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What To Do When Health Coverage Ends

The entertainment industry is a Gold Rush industry: it has no ceiling, nor does it have a floor. For writers, healthcare can be an area in which they keenly feel the ups and downs of their careers. Thanks to the Health Plan’s creation of an Extended Coverage Program, various industry-related resources, and the Affordable Care Act, writers have significant options in addition to opting for COBRA when their Plan coverage is about to expire.

First Things First

CHECK COVERED CONTRIBUTIONS (PENSION) If you receive a letter from the Health Plan warning that your coverage is about to expire, the first thing you should do is check to see if your employers have properly reported – and made contributions on – your covered income. Twice a year, the PWGA sends out a pension statement setting forth the details of what you have been paid. In addition, the information is available under the CONTRIBUTIONS HISTORY section of the Participant Toolkit on the right side of the screen. If you discover an inaccuracy, contact the Employer Compliance Department at the PWGA: (818) 846-1015 x603.

CHECK COVERED CONTRIBUTIONS (HEALTH) Approximately 3-months before your earnings cycle ends, the Health Fund will send you a Health Fund Summary of Contributions Statement. Please read this statement carefully as it contains detailed information about your eligibility status such as whether or not you have satisfied the earnings minimum, and if you qualify for the Excess Earnings Extension. The statement lists all of the employer contributions that have been reported during that specific earnings cycle. If you discover an error, the Health Fund Summary of Contributions Statement includes a form to report missing or incorrect earnings.

CHECK EXTENDED COVERAGE For most writers in the entertainment industry, employment is intermittent. Recognizing the difficulties of writers’ employment patterns, in April of 2000, the PWGA announced the inception of the Extended Coverage Program which credited writers with health coverage points for each year of regular, employer-paid eligibility commencing on and after January 1, 1990. Writers are able to accumulate up to a maximum of fifty (50) points. These points can then be used to extend health coverage during periods of unemployment. The Health Plan awards Extended Coverage points as follows:

  • One point for each four quarter eligibility cycle ending on or after September 30, 1989 which resulted in Health Fund eligibility.
  • One additional point for each four quarter earnings cycle ending on or after September 30, 1989 during which the writer earned at least $100,000* in covered compensation as reported to the Health Fund.
  • One additional point awarded for each four quarter earnings cycle ending on or after September 30, 1989 during which the writer earned at least $200,000* or more in covered compensation as reported to the Health Fund.

In simple language, what this means is that a Writer may earn up to three points for each year of employer paid Health Fund coverage earned, beginning January 1, 1990 which can be applied to continue health coverage. The Extended Coverage Program works like this:

If a writer loses eligibility due to failure to earn sufficient compensation within his or her earnings cycle, and has accumulated at least 10 points, the Writer will automatically be placed in the Extended Coverage Program and will be notified by the Plan. Although the writer must have 10 points to be eligible for the Extended Coverage Program, based upon their state of residence, there are up to four different benefit plans available with point values ranging from 2.5 to 1.5 points per quarter.

For each quarter that a participant receives benefits under this program, the applicable number of points will be deducted from their point balance. This process will continue until: 1) the participant regains employer-paid eligibility; or 2) the participant retires under the Producer-Writers Guild of America Pension Plan as a Certified Retiree; or 3) there are an insufficient number of points available for continuation in the program – whichever of these occurs first.

Note: As long as a participant has at least 1.5 points remaining (1 point if on the Low Option Plan), the Fund will subsidize the difference and he or she will be granted one last quarter of coverage in the plan then in effect. If all points are exhausted and eligibility is not regained, the participant and all eligible dependents will be offered COBRA Continuation Coverage.

Extended Coverage Program Point Threshold Chart

Earnings Minimum for Second Point Earnings Minimum for Third Point Earnings Cycle Effective Date Earnings Cycle Effective Date Earnings Cycle Effective Date Earnings Cycle Effective Date Earnings Cycle Effective Date Earnings Cycle Effective Date
$100,000 $200,000   04/01/00 07/01/00 10/01/00    
$103,252 $200,000 01/01/01 04/01/01 07/01/01 10/01/01    
$106,089 $200,000 01/01/02 04/01/02 07/01/02 10/01/02    
$108,741 $200,000 01/01/03 04/01/03 07/01/03 10/01/03    
$111,460 $200,000 01/01/04 04/01/04 07/01/04 10/01/04    
$113,968 $204,500 01/01/05 04/01/05 07/01/05 10/01/05    
$116,534 $209,101 01/01/06 04/01/06 07/01/06 10/01/06    
$119,156 $213,806 01/01/07 04/01/07 07/01/07 10/01/07 01/01/08 04/01/08
$122,731 $220,220   04/01/08 07/01/08 10/01/08 01/01/09 04/01/09
$126,413 $226,827     07/01/09 10/01/09 01/01/10 04/01/10
$130,205 $233,631     07/01/10 10/01/10 01/01/11 04/01/11
$132,809 $238,304     07/01/11 10/01/11 01/01/12 04/01/12
$135,133 $242,474     07/01/12 10/01/12 01/01/13 04/01/13
$137,498 $246,717     07/01/13 10/01/13 01/01/14 04/01/14
$125,000 $250,000     07/01/14 And Beyond…

Note: Effective July 1, 2014, the covered earnings minimum on which the 2nd and 3rd points are awarded will no longer be increased based on any increase in the MBA minimum.

If you think a mistake has been made and that you may be entitled to Extended Coverage benefits, call the PWGA’s Eligibility Department at: (818) 846-1015 x605.

EXCESS EARNINGS EXTENSION (AKA THE $250K EXTENSION) If you earned at least $250K (or more) in gross covered earnings in one earnings cycle but you do not meet the eligibility minimum in your next personal earnings cycle, the Fund will provide coverage for another year by dividing the $250K (or more) equally between the two consecutive earnings cycles. For individual writers this extension is automatic.

This extension is also available to Bona Fide Two-Person Writing Teams that equally split $250K (or more) in gross covered earnings in one earnings cycle and one or both writers do not meet the eligibility minimum in their next personal earnings cycle. If this is your situation, you should contact the Eligibility Department and ask that a review be done to determine if one or both of you qualify for this extension. If approved, the Fund will provide coverage for one or both you by dividing your equal share of the $250K (or more) between your two consecutive earnings cycles.

Other Possibilities

If you don’t have misreported income, and you’re not entitled to Extended Coverage, you still have health coverage options available to you.

ACTOR’S FUND Even though you’re not an actor, The Actor’s Fund is a great resource (available to all in the entertainment industry) for information about health care services. As per their website:

Our Health Services programs offer both Internet-based and personal health insurance guidance, solutions-based health care counseling, experience-based health referrals and, through our own free clinic, direct medical care for people who are uninsured.

The Actor’s Fund offers seminars, clinics, free health services, and serves as a clearing house for a wide range of available healthcare resources. You can find out more at their website.

TIHN The Industry Health Network (TIHN) is run by the Motion Picture & Television Fund (MPTF). They have health services available at little or no cost so that if you are underinsured or uninsured you can see a doctor for a fee of $25 for an office visit, and if necessary receive basic lab services and x-rays at no extra cost. In addition, they offer low-cost prescriptions through a variety of pharmacies. You can find out more at their website.

ACA The Affordable Care Act (ACA) provides for a Health Insurance Marketplace where you can select the best healthcare coverage for you and your family.

The Health Insurance Marketplace offers “one-stop shopping” to find and compare private health insurance options. In the Marketplace, you could be eligible for a new kind of tax credit that lowers your monthly premiums and cost-sharing reductions (amounts that lower your out-of-pocket costs for deductibles, coinsurance, and copayments) right away, and you can see what your premium, deductibles, and out- of-pocket costs will be before you make a decision to enroll.

Through the Marketplace you’ll also learn if you qualify for free or low-cost coverage from Medicaid or the Children’s Health Insurance Program (CHIP). Coverage through the Marketplace may cost considerably less than COBRA continuation coverage. Being offered COBRA continuation coverage won’t limit your eligibility for coverage or for a tax credit through the Marketplace.

You have 60 days from the time you lose your job-based coverage to enroll in coverage through the Marketplace, because loss of job-based coverage is a “special enrollment” event. After 60 days your special enrollment period will end and you may not be able to enroll, unless there is an “open enrollment” period for Marketplace coverage.

To find out more about enrolling in the Marketplace, such as when the next open enrollment period will be and what you need to know about qualifying events and special enrollment periods, visit:

If you reside in California, information is available at:
If you reside in New York, information is available at:
If you live elsewhere, go to:

SPOUSE’S PLAN If your spouse’s employer offers healthcare coverage, you may be able to obtain through his/her plan. Depending upon what they charge for dependent premiums, this may be the easiest and least costly option available to you.

COBRA If all else fails, though it is expensive, you have COBRA coverage available to you. The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end because of a life event known as a “qualifying event.” More information about qualifying events can be found under the Health Fund tab, or by calling the Eligibility Department at: (818) 846-1015 x605

The costs are as follows below:

Writers’ Guild-Industry Health Fund – Regular COBRA Monthly Rates April 1, 2016 through March 31, 2017
Single Two-Party Family
Plan C – Regular Medical/Hospital, Delta Dental (DPO), Rx, Vision, Wellness $891.44 $1,766.34 $2,398.89
Plan B – Regular Medical/Hospital, Rx, Vision, Wellness (no dental) $838.84 $1,664.59 $2,261.62
Plan CU – Regular Medical, Delta Care Dental (HMO), Rx, Vision, Wellness ** $909.40 $1,702.76 $2,285.32
Plan L – Low Cost Medical/Hospital ONLY – $750 Deductible $508.03 $1,004.30 $1,363.19
Single Two-Party Family
Plan RC – (same as Plan C above) $751.02 $1,484.10 $2,014.04
Plan RB – (same as Plan B above) $685.13 $1,355.64 $1,840.36
Plan RU – (same as Plan CU above) $749.95 $1,393.43 $1,865.86
Plan RL – (same as Plan L above) $547.68 $1,084.00 $1,471.73


LOW OPTION PLAN (PLAN L)* With the cost of health care being what it is, no one should be without coverage if at all possible. To make COBRA Continuation coverage more affordable to Writers who don’t qualify for Health Fund coverage, the Health Fund offers the Low Option Plan (Plan L) which can be purchased at a lesser cost than the current COBRA continuation plan options (which continue to be available, as well).

Before any benefits are payable under Plan L, hospital or otherwise, you must satisfy the annual deductible. The key provisions of Plan L are as follows:

Annual Deductible:

$750 per individual
$2,250 per family

Coinsurance In-Network:

Plan pays 70%
You pay 30%

Coinsurance Out-of-Network:

Plan pays 60%
You pay 40%

Annual Out-of-Pocket Maximum:

$4,500 per individual In-Network
$6,000 Out-of-Network, excluding the deductible

In addition, if your care requires hospitalization or outpatient surgery, you will need to have the hospital stay or surgery pre-certified. If you do not get the required pre-certification, there will be a $500 reduction in benefits in addition to the deductible and coinsurance required on hospital confinements. *Plan L provides medical and hospital coverage only. Life, accidental death and dismemberment insurance, prescription drug benefits, dental benefits, vision, and wellness benefits are not included. For more details on this coverage, you may contact the Participant Services Department at option #1, then option #1 again. You may also visit our website for additional information click here.

Once you’ve exhausted your COBRA continuation coverage and the coverage expires, you’ll be eligible to enroll in Marketplace coverage through a special enrollment period, even if Marketplace open enrollment has ended.

If you sign up for Marketplace coverage instead of COBRA continuation coverage, you cannot switch to COBRA continuation coverage under any circumstance. You can learn more about many of these options at:

If you reside in California, information is available at:
If you reside in New York, information is available at:
If you live elsewhere, go to:

As you can see from the options laid out above, if and when the time comes that you are in jeopardy of losing your Health Fund coverage, there are still many options available to you and your family.