Deductible Amount
In-Network
Individual Deductible Amount (every Plan Year)
$300
Family Maximum Deductible Amount (every Plan Year)
$600
Out-of-Network
Individual Deductible Amount (every Plan Year)
$600
This Plan has no Out-of-Network Family Deductible
Out-of-pocket limit
Individual
In-Network only (every Plan Year)
$3,000
Not including Deductible
Family
In-Network only (every Plan Year)
$6,000
Not including Deductible
Fund pays
In-Network
After Deductible
75%
Out-of Network
After Deductible
50%
Certain Out-of-Network emergency services, Out-of-Network services at an In-Network Facility and Air Ambulance Services are payable at In-Network rates. See Section 8.16 for more information
Indiana Laborers Fringe Benefit Funds
413 Swan Street, Terre Haute, Indiana 47807, United States
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