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All glossary terms
Plan design

OOP max

Also called: out-of-pocket maximum

Definition

The most a plan member can pay out-of-pocket for covered services in a plan year. Once hit, the plan pays 100% of covered costs. ACA caps the OOP max ($9,450 single / $18,900 family for 2024 plans).

Related in plan design

SBC

A standardized plain-language summary of what a health plan covers and what it costs.

SPD

The detailed legal document that describes how a self-funded ERISA health plan operates — eligibility, contributions, claims procedures, appeals, fiduciary roles.

RFP

A document an employer (or their broker) sends to carriers asking for medical / dental / vision / ancillary plan quotes for a renewal cycle.

Deductible

The dollar amount a plan member pays out-of-pocket each year before the plan starts paying for covered services.

Velora speaks the broker domain natively.

SIC, enrolled lives, renewal month, current carrier — every term in this glossary corresponds to a field Velora's outbound engine actually uses for targeting, segmentation, and cadence selection.

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