Coordination of Benefits

If you or an eligible dependent is covered by the Alcoa medical plan and another employer's plan, the two plans work together to avoid duplicating payments. This is called coordination of benefits.

Coverage for Children After a Divorce of Separation


When parents who are legally separated or divorced and both cover an eligible dependent child, the following rules apply.

  • If the parents have joint custody and there is no court decree stating which parent is responsible for health care expenses, the birthday rule will apply.
  • If one parent has custody, his or her plan is primary and the other parent's plan is secondary, unless a legal document such as a QMSCO is presented.
  • If the remarried parent with custody has no health care coverage, the stepparent's plan is primary and the plan of the parent without custody is secondary.
  • Regardless of which parent has custody, whenever a court decree specifies the
  • parent who is financially responsible for the child's health care expenses and that parent has enrolled the child in his or her plan, that parent's plan is primary.
  • A plan that covers an active employee or the dependent of an active employee pays before a plan that covers an inactive or retired employee or the dependent of an inactive or retired employee.


When none of the previous rules applies, the plan that has covered the patient for the longer period is primary.

Your Alcoa medical benefits are coordinated with benefits from:

  • other employers' plans
  • certain government plans
  • motor vehicle plans when required by law


Coordination of benefits does not apply to prescription drug benefits.


How Coordination of Benefits Works

When an expense is covered by two plans, the following apply:

  • the primary plan is determined and pays the full amount it normally would pay
  • the secondary plan calculates the amount it normally would pay and then pays any portion of that amount not paid by the primary plan
  • you pay any remaining expenses


For example, suppose the covered charge is $100 and the Alcoa plan normally would pay $80. If the primary plan paid $50, your benefit from the Alcoa plan would be $30 ($80 minus $50).


Determining Primary and Secondary Plans

Primary and secondary plans are determined as follows.

  • A plan that does not contain a coordination of benefits provision is primary.
  • If you're the patient and you're not eligible for Medicare, the Alcoa plan normally is primary when you have a covered expense.
  • If your covered spouse is the patient, your spouse's company plan is primary. Your spouse should submit expenses to that plan first, wait for the payment,  and then submit the claim to the Alcoa claims administrator with copies of the expenses and the primary plan's Explanation of Benefits (EOB).


Coverage for Children

When both parents' plans cover an eligible dependent child, the plan of the parent whose birthday (month and day) comes first in the calendar year is primary. For example, if your spouse's birthday is March 15 and your birthday is September  28, your spouse's plan is primary for that dependent. If both parents were born on the same day, the plan of the parent who has had coverage in effect the longest will be primary.


However, if the other plan does not have this birthday rule and, as a result, the plans do not agree on the order of benefits, the rule of the other plan will determine the order of benefits.