CHOICES HEALTH CARE PLAN BENEFITS - MyAlcoaBenefits

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More Benefits You’re automatically enrolled, at no cost to you, in the following coverage: disability, employee life insurance, and employee accidental death and dismemberment (AD&D) insurance. You have the option to elect additional coverage amounts for all of these benefits. You also may elect the following types of coverage: spouse/domestic partner life insurance, child life insurance, and dependent AD&D insurance. For more information, including details about even more Alcoa benefits, go to www.MyAlcoaBenefits.com. More Benefits Short-Term Disability (STD) Long-Term Disability (LTD) (may not be offered to all groups or locations) Employee Life Insurance* Spouse or Domestic Partner Life Insurance* Child Life Insurance Employee Accidental Death and Dismemberment (AD&D) Insurance Dependent AD&D Insurance • Coverage options represent a weekly benefit based on a percentage of your base pay. Keep in mind: If you are disabled, you will need sufficient funds to pay your bills. You should figure that in when deciding which option is best for you and your family. • “Income-based” price tags. • Three coverage options, each representing a monthly benefit based on a percentage of your base pay. Lowest coverage option is provided at no cost to you. • “Income-based” price tags. • Not available to part-time employees. • If this coverage applies to you, it will be listed on your Enrollment Worksheet. • Elect from 1 to 8 times pay in term life insurance; 1 times pay (maximum $200,000) provided at no cost to you. • Definition of pay includes base pay only. • Evidence of insurability may be required. • Price of coverage is based on the insured person’s age as of December 31, 2013. • Three coverage options — $25,000, $50,000, $100,000 — or “No Coverage.” • No evidence of insurability required for lowest option. • Price of coverage is based on the insured person’s age as of December 31, 2013. • Two coverage options — $5,000 or $10,000 per child — or “No Coverage.” • No evidence of insurability required. • Elect from 2 to 8 times pay in coverage; 2 times pay provided at no cost to you. • Definition of pay includes base pay only. • No evidence of insurability required. • Elect from 1 to 8 times pay in coverage for your eligible spouse or domestic partner and/or children, or “No Coverage.” • No evidence of insurability required. * If you increase employee or spouse life insurance coverage levels, you may be asked to provide evidence of insurability by completing the MetLife “Statement of Health” form. You can complete this form online during the enrollment period. If you do not have access to the internet, you will receive the form in the mail. 10 CHOICES HEALTH CARE PLAN BENEFITS
Alcoa is required to provide the following information. For more information about any of these notices, please call 1-888-ALCOA123 (1-888-252-6212). Changes to Women’s Preventive Services Due to the Patient Protection and Affordable Care Act (PPACA), effective January 1, 2013, the following preventive services will be covered at 100% with no deductible: • screening for gestational diabetes • breastfeeding supplies (pump and tubing) • contraception drugs and devices without a generic equivalent • contraceptive sterilization — tubal ligation Women’s Health and Cancer Rights Act The Women’s Health and Cancer Rights Act of 1998 requires group health plans that provide coverage for mastectomies to also provide reconstructive surgery and prostheses following mastectomies. The law mandates that a participant or eligible dependent who is receiving benefits for a covered mastectomy and who elects breast reconstruction, will also receive coverage for: • All stages of reconstruction of the breast on which the mastectomy has been performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; and • Prostheses and treatment of physical complications of all stages of mastectomy, including lymphedemas. This coverage will be provided in consultation with the patient and the patient’s attending physician and will be subject to the plan’s annual deductible, coinsurance, and/or copayments. Medicaid and the Children’s Health Insurance Program (CHIP) If you are eligible for health coverage from Alcoa, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for coverage, but need assistance in paying their health premiums. If you or your dependents are already enrolled in Medicaid or CHIP, you can contact your state Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you might be eligible for either of these programs, you can contact your state Medicaid or CHIP office, call 1-877-KIDS NOW or log on to www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the state if it has a program that might help you pay the premiums for Alcoa’s plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, Alcoa’s health plan is required to permit you and your dependents to enroll in the plan — as long as you and your dependents are eligible, but not already enrolled in coverage. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. CHOICES HEALTH CARE PLAN BENEFITS 11
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Page 3 and 4: Medical PLAN OPTIONS With Choices,
Page 5 and 6: Prescription Drug Coverage Prescrip
Page 7 and 8: Flexible Spending Accounts You can
Page 9: Vision Coverage Your Vision Plan In

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