms like co-payments and deductibles until they reach their stop-loss limit. After this point, the insurance company pays 100% of covered expenses. This provision is crucial as it provides financial protection against high medical costs, ensuring that individuals are not burdened with unlimited out-of-pocket expenses.

In contrast, a deductible refers to the amount an insured must pay out-of-pocket before their insurance coverage begins to pay. Co-payments are fixed amounts the insured pays for specific services at the time of care. The out-of-pocket maximum is a related concept that caps the total expenses incurred by the insured during a policy period, which may include co-payments, deductibles, and other cost-sharing mechanisms, but it is not focused solely on the point at which expense sharing stops. The stop-loss limit specifically delineates the point where the insured no longer has any financial obligation for covered expenses, distinguishing