What is the term for the provision in major medical policies where the insurer pays 100% of remaining covered charges after expenses exceed a certain dollar amount?

The term that describes the provision in major medical policies where the insurer pays 100% of remaining covered charges after expenses exceed a certain dollar amount is known as the stop-loss limit. This provision is crucial because it protects the insured from high out-of-pocket costs by capping the amount the insured must pay in a given period before the insurance company covers all additional expenses.

The stop-loss limit is particularly important in managing healthcare costs. Once the insured's medical expenses reach this designated limit, the insurer assumes full responsibility for additional covered healthcare services for the remainder of the policy year. This gives policyholders peace of mind, knowing that there’s a cap on their financial obligations.

In contrast, the deductible limit refers to the amount an individual must pay out-of-pocket before the insurance begins to cover expenses, while the out-of-pocket maximum encompasses all expenses an insured individual would pay, including deductibles, copayments, and coinsurance. The co-insurance threshold does not directly indicate a provision where the insurer takes over full payment after reaching a certain amount; rather, it usually refers to the shared cost arrangement before reaching a stop-loss limit.