CHOICES HEALTH CARE PLAN BENEFITS - MyAlcoaBenefits

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Medical Plan Options, continued Coverage Changes Effective January 1, 2013 Inpatient Facility Deductible Inpatient facility admissions will require a separate deductible. This deductible is in addition to the annual deductible that must be paid. This change applies to the Basic, Comprehensive, and HRA options. It does not apply to the HSA option. The inpatient facility deductible is the additional amount you must pay for medically necessary and appropriate health care you receive during an admission to a facility. The inpatient facility deductible must be met before the program begins to pay all or part of the remaining expenses. This inpatient facility deductible amount may not be applied toward the satisfaction of any other deductible required by your program. However, any inpatient facility deductible amounts paid will apply to your annual out-of-pocket maximum. The inpatient facility deductible will apply to each admission to a hospital, rehabilitation facility, psychiatric hospital facility, skilled nursing facility, hospice facility, birthing center, or substance abuse treatment facility. If you are readmitted to the hospital for treatment of the same condition within 30 days of your discharge date, you will not have to pay another inpatient facility deductible. Advanced Imaging You or your physician will be required to obtain pre-certification prior to receiving any of the following services that are not performed in an emergency room, as an inpatient, on weekends, or on holidays: • computerized axial tomography (CAT scans) • magnetic resonance imaging (MRI scans) • positron emission tomography (PET scans) New Wellness Benefits Alcoa’s enhanced emphasis on employee wellness means that, effective January 1, 2013: • Nutritional counseling is a covered service when prescribed by a physician. Covered services include diet modifications and disease self-management skills training. Coverage is limited to 15 visits per person per year. • Drugs for weight loss are now covered. • Physician-prescribed over-the-counter tobacco-cessation products will be covered at 100% with no deductible. 4 CHOICES HEALTH CARE PLAN BENEFITS
Prescription Drug Coverage Prescription Drug Coverage Retail Pharmacy (up to 30-day supply) Additional 10% coinsurance for a maintenance drug at a retail pharmacy after 3 fills. Mail Service (up to 90-day supply) Coinsurance Coinsurance Deductible Generic You pay 10% Alcoa pays 90% Maximum coinsurance: $100 You pay nothing Alcoa pays 100% NONE for retail or mail service BRAND 80/20 Brand-name with no or few generic alternatives You pay 20% Alcoa pays 80% Maximum coinsurance: $100 You pay 20% Alcoa pays 80% Maximum coinsurance: $200 NONE for retail or mail service When Brand 80/20 drug has a generic equivalent but you choose brand You pay 10% of the generic drug cost plus difference in cost between brand-name and generic drug. Maximum coinsurance: $100. There is no maximum for difference in cost or for the additional 10% for filling maintenance drug at retail. You pay the difference in cost between the brandname and generic drug. Maximum coinsurance: $200. There is no maximum for difference in cost. NONE for retail or mail service BRAND 50/50 Brand-name with appropriate generic alternatives You pay 50% after deductible Alcoa pays 50% Maximum coinsurance: $100 You pay 50% after deductible Alcoa pays 50% Maximum coinsurance: $200 $50/person $100/family (one deductible that includes drugs purchased at retail and mail service) When Brand 50/50 drug has a generic equivalent but you choose brand You pay 10% of the generic drug cost plus difference in cost between brand-name and generic drug. Maximum coinsurance: $100. There is no maximum for difference in cost or for the additional 10% for filling maintenance drug at retail. You pay the difference in cost between the brand-name and generic drug. Maximum coinsurance: $200. There is no maximum for difference in cost. $50/person $100/family (one deductible that includes drugs purchased at retail and mail service) Contraception drugs and devices without a generic equivalent will be paid at 100% regardless of retail or mail, effective January 1, 2013, based on changes required by the Patient Protection and Affordable Care Act (PPACA). CHOICES HEALTH CARE PLAN BENEFITS 5
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Page 11 and 12: Alcoa is required to provide the fo

CHOICES HEALTH CARE PLAN BENEFITS - MyAlcoaBenefits

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