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.