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Active Participants

You are considered an Active Participant the first time the Fund receives a contribution on your behalf. (See "How to Become Eligible for Benefits" on page 17.)

Your Eligible Dependents

If you are eligible for benefits, you may enroll:

Note: Your domestic partner's children are not eligible for coverage, unless you have legally adopted them. In addition, if your dependent child is married, coverage will not be extended to your dependent's spouse or children.

Same-Sex Domestic Partners

Click here to download the Same-Sex Domestic Partnership packets.

You may enroll your Same-Sex Domestic PartnerAn individual who has submitted to the Fund an Affidavit of Domestic Partnership on a form provided by the Fund, along with supporting documentation, and who meets the criteria set forth in such Affidavit. Generally, for a partner to qualify, both the participant and his/her same-sex partner must acknowledge being in a committed relationship which has been in existence for at least six months. For more information, contact the Administrative Office. for coverage under the Fund's health plans. For purposes of the Fund's coverage, the Fund's definition of a domestic partnership is a committed same-sex relationship that:

  • Has been in existence for at least six months;
  • Includes financial interdependence; and
  • Is intended by both partners to be permanent.

You must complete and notarize an Affidavit of Domestic Partnership and submit other documents to enroll your partner. If you live in a jurisdiction that allows you to register your partnership, you must do so and provide documentation of such. Contact the Administrative Office for a complete information package on Same-Sex Domestic Partner coverage, including an affidavit form. Same-Sex Domestic Partner coverage is different from spouse coverage.

For instance:

  • You are required to pay income taxes on the dollar value of the benefits provided to your domestic partner if your partner does not qualify as your "dependent" according to the IRS Code. You do this by paying the Fund the amount of any state and federal tax required to be withheld (as indicated on the invoice that you receive from the Administrative Office), in advance, on a quarterly basis. The tax amount will be based on the value of the coverage the Fund provides to your partner, less the amount of your quarterly dependent premium payment. If you do not pay the amount required by the Fund, your Domestic Partner will not be covered.
  • Your application to cover your domestic partner is evidenced by the submission of a copy of the notarized Affidavit of Domestic Partnership and satisfactory completion of the "Affidavit of Dependency for Tax Purposes" (if applicable), and quarterly prepayment of the required taxes (if applicable). These documents should be received by the Administrative Office as soon as possible to assure Health Plan coverage for your Same-Sex Domestic Partner.
  • If you do not enroll your Same-Sex Domestic Partner when he/she is first eligible, coverage for any pre-existing conditionsA pre-existing condition is an injury or illness for which your partner has received treatment, incurred expenses or received a diagnosis within the 90 days before his/her enrollment date.* will be limited. Pre-existing conditions will not be covered until the calendar quarter beginning after the earlier of:
    • 90 days after your Domestic Partner was last treated for the condition; or
    • One year from the date your Domestic Partner could have first received coverage.
  • Your Domestic Partner's children are not eligible for coverage unless you have legally adopted them.
  • COBRA The acronym for the Consolidated Omnibus Budget Reconciliation Act of 1985 which allows for the purchase of coverage after loss of eligibility due to certain qualifying events. continuation coverage is not available for your Domestic Partner.
  • The extension of benefits due to a disability doesn't apply to Domestic Partners.

* This pre-existing condition exclusion period will be reduced on a day-for-day basis if your Domestic Partner provides a certificate of creditable coverage indicating that he/she didn't have a break in coverage of 63 days or more. Effective January 1, 2014, these pre-existing exclusions will be eliminated in accordance with the applicable requirements under the PPACA.

A pre-existing condition exclusion is an injury or illness for which your Domestic Partner has received treatment, incurred expenses or received a diagnosis within the 90 days before his/her enrollment date.


Same-Sex Spouses

In 2009, the Trustees decided to allow Same-Sex Spouses to be added to the Health Fund using the procedures currently in place for Same-Sex Domestic Partners, with some modifications to the list of documents that would otherwise be required to be submitted to the Health Fund to establish eligibility for coverage. Same-Sex Spouses will also be treated like Same-Sex Domestic Partners for purposes of other plan requirements, including the payment of taxes on the value of coverage (unless your Same-Sex Spouse qualifies as your tax dependent).

Please note the following important information:

  • If you were legally married in a state or country legalizing Same-Sex Marriage, and you have a certified marriage certificate,* the following are not required:
    • An Affidavit of Domestic Partnership;
    • Proof that you registered your domestic partnership with the State of California (or any other jurisdiction which allows you to register your partnership); and
    • Provide 3 pieces of documentation to prove your relationship has been in existence for at least 6 months.

However you must:

  • Submit a copy of your marriage certificate to the Administrative Office;
  • Pay the required quarterly Domestic Partner taxes (unless you submit the Fund's Tax Affidavit declaring that your Same-Sex Spouse is your dependent under Federal and State tax law for health coverage purposes); and
  • Pay the applicable quarterly dependent premium (if you are not doing so already).

*Note: This applies to the states that have legalized same-sex marriages.

Like a Same-Sex Domestic Partner, if your Same-Sex Spouse does not qualify as a "dependent" according to the IRS Code, the Fund will be required to collect from you and pay state and federal tax withholdings based on the value of the coverage being provided to your Same-Sex Spouse. You must pay all State and Federal tax required to be withheld (as indicated on the invoice that you receive from the Administrative Office), in advance, on a quarterly basis. The tax amount will be based on the value of the coverage the Fund provides to your spouse, less the amount of your quarterly dependent premium payment.

For California Residents: California law provides that if a domestic partnership is registered with the state, the Domestic Partner shall be treated the same as a spouse for certain State tax purposes applying to health care benefits. Accordingly, when calculating your income subject to California State tax, the value of your Same-Sex Spouse's health care would not be included. In order to ensure compliance with the new tax provision, the Fund will consider the certified copy of your marriage certificate to be the equivalent to the Declaration of Domestic Partnership you would have filed with the Secretary of State had you not gotten married.

Your application to cover your Same-Sex Spouse is evidenced by the submission of a copy of your certified marriage certificate and satisfactory completion of the Affidavit of "Dependency" for Tax Purposes (if applicable), and quarterly prepayment of the required taxes (if applicable). All should be received by the Administrative Office as soon as possible to assure Health Plan coverage for your Same-Sex Spouse.


Important!

Like a Same-Sex Domestic Partner, if you do not enroll your Same-Sex Spouse when he or she is first eligible for enrollment, coverage of pre-existing conditionsA pre-existing condition is an injury or illness for which your partner has received treatment, incurred expenses or received a diagnosis within the 90 days before his/her enrollment date.* will be subject to certain limitations. Late enrollment means that your Same-Sex Spouse will not be eligible for coverage for a pre-existing health condition until the calendar quarter beginning after the earlier of:

  • 90 days after your Same-Sex Spouse was last treated for the pre-existing condition*; or
  • One year from the date your Same-Sex Spouse first could have received coverage.
  • * This pre-existing condition exclusion period will be reduced on a day-for-day basis if your partner provides a certificate of creditable coverage indicating that he/she didn't have a break in coverage of 63 days or more. Effective January 1, 2014, these pre-existing exclusions will be eliminated in accordance with the applicable requirements under PPACA.



We urge you to consider enrolling your Same-Sex Spouse immediately upon becoming eligible.

Note: You must notify the Administrative Office of a divorce, legal separation or (if applicable, termination of a domestic partnership) within 60 days after the date of the event. COBRA Continuation Coverage is not available to Same-Sex Spouses or Same-Sex Domestic Partners.

For more information regarding adding your Same-Sex Spouse or Same-Sex Domestic Partner, please contact the Eligibility Department of the Administrative Office.


Enrolling Your Dependents

To enroll your dependents, you must submit to the Fund a completed dependent enrollment form, along with your premium payment and all required documentation, generally within 30 days of the date you become eligible. If you do not enroll your dependent within this 30-day period, you will not be able to enroll them until the next Open Enrollment period unless you experience a Life Event that qualifies you to Special Enroll your dependents in the Fund as described below.

TO ENROLL... YOU'LL NEED...
Your spouse
(opposite or same-sex)
A certified copy of your marriage license/certificate
Your Same-Sex Spouse A copy of your certified marriage license/certificate. (See qualifying marriage criteria above)
Your Same-Sex Domestic Partner A signed Affidavit of Domestic Partnership and any additional documents requested by the Fund
Your child His/her birth certificate (for newborns, since official birth certificates often are not available within 30 days of a birth, the Fund will accept temporary documentation (such as a copy of an official hospital birth record or a certificate signed by the attending or supervising physician, or midwife) along with your completed Dependent Enrollment Form to add a new child to coverage)
Foster child, adopted child, a child placed for adoption with you or a child for whom you're the legal guardian

A copy of the adoption/release, guardianship or placement documents

All of the above Important: you must provide the Social Security number for each dependent you are enrolling, unless they are not a citizen of the United States. If adding a newborn, please submit the social security number to the Administrative Office once it is received by you.

Important!

If you choose to cover your dependents and you fail to make a premium payment by the due date, coverage for your dependents will be terminated. Coverage will be reinstated during the next open Enrollment period, effective January 1, provided you prepay the premium for the first quarter (Jan 1 to March 31).


Additionally, if you decline coverage for your dependents because they have other health insurance coverage, and your dependents then lose that coverage (or if their employer stops contributing toward your dependents' other health coverage), you have the right to Special Enroll your dependents in the Fund. In order to do so, you must request and submit a Dependent Enrollment Form to the Administrative Office within 30 days after the other coverage ends (or after the employer stops contributing towards your dependent's other health coverage), and provide proof of the termination from the other health insurance plan. If a Special Enroll request is made due to marriage, your spouse's (opposite or same-sex) coverage will be backdated to the date of your marriage. However, due to the fact that there is no daily proration of dependent premiums, you may instruct the Fund to make your spouse's (opposite or same-sex) coverage effective on the 1st day of the month after your date of marriage.

If your dependent's Medicaid or State Children's Health Insurance Program ("CHIP") coverage is terminated due to loss of eligibility; or if your dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP, then you may enroll your dependents in the Fund within 60 days of such event. Coverage will become effective the date after the Medicaid or CHIP coverage ends, or your dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP provided that the request for enrollment, the required documentation and the dependent premium, if applicable, is received by the Administrative Office within 60 days of the termination of Medicaid or CHIP coverage.

If you and/or your dependents experience a Life Event, (click here for more information) you have the right to Special Enroll your dependents in any benefit option for which you are eligible under the Fund. (For example, if you reside in California and are enrolled in the Medical PPO Plan and the Dental PPO and subsequently obtain a new dependent, you have the option of enrolling your dependent in the Plan in which you are currently enrolled.)

To enroll your dependents, you will need to provide the following documentation:

DEPENDENT TYPE REQUIRED DOCUMENT
Dependent children younger than age 26 His/her birth certificate
Other dependents A copy of the adoption/release, foster placement, guardianship or placement documents
Mentally retarded or physically handicapped dependents over age 26 Proof of incapacity, medical records and proof that you're providing support

If you're re-enrolling a dependent, have previously submitted the appropriate documentation, have not been asked to supply additional or modified information and have not been advised that your dependent(s) is not eligible to enroll, then all you need to do is complete a "Dependent Reinstatement Form" and pay the dependent coverage premium, if applicable.

Paying For Dependent Coverage

In addition to meeting eligibility earnings requirements, you must pay a monthly premium if you wish to cover your dependents.

Your dependents include:

  • Your spouse (opposite or same-sex) or Same-Sex Domestic Partner; and
  • All eligible dependent children.

(See "Your Eligible Dependents" for the definition of "eligible dependents.")

This premium covers all eligible dependents in your household who you enroll for medical, dental and vision benefits. Your own coverage, which you receive when you meet the eligibility earnings requirement, doesn't require a premium payment. The dependent premium amount is listed in the Summary Of Benefits section.

Plan Participants (not including employees of "Named Employer") pay dependent premiums on a quarterly basis, in advance, based on invoices issued by the Fund. Only the dependents you have enrolled will be covered. To enroll dependents, you must complete and submit a "Dependent Enrollment Form" (including all required documentation, if applicable) to the Fund office. If the Fund does not receive the required premiums by the due date, dependent coverage will be terminated, and you will not have another opportunity to enroll your dependents, unless you or your dependents experience a Life Event that allows you to Special Enroll, or until the next Open Enrollment period, with coverage taking effect the following January 1.  (See "Life Events" below for more information).

Newborns of participants who have earned coverage or coverage through any of our COBRA plans are covered for the first 31 days after birth, but lose coverage thereafter, unless:

  • A completed Dependent Enrollment Form is received;
  • The required documentation is provided; and
  • The dependent premium is paid, if applicable.

Note: If you have already paid the dependent premium for your existing dependents, you do not need to submit an additional premium for the newborn.

Health Coverage For Children and Families

If you are eligible for health coverage from your employer (which includes coverage provided through plans sponsored by unions and employers, like the Fund), but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. These are existing state programs and are not related to the Health Care Reform Act.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state that offers this program, you can contact your state Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your state Medicaid or CHIP office or dial 1-877-KIDSNOW, or go to www.insuredkidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

Once it is determined by the State that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer's health plan is required to permit you and your dependents to enroll in the plan - as long as you and your dependents are eligible, but not already enrolled in the employer's plan. This is called a "Special Enrollment" opportunity, and you must request coverage from the plan within 60 days of being determined eligible for such premium assistance.

If you would like to request that you be provided with this Special Enrollment opportunity from the Fund, please contact the Eligibility Department at (818) 846-1015 or (800) 227-7863 to request the necessary forms.

To determine which states have added a premium assistance program or to obtain more information on Special Enrollment rights, you can contact either:

U.S. Dept. of Labor Employee
Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272), or
U.S. Dept. of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Ext. 61565

Granting Retroactive or Terminating Prospective Coverage

Sometimes Employer Compliance audits uncover cases in which a participant gains or loses eligibility due to misreported earnings and was unaware of his/her correct status. The Fund then makes the appropriate adjustments:

  • Retroactive eligibility will be granted for the period in which you would have been eligible if earnings were accurately reported.
  • Note: you may submit claims for all medical, mental health and chemical dependency, hospital, vision, dental and pharmaceutical expenses that you incurred during the period of retroactive eligibility.

  • If you're awarded retroactive eligibility and want dependent coverage, you'll have to pay monthly premiums retroactively for the number of consecutive quarters for which you want dependent coverage.
  • If the Fund determines that current coverage was granted in error, your coverage will be terminated prospectively, (as opposed to retroactively, except as otherwise provided herein). Coverage will end on the last day of the month following the month in which our notice of termination is dated. For example, if our notice is dated March 15th, your coverage will terminate April 30th.

The collection of any delinquent contributions may result in the granting of retroactive eligibility for Health Fund coverage. Should retroactive eligibility be granted, you will be notified by the Administrative Office of:

  • Your new eligibility period; and
  • The process for submitting receipts for retroactive medical, mental health and chemical dependency, dental, vision and prescription claims. Please save your receipts!
Life Events

If you experience one of the following Life Events, you will be allowed to Special Enroll or drop dependent coverage during the year provided you have notified the Fund within 30 days of the Life Event:

  • Marriage, divorce or legal separation (in the instance of a divorce the Fund must be notified within 60 days of the event);
  • Birth or adoption of a dependent child or placement of a child for foster care or adoption;
  • Legal judgment or court order to cover a dependent child;
  • Death of a spouse (opposite or same-sex), Same-Sex Domestic Partner or dependent;
  • Any change in a spouse's (opposite or same-sex), Same-Sex Domestic Partner's or dependent's employment status that results in a significant change to benefits, such as the start or end of employment, change from full-time to part-time employment, or start or end of an unpaid leave of absence;
  • Termination of Medicaid or CHIP coverage (Fund notification within 60 days is required);
  • Unmarried dependent's (up to age 26) loss of health insurance benefits provided by their employer; or
  • Change in work-site or residence for the participant or his/her spouse (opposite or same-sex), Same-Sex Domestic Partner or dependent if that change affects benefits.

Note: If you timely request to special enroll in the Health Plan due to birth, adoption or placement for adoption of a dependent child, coverage will become effective as of the date the event occurred.

Other status changes, such as a change in a family member's coverage, may apply. For example, if your spouse (opposite or same-sex) elects family coverage during his/her open enrollment period, you may be allowed to drop dependent coverage. You may contact the Eligibility Department at the Administrative Office if you have questions about any of the Life Events described in this section.

You will not have to pay the entire quarterly premium if your Life Event takes place during the quarter. Instead, your premium will be prorated to the first day of the month in which the most recent Life Event takes place. If you do not make a premium payment at the time of a Life Event, or if you do not make your request to Special Enroll a dependent within 30 days of a qualified Life Event, you will not be able to enroll your dependents until the next annual Open Enrollment period.

When Coverage Begins

Not applicable to eligible Named Employers (e.g., Writer's Guild-Industry Health Fund, Producer-Writers Guild of America Pension Plan, Writers Guild of America East and West, Writers Guild Foundation and employees of the CBS Staff group).

accommodate necessary administrative processes, your coverage will take effect one calendar quarter after the quarter in which you satisfy the eligibility earnings requirement. (See chart below or the Summary of Benefits section for more details). Your coverage will begin on the first day of the month after your one quarter administrative period and will continue for one year.

Once you have established eligibility, it is important to be aware of your personal earnings cycle (the period in which you must meet the Eligibility Earning requirement to continue uninterrupted coverage).

The chart below provides some examples.*

If You Satisfy the Eligibility Earnings Requirement In
Your Coverage
Period Will Be
The Earnings Cycle
for Continued Coverage Will Be
October 1 – December 31
April 1 - March 31
January 1 - December 31
January 1 - March 31
July 1 – June 30
April 1 – March 31
April 1 - June 30
October 1 – September 30
July 1 – June 30
July 1 - September 30
January 1 – December 31
October 1 –September 30

For example, if a writer is hired on March 15, 2013 for a covered writing project and thereafter meets the eligibility earnings requirements by June 15, 2013, his/her coverage cycle will begin October 1, 2013 and run through September 30, 2014. To qualify for another year of coverage, he/she must earn the applicable eligibility earnings requirement in the period July 1, 2013 through June 30, 2014. If the earnings requirement is not met in this period, earned coverage under the Fund will end. He/she may regain earned coverage when the eligibility earnings requirement is met in a subsequent four-quarter earnings period.


When Coverage Ends

Not applicable to eligible Named Employers (e.g., Writer's Guild-Industry Health Fund, Producer-Writers Guild of America Pension Plan, Writers Guild of America East and West, Writers Guild Foundation and employees of the CBS Staff group).

If you continue to meet the eligibility earning requirement, coverage for you and your eligible dependents will continue uninterrupted. If you do not meet the eligibility earnings requirement during your personal earning cycle, your employerpaid coverage will end on the last day of your 12-month coverage cycle.

Your coverage will end if:

  • The Health Fund is modified to terminate coverage for your class of participants; or
  • The Plan ends.

Your dependents' coverage generally ends when your coverage ends. Additionally, dependent coverage will end if:

  • You do not pay the dependent premium by the due date;
  • On the last day of the month that a dependent child reaches age 26 (in the case of a covered child who is mentally or physically disabled who had extended coverage beyond age 26, the last day of the month that such child no longer to have such disability);
  • Your mentally or physically disabled dependent child over the age of 26 loses total disability certification because he/she no longer meets the Fund's definition of total disability (coverage will end on the last day of the month in which the child loses certification); or
  • Your dependent child enters full-time military service.

If you become legally separated or divorced, coverage for your spouse (opposite or same sex) will end on the last day of the month in which:

  • You were legally separated; or
  • Your divorce was final.

Your Same-Sex Domestic Partner'sAn individual who has submitted to the Fund an Affidavit of Domestic Partnership on a form provided by the Fund, along with supporting documentation, and who meets the criteria set forth in such Affidavit. Generally, for a partner to qualify, both the participant and his/her same-sex partner must acknowledge being in a committed relationship which has been in existence for at least six months. For more information, contact the Administrative Office. coverage will end on the last day of the month in which:

  • You fail to pay the required taxes to the Fund by the due date;
  • You fail to pay the required dependent premium to the Fund by the due date; or or
  • The partnership ends.

As required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA),if you or your dependent's health coverage ends under the Fund, you and your dependents are entitled by law to, and will be provided with, a "Certificate of Creditable Coverage." Certificates of Creditable Coverage indicate the period of time you and/or your dependents were covered under the Fund (including COBRA coverage), as well as certain additional information required by law. A Certificate of Creditable Coverage may be necessary if you and/or your dependents become eligible for coverage under another group health plan, or if you buy a health insurance policy within 63 days after your coverage under this Fund ends (including COBRA coverage, not applicable to Same-Sex Domestic Partners). A Certificate of Creditable Coverage is necessary as it may reduce any exclusion for preexisting coverage periods that may apply to you and/or your dependents under the new group health plan or health insurance policy.

A Certificate of Creditable Coverage will be provided to you, upon request, up to 24 months after your coverage ends; when you are entitled to elect COBRAThe acronym for the Consolidated Omnibus Budget Reconciliation Act of 1985 which allows for the purchase of coverage after loss of eligibility due to certain qualifying events.; when your coverage terminates (even if you are not entitled to COBRA); or when your COBRA coverage ends. Certificates of Creditable Coverage should be kept as proof of prior coverage for you or your dependent's new health plan. To request a Certificate of Creditable Coverage, please contact the Administrative Office.