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Health Fund

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Plan Features

MEDICAL, MENTAL HEALTH AND CHEMICAL DEPENDENCY
PPO PLAN LOW OPTION PLAN 1
Network Provider 2 Non-Network Provider 3 Out Of
Area 3, 4
(For participants who live over 25 miles outside the PPO service area of 2 providers)
Network Provider 2 Non-Network Provider 3
Plan Features
Calendar-year deductibleThe portion of eligible expenses you're responsible for paying each calendar year before the Fund begins to pay certain benefits. 5 $300/person;
$900/family
$300/person;
$900/family
$300/person;
$900/family
$750/person;
$2,250/family
$750/person;
$2,250/family
Out-of-Pocket MaximumThe maximum amount you pay in coinsurance each plan year for eligible medical expenses.
7, 8
$1,000/person6
(coinsurance only)
ACA6
$6,350/person
$12,700/family/yr
(Includes in-network deductible, coinsurance & coapys)
$2,500/person $1,000/person $4,500/person6
(coinsurance only)
ACA6
$6,350/person
$12,700/family/yr
(Includes in-network deductible, coinsurance & coapys)
$6,000/person
Lifetime
Maximum
Unlimited Unlimited Unlimited Unlimited Unlimited

IMPORTANT!
Note: All services are subject to medical neccessity review at the time of payment.

1. For COBRA participants and Extended Coverage participants only.

2. Benefits for services received from a network provider will be paid based on the contracted rate.

3. Benefits for services received from non-network and out-of-area providers will be paid based on reasonable and customary (R&C) allowances. The participant is responsible for any amount over the R&C.

4. The participant must contact the Fund office to determine if the provider qualifies for the out-of-area benefit. If the provider is approved, the participant is responsible for filing claims with the Fund to receive benefit reimbursement.

5. All plan benefits are paid after the deductible, unless otherwise noted.

6. Calendar-year deductible, office visit and hospital copays do not apply toward the out-of-pocket maximum. When the out-of-pocket maximum is reached, benefits are payable at 100% of R&C allowances or the contracted rate (whichever applies) for the rest of the calendar year. The Affordable Care Act (ACA) level for in-network services only includes the deductible, coinsurance and copays.

7. The out-of-pocket maximum (after deductible) for Medicare-eligible Certified Retirees who retired prior to March 1, 1997, and are receiving a benefit from the Producer Writers Guild of America Pension Plan of less than $800 per month, is $400 for network providers (with coverage at 85%) and $600 for non-network providers (with coverage at 70%).

8. Both network and non-network charges apply toward your out-of-pocket maximum, unless otherwise noted.


Covered Earnings Minimum

Eligibility Earnings Minimum
(effective 7/1/12):
$34,956 (One hour network prime-time story and teleplay)
Eligibility Earnings Minimum
(effective 7/1/13):
$35,568 (One hour network prime-time story and teleplay)
Eligibility Earnings Minimum
(effective 7/1/14):
$36,457 (One hour network prime-time story and teleplay)
Eligibility Earnings Minimum
(effective 7/1/15):
$37,551 (One hour network prime-time story and teleplay)
Premium for
Dependent Coverage:
$50 per month, payable quarterly, in advance
Life Insurance Benefit for Active
Participants and Certified
Retirees: PPO Plan only
$5,000