Mental/Nervous Benefits For Participants Who Have Selected The Pipe Trades PPO Plus Self-Funded Indemnity Medical Plan

Counseling Benefits For All Participants
	In-Network	Out-of-Network¹
Mental/Nervous/Psychiatric Conditions
Inpatient 30 day yearly maximum	90% of contract rate, after deductible.	70% of usual, customary & reasonable, after deductible.
	Not covered unless Pre-Certified.
Outpatient	90% of contract rate, after deductible.	70% of usual, customary & reasonable, after deductible.
	20 Visit Yearly Maximum ².
Counseling Benefit
Family counseling, grief counseling, outpatient counseling, etc.	90% of contract rate, after deductible.	70% of usual, customary & reasonable, after deductible.
	20 Visit Yearly Maximum².

¹ Only In-Network benefits count toward the $5,000 coinsurance maximum. Charges incurred Out-of-Network will never be paid at 100%.

² Annual 20 visit limit applies to mental/nervous/psychiatric and counseling benefits combined.