The Comprehensive Major Medical Benefits provide medical coverage to you and your family for covered medical expenses. In general, there is no limit to how much the Plan pays in covered expenses for you and your eligible dependents. However, specific benefit maximums may apply for certain covered services.

Overall Lifetime
Maximum Benefit . . . . . . . . . .Unlimited
Deductible (Calendar Year) *
Individual . . . . . . . . . . . . . . . .$250
Family . . . . . . . . . . . . . . . . . . 3 per family

When three eligible family members have met their individual deductibles, no other covered family members will have to meet the individual deductible.

Coinsurance
(for most covered services)* . . . 80%

The Plan pays 85% of covered expenses for services received from PPO physicians.

* You will not be required to pay a deductible or coinsurance for covered expenses for covered organ transplants that are performed at BlueCross BlueShield of Illinois Centers of Excellence. Contact the Welfare Fund Office for details.

The Plan pays only 70% of covered expenses for services received from non-PPO hospitals and non-PPO ambulatory surgical facilities.

PPO Provider Out-of-Pocket Maximum .. . . . . . . . .$1,250 per person
(calendar year)

Non-PPO Provider Out-of-Pocket Maximum .. . . . .$5,000 per person
(calendar year)

Once you reach the out-of-pocket maximum, the Plan generally pays 100% of your remaining covered expenses for the rest of the calendar year. However, the following services are not covered at 100% after the out-of-pocket maximum is satisfied:

• Treatment received at a non-PPO hospital or non-PPO ambulatory surgical facility.
• Treatment for mental health and/or substance abuse.
• Treatment for infertility.

Expenses paid to satisfy the deductible, covered expenses for services received at non-PPO hospitals and non-PPO ambulatory surgical facilities, and mental health and substance abuse treatment do not apply to satisfy your out-of-pocket maximum.