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Just So You Know – July 2018

CONTRIBUTIONS ON COVERED SERVICES

Be Proactive!

Contributions on covered services are critical for your client to obtain health and pension benefits. If there’s an issue, the first thing we need to do is look at contributions. You can help speed up the process and avoid problems by giving us the tools to help your client before there’s a hiccup.

Send the PWGA’s Employer Compliance Department a copy of your client’s contract as soon as it is available. That way, we know about your client’s employment. We can also determine whether the services are reportable, and we can monitor when contributions are due and expected to be remitted.

If your employer does not honor their obligation, you can have our Employer Compliance Department send them a reminder billing. You will need to forward a copy of the contract and evidence of payment for services to the Employer Compliance Department. If we already have a copy of the contract – because you have been proactive on your client’s behalf – we can move that much faster.

A writer needs to be paid before contributions can be made on his/her behalf by the employer. Let us know when your client has been paid for covered services. Send us copies of his/her check stubs. That way, we know that contributions are forthcoming (due 30 days after writer’s payment) and we can monitor them on your behalf. We can also initiate a bill to the employer should the deadline for payment pass and the contributions become delinquent.

For more information, please contact Employer Compliance (818) 846-1015 ext. 603 or email us at EmployerCompliance@wgaplans.org

PERSONAL HEALTH INFORMATION

Personal Health Information (PHI) is protected by law. In order for a third party to access PHI, they must have written authorization regarding their client’s benefits, claims and eligibility.

It is important to obtain this permission in advance both to protect clients’ privacy, but also, in case a client is not able to obtain it themselves due to an unforeseen medical condition, or other circumstance.

When filling out the authorization to release information form, please make sure your client lists each individual person that he/she would like to give authorization to. There may be multiple people in your office who have overlapping responsibility for a given client. Each of these persons must have written authorization to call the Fund on the client’s behalf.

The PHI form is only valid for two (2) years and needs to be refilled, signed and dated by the client (18 years of age or older). Once completed and signed, the client may return the form via e-mail to: pmailbox@wgaplans.org, by fax to: 818-566-8445, or via mail to: WRITERS’ GUILD-INDUSTRY HEALTH FUND, 2900 W. Alameda Ave., Suite 1100, Burbank, CA 91505, Attn: CLAIMS DEPARTMENT.

Please be aware that there are two different authorization to release information forms: There is one form for the Health Fund and another for the Pension Plan. You will need to fill out both forms if you would like to authorize someone to call in on your behalf on either plans. Please click on the link directly below to download the necessary forms:

https://wgaplans.org/health/health_forms.html

If you have any questions or concerns, please contact the Participant Services Department at:

(818) 846-1015 / (800) 227-7863
(Press 1, then press 1)
Email: ParticipantServices@wgaplans.org
Fax: (818) 566-8445

HOW TO SUBMIT FOREIGN CLAIMS

Make sure if your client goes to a foreign country and fills a prescription while outside the USA to hold on to all documents given to them by the pharmacist.

In order to obtain reimbursement from the Health Plan you will need to:

  1. Provide a filled out PWGA Health Plan prescription claim form. If you don’t have this form on hand, you can obtain it at our website:

    https://wgaplans.org/health/forms/Coordination_Benefits_Direct_Claim.pdf

    Make sure that you check the box that states medication purchased outside of the United States. You must also indicate the country and currency used to pay for the medication.

  2. Provide all documents given to your client by the pharmacist. Make sure the prescription includes the name of your client, name and address of the pharmacist or pharmacy, name of the medication, and quantity and strength of medication.

  3. Mail the form and paperwork directly to the Health Fund office, c/o the Claims Department. We can track the reimbursement, and if any issues arise we can work with Express Scripts to resolve issues so that the claim can be processed and paid quickly.

    The materials should be sent to:

    PWGA
    C/O Claims Department
    2900 W. Alameda Ave.
    Suite 1100
    Burbank, CA 91505