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Health Fund FAQs

Dependent Coverage

A: When you receive health care coverage, this includes your spouse and children, as long as the Administrative office receives your dependent premium of $150.00 (quarterly paid in advance premium).

A: No, coverage is not automatic; you need to notify the Eligibility Department of your Life Event. If your new daughter is the first dependent being added to your coverage, you will need to complete a Dependent Enrollment Form pdf , attach a copy of their birth certificate or hospital record of birth and pay the dependent premium. However, if you have already added dependents and paid your quarterly premium, simply submit the paperwork, and your new baby will be added as a dependent for health coverage.

**Exception to this rule is if the participant does not have any other dependent and does not plan to added the newborn to the plan, the newborn is still covered under the mother's plan for the first 31 days.

A: As a matter of fact, yes, it can. Your health coverage under the Health Fund can coordinate benefits after the primary insurance has paid.

A: Unfortunately, no, your fiancé is not covered under the Health Fund. You must be married and have a copy of your marriage certificate (or provide a signed affidavit of domestic partnership), and any additional documentation requested by the Health Fund on record with the Fund.

A: Yes! But, you will be required to provide a copy of the adoption release, guardianship or placement documents to the Health Fund.

A: You may cover your daughter until the last day of the month in which she turns 26, provided your earned eligibility continues under the Fund.

A: Yes. To cover all your eligible dependents the Fund requires a quarterly premium of $150 ($50 per month). Click here for a list of eligible dependents and required documentation necessary to add them to your plan.

A: Effective January 1, 2011, plan participants may cover their dependent children through the last day of the month in which they turn 26 (provided the participants earned eligibility continues under the Fund). To add your 23 year old, complete a Dependent Enrollment Form pdf  and mail it to the Fund Office with a copy of their birth certificate. If you are not already paying dependent premiums on other dependents, you will need to include payment of the quarterly dependent premium.

A: Sorry, but no, you cannot add a parent as a dependent under the Health Fund.

A: Yes, there are four ways you may be able to continue your Health Fund coverage; you may qualify for the Excess Earnings Extension (also know as the $250k extension), the Extended Coverage Program, the COBRA Continuation Coverage Program or if you considering retiring, you may qualify for Certified Retiree Health Fund Coverage. The Fund will automatically use the Excess Earnings Extension or the Extended Coverage Program to extend your coverage, if applicable. You must apply for the COBRA Continuation Coverage Program and Certified Retiree coverage. Click to download the COBRA Enrollment packet pdf and the Extended Coverage Packet pdf.

A: Please notify the Eligibility Department in writing when your divorce in final. You should include a copy of your final divorce decree (specifically the page indicating the final date of divorce) and address information for your ex-spouse so the Fund can mail him/her information regarding their right to purchase COBRA Continuation Coverage. Important; you must notify the Fund within 60-days of your divorce or your ex-spouse will lose their right to purchase COBRA coverage. Note: If you obtained a legal separation from your spouse, you may provide the court papers and request that your spouse be removed as of the date of your legal separation. For more information, please contact the Eligibility Department at the Fund Office. Click to download the COBRA Enrollment packet pdf.

Health Fund

A: If you use a non-network physician, you will need to fill out the Participant Submitted Claim Form and attach the original itemized bill from the provider that includes the patient's name, identification number, provider information (including name, address and tax identification number) as well as the procedure and diagnostic services. Non-contracted providers can submit paper or electronic claims on behalf of the Participant; however, they are not required to. It will depend on the individual provider's office/facility billing practices. If you use a network physician, then the rendering physician will submit the bill(s) on your behalf.

A: Well, there's some good news, the office visit and labs would likely be considered a covered expense as long as the provider is diagnosing the infertility. But, you are right, once the infertility has been diagnosed; fertility treatment is not a covered benefit. So, with a few more specifics, if the referral to the GYN is to determine whether you are infertile or whether there are other medical indications, then the services performed during that visit would be considered diagnostic and eligible for reimbursement. If, however, you have already been diagnosed as infertile, the services would be considered treatment of infertility and not covered. And of course, no answer would be complete without your friendly disclaimer: This is not a guarantee of benefits. Benefits are determined at the time of service and based on continued eligibility. This response was based on the limited information provided. All benefits quoted herein are governed by the limitations and other information contained in your SPD and its supplements.

COBRA

A: Once the signatory company has reported the monies and you meet the minimum earnings amount, there is a calendar quarter waiting period. Your effective date of health care coverage under the Health Fund would be the following month after this waiting period and the coverage will extend for twelve months.

A: Why yes, there are different rates. Upon receipt of your COBRA packetpdf, there are several options for you to review for health coverage - for one family member or the entire family.

Health Plan Options

A: All industry participants have the opportunity in the Southern California area to use the Industry Health Network at any time. However, it is required that you contact the Industry Health Network directly to set up an appointment and all applicable co-payments apply. http://www.mptf.com/healthcare

A: Yes, you can use your coverage in Europe and beyond! Under the Health Fund Regular Medical Plan coverage obtained by seeing a licensed provider while out of the country can be submitted for reimbursement at 80%.

A: No, you are not required to use the insurance coverage under the Health Fund for any reason. The decision is totally up to you!

Eligibility

A: To become eligible for one year of Health Fund coverage you must have covered earnings reported to the Fund and contributions paid on those amounts that are equal to or greater than the current earnings minimum requirement during a period of four or fewer consecutive calendar quarters.

The earnings minimum requirement is equal to the current Writers Guild of America minimum for a one hour network prime-time story and teleplay. Earnings minimums will increase with any increase in the Guild minimum provided by the collective bargaining agreement. Click to view the earnings minimum chart.

A: The Fund needs time to receive and process employer contribution reports so there is a three month (one calendar quarter) lag period between your satisfying the earnings requirement and commencement of coverage. Once your coverage begins, it remains in effect for 12 consecutive months (four consecutive calendar quarters). Click here to view the earnings cycle chart to get a better understanding on how eligibility is granted and how to continue coverage from year to year.

A: The Excess Earnings Extension does have a provision for writers who were part of a bona fide two-party writing team. If you think you qualify, please contact the Eligibility Department at the Fund Office for more information.

A: Contact the Guild before your contract is executed. The Guild has a married writer exemption which may allow one partner to receive enough covered earnings to qualify for coverage. After payment of the dependent premium, the spouse is also covered. This exemption also applies to Same-Sex Domestic Partnerships (SSDP) and Same-Sex Marriages.

A: The Fund offers COBRA Continuation coverage for periods of 18, 24 or 36 months depending on the situation. Click here to view the COBRA Qualifying Event Chart. You may also contact the Eligibility Department at the Fund Office for more information. Click to download the COBRA Enrollment packet pdf.

A: Your buddy was probably referring to Certified Retiree Health Fund Coverage. In order to receive this benefit you must retire from the Producer-Writers Guild of America Pension Plan and at the time of retirement you must have accumulated at least 68 qualified Health Fund quarters. If you satisfy both requirements, you would qualify for Certified Retiree Health Fund coverage. The benefits are the same as Active Coverage. However, if you are eligible for Medicare, Medicare will be considered your primary insurance and the Fund will be secondary. You can continue to cover your eligible dependents (pdf of chart) as long as you continue pay the dependent premiums (if applicable). For more information about this benefit, please contact the Eligibility Department at the Fund Office.

A: This statement is sent to covered plan participants approximately 45 to 60 days before their earnings cycle ends. It contains important information regarding your status for continued coverage. If, after reviewing your statement, you find certain employer contributions are missing, please use the form included with your statement to report the missing earnings to the Employer Compliance Department. Please review your statement as soon as you receive it, the sooner you report a discrepancy, the sooner we can contact your employer and collect delinquent contributions.

Retiree Coverage

A: The Health Fund doesn't offer senior citizens discount or special rate, sorry.

A: Yes, you are required to enroll in Medicare Part B when the Health Fund coverage is your secondary coverage. If you fail to enroll in Medicare Part B, the Fund's benefits are reduced by 80%.

Claims

A: The good news is that the Health Fund will coordinate benefits with other plans that are group coverage. The determination of which plan pays first is based on specific Fund rules. And, the bad news is that you cannot elect which plan you want as your primary plan.

A: Sometimes we need to ask a lot of questions. Like, 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 provide benefits. For example, if the injury is the result of an automobile accident, the Health Fund must coordinate with the auto insurance company. If a third party were liable for the accident, the third party would be responsible for the benefits. In these accident types of situations, we need information from you to determine how your medical expenses should be paid.

A: Please contact the Eligibility Department and ask for a "Vacation Override". This will allow you to obtain more than the normal 30-day supply refill at your retail pharmacy or more than the 90-day supply refill through mail order. However, you will be required to pay applicable multiple co-pays.

A: Express Scripts-by-mail is the answer. The Health Fund prescription plan allows you one initial fill and one refill through your local pharmacy. If you are taking medication long term (e.g., blood pressure or diabetes medication), you must use Express Scripts mail order pharmacy pdf. Obtaining prescriptions by mail saves you and the Health Fund money. To get started, ask your doctor to write a prescription for a 90-day supply (plus up to 3 refills), complete the Express Scripts mail order form pdf and mail it and your prescription directly to Express Scripts Mail Order Pharmacy. Click here to view the prescription co-pay chart. In the meantime, if you're completely out of your medication please contact the Eligibility Department at the Fund Office for assistance.

A: Yes. Simply complete a Express Scripts Foreign Claim form pdf, attach your receipt and mail it directly to Express Scripts for reimbursement. Express Scripts will process your claim based on the exchange rate that was in effect when your prescription was filled.

Vision Plan Benefits

A: Yes. Effective July 1, 2017 Vision Care Benefits are provided by VSP. Services rendered prior to July 1, 2017 were covered under Davis Vision.

A: No. When you schedule an appointment with a VSP Network provider, simply let them know you have coverage through VSP. The provider will electronically verify your eligibility and benefits. If you would prefer to carry an ID card, visit: vsp.com, create and account and then you can print an ID card on demand.

A: No. However PWGA Participants will receive (on average) a 15% discount off the regular price for Laser Vision Correction if performed by a VSP network provider. If the network provider is running a promotion for this service, PWGA Participants will receive a 5% discount off the promotional price. These discounts are only available from VSP contracted facilities.

A: If you receive vision services from an out-of-network provider, you must pay the provider directly at the time services are rendered. Claims for non-network vision care must be filed with VSP no later than 12-months after the date of service. Submit a completed VSP claim form, the itemized bill and proof of payment to:

VSP
P.O. BOX 385018
Birmingham, Alabama 35238-5018

You can obtain a copy of the VSP Vision Claim form from our website or on-line at: vsp.com

A: Yes, VSP allows coordination of benefits for patients eligible for coverage by more than one vision plan. Please contact VSP directly for more information at 800-877-7195.

A: No. Under VSP, a Participant may purchase frames once every other year and lenses every year. Since you already purchased glasses (frames and lenses) this year, you will not be eligible to purchase new frames until two years from the date of your last purchase. If you need a new prescription next year, you may obtain new lenses for your existing frames.

A: No, each calendar year, you can elect to purchase one or the other, not both (keep in mind, you can only purchase frames every other year).