Highlights of the Plan

ProvidersYou choose any provider you wish. 

Annual Deductible
  • Alliance Coal Direct: None
  • Non-Direct: $400 per person/$800 per family

Your Cost for Services

Your costs for most services depend on whether the provider you choose is an Alliance Coal Direct provider or a Non-Direct provider.

Alliance Coal Direct: For most eligible expenses (except emergency room), the Plan pays 100% of Allowable Charges, with no annual deductible.

Non-Direct: For most eligible expenses (exceptions include emergency room,preventive care, and chiropractic care), the Plan pays 80% of Allowable Charges after you have satisfied the annual deductible.

For emergency room services per family, you pay the following, based on the number of visits per calendar year for your family. For Non-Direct providers, you will first need to satisfy the annual deductible.

  • Visits 1-2: You pay $150 copay (no coinsurance)
  • Visits 3-4: You pay $150 copay plus 20% coinsurance
  • 5 or more visits: You pay 50% coinsurance

For designated procedures, the Plan has identified Centers of Expertise. When you use a Plan-approved Center of Expertise for these procedures, the Plan pays 100% of Allowable Charges, and you avoid a 40% benefit penalty.


Annual Out-of-Pocket Limits

Out-of-pocket limits provide financial protection for you, by limiting certain cost-sharing amounts you must pay for Allowable Charges in a calendar year.

The medical coinsurance limit (includes deductible) is:

  • Alliance Coal Direct: $2,000 per person; $4,000 per family
  • Non-Direct: $4,000 per person; $8,000 per family

The combined medical/prescription out-of-pocket limit is $7,350 per person and $14,700 per family. These amounts are combined for Alliance Coal Direct and Non-Direct, and they generally are adjusted each year by the federal government.

The medical coinsurance limit does not include copays or prescription drugs. Neither the medical coinsurance limit nor the combined medical/prescription limit include the 25% benefit penalty (100% benefit penalty for transplants) for preauthorization non-compliance (if required for a specific service), the 40% penalty for Care Coordination non-compliance (if required), the 40% penalty for using a provider that is not a Plan-approved Center of Expertise (if required), premiums, amounts paid above Allowable Charges (i.e., amounts that are balance-billed by a provider), covered services not considered essential health benefits by federal law (such as chiropractic and acupuncture), any discounts or similar reductions by providers/manufacturers, and health care the Plan does not cover.


Care CoordinationCare Coordination helps members with complex or chronic health conditions receive medically necessary treatment and avoid gaps in care. You may request Care Coordination by calling Member Services at (855) 979-5192.

For some conditions, Care Coordination is required to receive the normal level of benefits. If this applies to you, Care Coordination will contact you. If you decline required services, you will be subject to a benefit penalty equal to 40% of the amount the Plan would normally pay.

Preauthorization Requirement

To avoid a benefit penalty, you are required to obtain preauthorization for many services and products. For a detailed listing, see "Appendix C: Services and Products that Require Preauthorization."

To request preauthorization, you or your provider should call Member Services at (855) 979-5192:

  • As soon as possible before a scheduled, nonemergency procedure
  • Within two business days after an unscheduled inpatient admission
Failure to obtain preauthorization when required will result in a 25% benefit penalty (100% benefit penalty for transplants). Preauthorization allows you to know whether a service is medically necessary under the Plan's rules before you incur an expense. As with all claims, any services determined not to be medically necessary will not be covered.

Cost of CoverageYou and the Company share the cost of your medical care. You do not pay a premium contribution for your coverage, but both you and the Plan share the cost of eligible expenses.

How to Reach Member Services
Call Member Services at (855) 979-5192