What Happens When You Need Medical Care
If You Stay In Network
If You Go Out of Network
If You Live Where No Network is Available
If You are Traveling
What You're Responsible for If You Stay In Network
- Your provider (doctor's office, hospital, laboratory, etc.) files the claim. You'll receive the bill after the claim has been processed. If your service was routine preventive care, you pay nothing.
- You pay your deductible and coinsurance.
- You can use the money in Your Spending Account to pay these expenses.
- Your costs for services are less because the network providers generally discount services between 40%-50% of the total costs.
- Check your Explanation of Benefits (EOB) to make sure it's accurate, and keep it for future planning.
What You're Responsible for If You Go Out of Network
- You need to file a medical claim. It's likely that your provider (doctor's office, hospital, laboratory, etc.) will bill you for the entire cost of the service. Some out-of-network providers may require you to pay for the charges up front.
- You pay more of the costs, higher deductibles, coinsurance, and out-of-pocket maximum, plus there are no network discounts
- There is a Reasonable & Customary (R&C) limit set by your medical claims administrator. It's based on the amount that 90% of doctors and other providers in the area charge for a given service. You pay all costs over R&C each time you use an out-of-network doctor or service. You'll receive a separate bill for these costs.
- You can use the money in Your Spending Account to pay these expenses.
- After you file the claim and then receive the Explanation of Benefits (EOB), keep it for future planning.
What You're Responsible for If You Live Where No Network is Available
- Your doctor's office/hospital files the claim. You'll receive the bill after the claim has been processed. If your service was routine preventive care, you pay nothing.
- You pay your deductible and coinsurance. You can use the money in Your Spending Account to pay these expenses.
- There is a Reasonable & Customary (R&C) limit set by the medical claims administrator. It's based on what 90% of the doctors in the area charge for that service. You pay all costs over R&C each time you use an out-of-network doctor or service. You'll receive a separate bill for these costs.
- Check your Explanation of Benefits (EOB) to make sure it's accurate, and keep for future planning.
At any time during the year, you may choose to declare yourself "in-network" and travel to an in-network provider to receive the higher in-network level of benefits. You are assigned to a network based on your home ZIP code.
You must call 1-888-ALCOA123 and speak to a customer service representative to change to the network-available status. You must call to renew this declaration each year.
What You're Responsible for While You're Traveling
- If you become ill or injured while traveling, contact your medical claims administrator (find telephone number on back of medical ID card) to find if there is a network doctor or hospital in the area. If so, charges will be covered at the in-network level. If not, you'll be charged at the out-of-network level.
- If you have an emergency while traveling, go to the nearest emergency room. If it's a true emergency, the charges will be paid at the in-network level. If it's not a true emergency, the charges will be paid at the out-of-network level. Some examples of true emergencies are: fractures, lacerations, motor vehicle accidents, hemorrhage, shock, or other conditions associated with deterioration of vital life functions.
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Ask for health care costs up front
Wish you knew how much that X-ray was going to cost before you got it? Now, more doctor offices and hospitals can confirm costs and coverage online. That means you can learn your costs up front, so ask. It also means your doctor may charge you when services are provided, so be ready to pay your deductible or coinsurance on the spot.
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