It’s important to understand how your other health coverage and the ASEA Health Trust Plan work together to pay covered expenses.
Group health plans usually use standard Coordination of Benefit (COB) rules. The ASEA Health Trust Plan is primary for you as the employee (it pays your claim first). Your other plan is secondary (it pays second). For your spouse, his or her employer plan is primary, and the ASEA Health Trust’s plan is secondary.
For your children, the plan of the parent with the birthday earliest in the year is primary, and the other parent’s plan is secondary.
- For example, if your birthday is October 15 and your spouse’s birthday is July 14, your spouse’s plan is primary for your children.
If you are separated or divorced, the custodial parent’s plan is primary unless otherwise ordered by the Court.
Once the primary plan pays benefits, the secondary plan reimburses covered expenses as allowed under its provisions. Benefits from your primary and secondary plans may combine to pay up to—but no more than—100% of covered expenses.
For example, you may be covered by both the ASEA Health Trust and by your spouse’s employer plan. The Plans coordinate benefits for you; all you have to do is make sure that the health care providers have complete coverage information and submit all claims to both plans.
When the ASEA Health Plan is the secondary plan, the Health Plan’s allowable expense will be limited to the expense that is allowed by the primary plan. In the event that the primary plan’s allowed expense has been reduced because you did not follow its plan rules and procedures (for example, you did not obtain a required precertification or did not use the plan’s in-network provider), the ASEA Health Plan will not pay the amount of the reduction.
The information provided above is a general summary of how Coordination of Benefits works. For more detailed information about Coordination of Benefits, please see the Coordination of Benefits section of the Plan Booklet.
Coordination with the State of Alaska health plan for active employees
The ASEA Health Trust Plan also coordinates coverage with the State of Alaska’s health coverage for active employees if you or your dependents are covered under both plans. The State’s Plan will reduce their benefits payable under certain circumstances. They will pay 30% of covered charges for you and/or your dependents if you, or your dependents are covered by a State employee ASEA Health Trust, and that coverage:
- Has been waived
- Pays less than 70% of covered expenses, or
- Has an individual out-of-pocket maximum, including deductible, of more than $3,500
This rule applies to any individual covered by the State’s Plan as the secondary plan under the standard Coordination of Benefits (COB) rules, where the ASEA Health Trust plan would normally pay first if you haven’t reduced or waived coverage.
- If you are covered as an active employee under the State of Alaska Plan, they may reduce your benefits if you elect Plan B, C, or D under the ASEA Health Trust.
If you are a retiree covered under the State of Alaska Plan, your benefits will not be affected.
For more information on Coordination of Benefits between the ASEA Health Trust Plan and the State of Alaska Plan, visit http://doa.alaska.gov/drb/pdf/ghlb/akcare/selectBenefitsEmployeeBooklet0713.pdf.
Other rules apply. Refer to the Coordination of Benefits section of the Plan Booklet for complete details.