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Health Coverage Basics

HOW A WRITER QUALIFIES FOR HEALTH INSURANCE

When you provide covered writing services for a WGA signatory, once your earnings in any consecutive four-quarter period equal the amount of a prime-time one-hour teleplay and story ($38,302 as of May 2, 2016) you (and your eligible dependents if you elect to cover them) will receive one year of health coverage – after a one-quarter waiting period, typically referred to as the lag period.

This approach is designed to make sure as many writers qualify for health coverage as possible. Many health coverage plans have what is referred to as an open enrollment period, and if you fail to qualify during this time period, you have to wait a full year before you can obtain coverage. This type of plan design doesn’t work well for the entertainment industry where employment patterns are often random.

HOW PWGA HEALTH COVERAGE DIFFERS FROM OTHER KINDS OF HEALTH PLANS

A writer may go months and months with no income – either because he/she is looking for work, or because the writer is laboring on a piece of material and will not get paid until a draft is delivered. The PWGA designed its health plan with these realities in mind.

PWGA health coverage allows a writer to earn the qualifying amount for coverage in any consecutive four-quarter period – it could even be over the course of two calendar years (e.g., 3rd and 4th quarters of 2016 and 1st and 2nd quarters of 2017). Once a writer reaches the threshold amount in a given quarter, the only restriction is a one quarter lag period before health coverage commences.

The practicalities of timing work like this:

If you satisfy the earnings requirement in: Your coverage period will be: Earnings Cycle for continued coverage:
1st quarter of 2015 (Jan, Feb, Mar) July 1, 2015 – June 30, 2016 April 1, 2015 – March 31, 2016
2nd quarter of 2015 (Apr, May, June) October 1, 2015 – September 30, 2016 July 1, 2015 – June 30, 2016
3rd quarter of 2015 (Jul, Aug, Sept) January 1, 2016 – December 31, 2016 October 1, 2015 – September 30, 2016
4th quarter of 2015 (Oct, Nov, Dec) April 1, 2016 – March 31, 2017 January 1, 2016 – December 31, 2016
1st quarter of 2016 (Jan, Feb, Mar) July 1, 2016 – June 30, 2017 April 1, 2016 – March 31, 2017
2nd quarter of 2016 (Apr, May, June) October 1, 2016 – September 30, 2017 July 1, 2016 – June 30, 2017
3rd quarter of 2016 (Jul, Aug, Sept) January 1, 2017 – December 31, 2017 October 1, 2016 – September 30, 2017
4th quarter of 2016 (Oct, Nov, Dec) April 1, 2017 – March 31, 2018 January 1, 2017 – December 31, 2017
1st quarter of 2017 (Jan, Feb, Mar) July 1, 2017 – June 30, 2018 April 1, 2017 – March 31, 2018
2nd quarter of 2017 (Apr, May, June) October 1, 2017 – September 30, 2018 July 1, 2017 – June 30, 2018
3rd quarter of 2017 (Jul, Aug, Sept) January 1, 2018 – December 31, 2018 October 1, 2017 – September 30, 2018
4th quarter of 2017 (Oct, Nov, Dec) April 1, 2018 – March 31, 2019 January 1, 2018 – December 31, 2018

DEPENDENT COVERAGE

PWGA health coverage allows you to add your eligible dependents for $50 per month, payable quarterly. Thus, if you have a wife (or husband) and several children, you pay $150 for each quarter you want to provide health coverage for them. It is one of the best bargains you will ever find when it comes to health care coverage.

HOW THE PWGA HEALTH PLAN HELPS WRITERS COPE WITH PERIODS OF UNEMPLOYMENT

As most writers know all too well, the entertainment industry is a boom or bust business. High earning years can be followed by long periods of unemployment. In order to help writers maintain coverage, the PWGA developed what has come to be called an Extended Coverage Program (ECP).

Beginning April 1, 2000, Plan Participants were credited with one, two or three points for each year of regular, employer-paid eligibility earned commencing retroactively for work performed on and after January 1, 1990. In addition, writers are awarded one point for each four-quarter eligibility cycle ending on or after September 30, 1989 which resulted in Health Fund eligibility. One additional point is also awarded for each four-quarter earnings cycle ending on or after September 30, 1989 during which the writer earned at least $100,000* in covered compensation as reported to the Health Fund. And finally, one additional point is awarded for each four-quarter earnings cycle ending on or after September 30, 1989 during which the writer earned at least $200,000 or more in covered compensation as reported to the Health Fund.

A writer may accumulate up to a maximum of fifty (50) points, which would provide five years of coverage. The chart below demonstrates how this system works:

Earnings Minimum for Second Point Earnings Minimum for Third Point Earnings Cycle Effective Date
$100,000 $200,000 04/01/00 07/01/00 10/01/00
$103,252 $200,000 01/01/01 04/01/01 07/01/01 10/01/01
$106,089 $200,000 01/01/02 04/01/02 07/01/02 10/01/02
$108,741 $200,000 01/01/03 04/01/03 07/01/03 10/01/03
$111,460 $200,000 01/01/04 04/01/04 07/01/04 10/01/04
$113,968 $204,500 01/01/05 04/01/05 07/01/05 10/01/05
$116,534 $209,101 01/01/06 04/01/06 07/01/06 10/01/06
$119,156 $213,806 01/01/07 04/01/07 07/01/07 10/01/07 01/01/08 04/01/08
$122,731 $220,220 04/01/08 07/01/08 10/01/08 01/01/09 04/01/09
$126,413 $226,827 07/01/09 10/01/09 01/01/10 04/01/10
$130,205 $233,631 07/01/10 10/01/10 01/01/11 04/01/11
$132,809 $238,304 07/01/11 10/01/11 01/01/12 04/01/12
$135,133 $242,474 07/01/12 10/01/12 01/01/13 04/01/13
$137,498 $246,717 07/01/13 10/01/13 01/01/14 04/01/14
$125,000 $250,000 07/01/14 And Beyond…

PRACTICALITIES OF THE ECP PROGRAM

In summary, a writer may earn up to three points for each year of employer paid Health Fund coverage earned, beginning January 1, 1990. If a writer loses eligibility due to failure to earn sufficient compensation within an earnings cycle, and they have accumulated at least 10 points, they will automatically be placed in the Extended Coverage Program and will be notified of such. Although a writer must have 10 points to be eligible for the Extended Coverage Program, based upon a writer’s state of residence, there are up to four different benefit plans available with point values ranging from 2.5 to 1.5 points per quarter. You can find a description of those plans here.

For each quarter that you receive benefits under this program, the applicable number of points will be deducted from your point balance. This process will continue until: 1) A writer regains employer-paid eligibility; or 2) A writer retires under the Producer-Writers Guild of America Pension Plan as a Certified Retiree; or 3) There are an insufficient number of points available for continuation in the program.

THINGS YOU MIGHT WANT TO KNOW ABOUT PWGA HEALTH COVERAGE

Much information about the health plan is contained in the newly published PWGA Participant Guide or can be found by searching this web site. Simple queries in the search field should provide excellent, contextualized information.

CONTRIBUTIONS

When a writer works for a signatory employer, in addition to the fees they are paid for their services, an additional 9.5% is contributed toward the writer’s health coverage. If a writer earns the equivalent of the price of a one hour primetime script ($38,302 as of May 2, 2016) during any consecutive four-quarter period, they qualify for a full year of health coverage.

DEPENDENTS

PWGA health coverage is very generous when it comes to dependents. Whether you have a spouse, or twelve children along with a spouse, the cost is the same: $150 per quarter. Once a writer qualifies for coverage, they have 30 days to decide whether or not to opt for dependent coverage. If a writer does not apply for dependent coverage during that 30 day window, the opportunity to obtain dependent coverage will be in one year, during the open enrollment period.

You must add your eligible dependents within 30-days of commencement of your Health Fund coverage. Your initial payment should be included with your completed enrollment documents. All subsequent payments can be made through our website or you can mail them to the Administrative Office.

DEPENDENT PREMIUMS AND PAYMENTS

You will receive a bill 30 days before the dependent premium is due. Please note, dependent coverage is NOT active until payment is received. Your initial payment should be included with your completed enrollment documents. All subsequent payments can be made through our website or you can mail them to the Administrative Office.

COORDINATION OF BENEFITS

If you receive health coverage through a non PWGA affiliated employer, through a spouse’s insurance, or perhaps through another entity such as Medicare, the PWGA will coordinate benefits appropriately.

You will receive a Coordination of Benefits form to complete during Open Enrollment or as a new Participant to the Plan. It is important to complete this form as soon as it is received to ensure we have the most up to date information on file and to prevent delays in the handling of your claims (s). If your other insurance terminates or changes during the year, please click here to complete an updated Coordination of Benefits form.

CERTIFIED RETIREE HEALTH COVERAGE

If a writer is a Certified Retiree, they are eligible for PWGA-provided health coverage from age 60 to 65 at which point Medicare will become the primary health care coverage provider and the PWGA will move to a secondary position. More information about this can be found online by reading the TURNING 65 GUIDE here.

The bottom line is that the PWGA is bringing significant resources to bear to ensure that as many writers as possible receive health coverage through good years and bad.