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Health Fund

Section 8
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Frequently Asked Questions

Q: How will I know when I've met the eligibility requirement?
A: Once you've met the covered earningsIncome for writing services covered by a collective bargaining agreement that employers report to the Fund. minimum, the Administrative Office will send you an enrollment package with a Notice of Eligibility. The notice outlines your eligibility period and benefit coverage. If you believe you have met the eligibility requirement but don't receive a Notice of Eligibility, you should call the Administrative Office.

Q: What is the reason for the three-month waiting period between the earnings period and the benefit period?
A: The three-month waiting period is needed for employers to submit a report of earnings and for the Fund to process these reports so the Fund can be sure it has a record of all of your earnings.

Q: Can I make up the difference in cash between what I've earned and what I need to have earned to qualify for benefits? For example, if I'm short of meeting the covered earnings minimum by $1,000, can I pay $1,000 so I can qualify?
A: No. The covered earnings minimum is based solely on employment covered by the collective bargaining agreement. You cannot pay to make up for any shortage in order to satisfy the covered earnings minimum.

Q: Do I have to accept or use this coverage?
A: The coverage you have earned under the Fund is automatically available to you as part of your collective bargaining agreement. However, you are not required to use the coverage provided by the Fund.

Q: Does my health care coverage include my family?
A: No, it covers you only. If you want to cover your eligible dependentsAny dependent of a participant who meets the criteria for eligibility established by the Fund., complete a dependent enrollment form, attach copies of all required documentation and pay the required applicable quarterly premium (s). Dependent coverage premiums are not required for Certified Retirees A participant who satisfies certain requirements is designated as a Certified Retiree. age 65 and over who do not have active earned coverage.

Q: Does my newborn automatically have coverage?
A: Yes, your newborn is automatically covered for 31 days after birth. But to continue coverage after that time, you must Special Enroll your child by submitting a completed dependent card and proof of birth, and pay the required dependent coverage premium by the 31st day following the birth of your child.

Q: I plan on adopting. Can my adopted child receive coverage?
A: Yes, if you Special Enroll your newly adopted child as a covered dependent and pay the required dependent coverage premium within 30 days following the adoption or placement for adoption. You may also enroll your adopted child during an Open Enrollment period. When you enroll your adopted child, you'll also be required to provide the Fund with a copy of the adoption, guardianship or placement documents.

Q: My spouse has coverage through work. Can my spouse be covered under the Fund as well?
A: Yes. If you cover your spouse, you will have to pay a dependent coverage premium. Then, your spouse's coverage under the Fund can coordinate benefits after your spouse's primary health plan has paid.

Q: I'm currently engaged. Is my fiancé covered?
A: No, not until you're married. Once you receive a certified copy of your marriage certificate you may add your spouse or Same-Sex SpouseAn individual who is legally married to a participant of the Same Sex or gender, and such relationship is legally recognized as a marriage in the state or jurisdiction where the marriage was performed. as your dependent. To cover 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., you must provide a signed Affidavit of Domestic Partnership and any additional documentation requested by the Fund. In either case, you must pay the required dependent coverage premium.

Q: Can I cover my parents under the Fund?
A: No.

Q: At what age do my children stop having coverage?
A: Unless your children are mentally or physically disabled and receiving coverage prior to age 26, your dependent children will be eligible for coverage until the last day of the month of their 26th birthday.

Q: Does the Fund offer a senior rate for health coverage?
A: No.

Q: Is there a different rate for COBRA Continuation Coverage for one person versus a family?
A: Yes. When you receive your 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. packet, you will have several options to review for health coverage on an individual basis or for the entire family.

Q: How does The Industry Health Network (TIHN) work for me?
A: All industry participants in the Southern California area have the same opportunity to use The Industry Health Network at any time. If you live in Southern California and enroll in the PPO Plan or the Low Option Plan, you can get medical care at one of the local area health centers established especially for members of the entertainment industry. You do not need to select a Personal Care Physician (PCP). All you have to do is call for an appointment. (See "How The Industry Health Network Works" for details.)

Q: Is there a separate deductible for the prescription drug program?
A: No.

Q: Can I use my health coverage if I am out of the country?
A: Yes. If you receive care outside the country, contact the BlueCard World Service Center for access to medical assistance services and healthcare providers around the world. The phone number is listed under the title "BlueCard Worldwide on the backside of your Medical ID Card. (See page 50 for details.)

Q: How are my claims paid if I also have coverage with another carrier?
A: The Fund will coordinate benefits with other group coverage plans. This is called coordination of benefitsThe payment of health care benefits when a member is covered by two or more benefit plans. One of the health plans will be primary and the other secondary. The primary plan pays first following its rules and schedule of benefits; then the payments under the secondary plan are coordinated so that combined plan payments don't exceed 100% of eligible expenses. (COB). Specific plan rules determine which plan pays first or how much. You cannot decide which plan pays first or second. (See "Understanding Coordination of Benefits (COB)" for details.)

Q: I am a Certified Retiree. I have coverage through the Fund, and I do not want to enroll in Medicare Part B. Do I have to?
A: Yes. If you fail to enroll, the Fund's payment of benefits will be processed assuming you have Medicare Part A and B benefits.

Q: Why am I asked for accident injury information on certain claims?
A: If a claim has an accident or injuryBodily harm caused by an accident. The injury must also result, for the purposes of accidental death and dismemberment coverage, directly and independently of all other causes, in a loss covered by the plan. diagnosis, there may be another plan or entity that should legally provide benefits. For example, if the injury is the result of an automobile accident, a third party may be liable. In this case, the Fund must coordinate benefit payments with the auto insurance company. If a third party were liable for the accident, the third party would be responsible for paying the costs incurred as a result of the accident. In these situations, the Fund needs information from you in order to determine how your medical expenses should be paid.

Q: My Certified Retiree Health Fund Coverage will begin soon; do I have to enroll in Medicare Part D?
A: No. The prescription drug coverage offered by the Health Fund, is expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Credible Coverage. You may keep your Health Fund coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug program.