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 2025 Out of Pocket Maximums are:

• In-network: $9,200 per person ($18,400 per family).   
• Out-of-network: $18,400 per person and ($36,800 per family).

The 2026 Out of Pocket Maximums are:

• In-network: $10,600 per person ($21,200 per family).   
• Out-of-network: $21,200 per person and ($42,400 per family).