Glossary

Open Access

See Direct Access

Open Enrollment

A time, often in the fall, when employees choose their health plans for the following year. You typically have 30-day period to decide.

Original Medicare Plan

See Medicare Part A and Medicare Part B.

Out-of-Network

Refers to care you receive from doctors and other health care professionals who do not participate in a health plan's network.

Out-of-Pocket

Amounts such as copayments and deductibles that an individual is required to contribute toward the cost of health services covered by his or her health benefits plan. In some instances this term also includes amounts the individual pays for health services not covered by the plan. There are substantial differences between plans in the amount of out-of-pocket costs you may incur. If your benefits plan has high out-of-pocket costs, you might consider participating in a Flexible Spending Account or Health Savings Account, if one is available to you.

Out-of-Pocket Maximum

The limit on the amount an individual is required to pay for health care services covered by his or her benefits plan. Look for this information in insurance plan documents such as your Certificate of Coverage.

Outpatient Care

Care provided without overnight admission to a hospital or other medical facility.

Outpatient Surgery

Surgical procedures that do not require an overnight stay in a hospital or other medical facility. Such surgery can be performed in the hospital, a surgery center or physician's office.

Over-the-Counter (OTC) Drug

Medication that may be obtained without a prescription from a medical professional.