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Certified Retirees

How To Qualify For Certified Retiree Health Fund Coverage

Before you qualify for coverage as a Certified Retiree, you must:

  • Satisfy certain employment minimums; and
  • Submit a Certificate of Retirement to the Administrative Office of the Producer-Writers Guild of America Pension Plan. This certificate can be obtained by contacting the Administrative Office.

Important!

If you retired before January 1, 1997, you are considered a Certified Retiree if you:

If you retired on or after January 1, 1997, you're considered a Certified Retiree if you:

  • Are at least 60 years old; and
  • Retired under the Producer-Writers Guild of America Pension Plan; and.
  • Accumulated at least 68 quarters of earned eligibility before your retirement, calculated as follows:
    • A qualified year under the Producer-Writers Guild of America Pension Plan for each year before 1988 equals four quarters of eligibility for each year before 1988; and
    • Each year of eligibility earned under the Health Fund during 1988 and every year thereafter equals four quarters of eligibility.

Important!

Certified retiree Health Coverage and eligibility requirements for the coverage can be amended and terminated at any time both for actives and for those who are inactive or already retired.  See "Plan Changes or Termination" on page 120.


When Certified Retiree Coverage Begins

If you still have employer-paid coverage when you retire, that coverage will continue until your employer-paid eligibility period ends. At that point, your Certified Retiree Health Coverage begins.

If you're younger than 60 years old and you have at least 68 qualified quarters when you retire, your Certified Retiree Health Coverage will begin on the first day of the month after you turn 60 (provided you are not on employer-paid coverage when you turn 60).

If you return to work after your Certified Retiree Health Coverage begins, and you regain employer-paid coverage by meeting the eligibility earnings minimum requirement, you will be considered an Active Participant on earned coverage and will be required to pay the premium for dependent coverage.

Generally, except for the very important rules that relate to Medicare (explained below), if you are a Certified Retiree, your health coverage includes the same benefits provided to participants with employer-paid coverage. (For information about how your benefits will be coordinated, see "Understanding Coordination of Benefits (COB)".)

As a Certified Retiree, you are not required to pay a premium for dependent coverage if you:

  • Are not eligible for active coverage under the Fund; and
  • Are 65 or older.
Medicare Parts A and B

Medicare is a two-part program. Part A covers hospitalization and certain follow up services, which is at no cost to you when you are Medicare eligible. Part B, which helps pay doctor bills and other medical bills, requires payment of a monthly premium and you must enroll prior to turning age 65. In order for you to receive optimum coverage and reimbursement for your hospital and doctor bills, it is important that you enroll in Part A and Part B of Medicare.

Please note: Medicare coverage will be the primary plan when you turn age 65 and on Certified Retiree Health Coverage. If Medicare enrollment has not occurred, the Fund will pay benefits as if you are enrolled in both Part A and Part B, and will coordinate benefits as if you had received reimbursement for your medical expenses from Medicare. (The Fund will pay 20% of the eligible medical expenses after the deductible is satisfied.)

You (and your dependents) may become eligible for Medicare upon turning 65, after the first 30 months of end-stage renal disease ("ESRD"), or if you have been deemed totally and permanently disabled by the Social Security Administration ("SSA").

If you are approaching age 65, you are not automatically enrolled in Medicare unless you have filed an application and receiving your monthly Social Security benefit. If you have not applied for Social Security benefits, you must file a Medicare application form during the three month period prior to the month in which you reach age 65. Call or write your nearest Social Security Office 90 days prior to your 65th birthday and ask for an application.

Medicare Part D

Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

The Fund has determined that its prescription drug coverage is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide To Join A Medicare Drug Plan?

If you enroll in the Medicare drug program, your prescription drug coverage under the Fund will be terminated. You will, however, remain eligible for all other Plan benefits that you were eligible for prior to enrolling in the Medicare prescription drug benefit, provided that you continue to qualify for those benefits. Your eligible covered dependents who have not enrolled in a Medicare drug program will continue to receive prescription drug coverage under the Fund.

If you decide to join a Medicare drug plan and drop your prescription drug coverage under the Fund, be aware that you will not be able to reinstate your prescription drug coverage under the Fund until the next annual open enrollment period. (Plan changes to the Fund's prescription drug benefits that are adopted during open enrollment generally become effective January 1st of the following year.)

More detailed information about Medicare plans that offer prescription drug coverage is in the "Medicare & You" Handbook. Every year, in the mail, you will get a copy of the handbook from Medicare. You may also be contacted directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

  • Visit www.medicare.gov,
  • Call your State Health Insurance Assistance Program for personalized help; or
  • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.ssa.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Medicare Private Contract

Under the law, you are entitled to enter into a Medicare private contract with certain health care practitioners under which you agree that no claim will be submitted to or paid by Medicare for health care services and/or supplies furnished by that health care practitioner. If you enter into such a contract, the Fund will pay a portion of the benefits for health care services and/or supplies you receive pursuant to it, but those benefits will be subject to all of the Plan's terms and provisions, including those relating to exclusions, medical necessity, reasonable and customary charges, and utilization management. Specifically, the Fund will pay 20% of the eligible medical expenses after the deductible is satisfied, and you are responsible for the rest.