Out of Pocket Maximums

Out of Pocket Maximums

The calendar year Out of Pocket Maximum represents the most you would have to pay out of pocket for covered services in a plan year. This includes deductibles, co-payments, and co-insurance for both in-network & out-of-network services. The Fund’s Out of Pocket Maximums are based on the Affordable Care Act guidelines. A link to the ACA website can be found here:  www.healthcare.gov/glossary/out-of-pocket-maximum-limit/. Please note, the Out of Pocket Maximum for out-of-network services is twice that of in-network services.

The 2023 Out of Pocket Maximums are:

  • In-network: $9,100 per person  
  • Out-of network: $18,200 per person

The 2024 Out of Pocket Maximums are:

  • In-network: $9,450 per person  
  • Out-of network: $18,900 per person

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