Membership in the Directors Guild of America is valuable in many ways. One of the important benefits of working for DGA signatory employers is the Directors Guild of America - Producer Health Plan. The Health Plan began in 1969, and since then has paid health and death benefits for tens of thousands of participants and their eligible dependents. The Board of Trustees is pleased to provide one of the finest benefit packages in the industry.

This site provides only a brief description of the eligibility requirements and the benefits. Further information can be found in the Summary Plan Description booklet which describes in detail how the Plan works. All Plan participants should have received our most recent booklet dated July 1, 2003. Participants who do not have a booklet should call the Health and Eligibility Department. The phone number is in the Directory.

Two Kinds of Health Plans

Participants eligible for health coverage can choose either the DGA Health Plan or the Health Maintenance Organization (HMO). [The HMO option is available through HealthNet to California residents only.] Under the DGA Health Plan, participants can choose between in-network (PPO) and out-of-network (non-PPO) doctors. There are separate out-of-pocket maximums and co-insurance for PPO and non-PPO doctors. Under the HMO, participants may not have the flexibility of choosing their doctor, but there is no deductible, a smaller co-pay and different benefits are covered.

This site summarizes benefits under the DGA Health Plan only, as the HMO has different benefit provisions. Participants who want information on the HMO in California should contact the Eligibility Department or HealthNet (see Directory).

Health Benefits for Participants and Family Members

The Health Plan provides benefits for participants and their eligible dependents. After meeting the eligibility requirements, benefits may be payable for:

• Medical expenses
  
• Hospital expenses
  
• Prescription drugs
  
• Vision care
  
• Dental care
  
• Psychiatric care
  
• Substance abuse treatment
  
• Wellness benefits
  
• Hospice care
  

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Two Plans: DGA Choice and DGA Premier Choice

There are two levels of benefits within the DGA Health Plan: the DGA Choice Plan and the DGA Premier Choice Plan. The services covered under each of these plans are the same, the only difference is the applicable non-PPO out-of-pocket limit and co-insurance for each plan.

For more information on the DGA Choice Plan and the DGA Premier Choice Plan, please refer to page 12 of the July 1, 2003 Health Plan Booklet.

How and When am I Eligible for Benefits?

Guild membership does not ensure Health Plan participation. In order to participate or become eligible you must work in DGA Covered Employment and meet the minimum earnings requirement for Earned Coverage. For benefits periods beginning in 2006, $30,400-$95,099 in DGA covered employment during a year qualifies you for one year of DGA Choice Plan coverage. For benefits periods beginning in 2006, $95,100 in DGA covered employment during a year qualifies you for one year of DGA Premier Choice Plan coverage.. (The Trustees generally increase the minimum earnings threshold annually based on increases in the Collective Bargaining Agreements between the Guild and Producer employers.) Benefit Periods last for 12 months and begin only on calendar quarter dates (January 1, April 1, July 1 or October 1). Because of the time needed to receive and process contributions on your behalf, there is a mandatory three month waiting period between the time you generate minimum earnings and the time your coverage begins.

Under certain circumstances your coverage or right to self-pay continues even when you do not generate enough earnings to qualify for Earned Coverage. This may occur through:

• Self-Pay/COBRA coverage
  
• Certified Retiree Coverage
  
• Carry-over Credits
  

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How Much Do These Benefits Cost Me?

There is no charge for participant-only coverage. However, effective October 1, 2003, there is an annual premium charged for dependent coverage. In order for a participant's eligible dependents to be covered under his or her health coverage, the dependent premium must be paid. Please note that one dependent premium covers all of a participant's eligible dependents.

Also, the Health Plan does not cover 100% of your medical expenses. Some expenses are not covered by the Plan at all; cosmetic surgery, for example. Some expenses have a dollar limitation; for example, substance abuse expenses have a lifetime maximum of $30,000. Other forms of treatment have an annual maximum, such as the 20-visit maximum for chiropractic services.

For The Medical Plan you share expenses through annual deductibles and co-payments. There is a $300 ($900 for a family) deductible amount you pay before the Plan pays for covered expenses. Once you satisfy the annual deductible, the Plan pays 90% of the Reasonable and Customary charges if services are provided through a Preferred Provider Organization (PPO). If you do not use a PPO provider, the Plan pays 70% for DGA Premier Choice Plan participants and 60% for DGA Choice Plan participants. Some treatments pay at a lesser rate, however. For instance, outpatient psychiatric pays at 50%.

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The Prescription Drug Plan is provided through Medco. When you have your covered prescription filled, simply present your card at a Medco participating pharmacy. The pharmacy will charge you $10 for generic drugs and $24 for brand name drugs at that time, excluding certain "specialty" drugs. There are no forms to fill out and no claims to send in. Mail order prescriptions for 90-day supplies have a $25 co-payment for generic prescriptions and a $60 co-payment for brand name drugs. There is no deductible associated with the prescription drug program, and your prescription drugs do not count towards your annual out-of-pocket or stop-loss amounts.

As of July 1, 2003, erectile dysfunction medication and non-sedating antihistamines were included in the "specialty" drugs tier. These drugs are covered at 50% co-insurance with a minimum $40 co-payment when obtained at a pharmacy and a minimum $60 co-payment when obtained through the mail order program.

Only those participants for whom the DGA Plan is primary should use the DGA Plan's Medco drug card. If the DGA Plan is secondary, prescription drugs should be purchased through your primary plan. For example, your spouse or dependent child may be primary under a health plan sponsored by your spouse's employer, and the DGA Plan would be secondary. Or you may have coverage with us, but your primary plan is the Screen Actors Guild Plan. In those cases, do not use your drug card when purchasing your prescriptions. However, you may be entitled to partial reimbursement from us under coordination of benefits. To file a claim in cases where we are your secondary plan, you may request a Direct Submittal Form from the Plan Office and submit this form to Medco. In cases where Medicare is primary and we are secondary, the Plan's prescription drug plan is primary for your drug purchases.

You may purchase your prescription drugs at any pharmacy and still be reimbursed; it does not have to be an Medco participating pharmacy. Be aware, however, that you cannot use the card program at a non-participating pharmacy, you will not receive the discount on the cost of your prescription, and you will have to pay in full at the time of purchase. To file a claim for prescriptions purchased at a non-network pharmacy, you must send Medco your receipts and they will reimburse you for the amount that they would have covered (the discounted price less the co-payment amount).

For more information about Medco see their website at: www.medco.com

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The Dental Plan - The Dental Plan is administered by Delta Dental of California. Similar to the Medical Plan and the PPO, some dentists have contracted with Delta Dental in the DeltaPreferred Option (DPO). When you use a DPO dentist, there is no deductible and benefits are paid at a higher percentage for most procedures.

When using a DPO or "in-network" dentist, there is no deductible. Dental expenses are covered at either 100%, 80% or 70%, depending on the type of treatment. Oral exams and cleaning are paid at 100%, fillings and crowns at 80%, endodontics and implants at 70%, for example.

When using a non-DPO or "out-of-network" dentist, there is a $50 ($100 for a family) annual deductible that is separate from the medical plan. Dental expenses are covered at either 85%, 60% or 50%, depending on the type of treatment. Once the deductible is met, the Plan pays at varying rates for different categorized procedures. Oral exams and cleaning are paid at 85%, fillings and crowns at 60% and endodontics and implants at 50%, for example.

The maximum amount payable for covered dental expenses during a calendar year is $2,500 per individual.

Orthodontia for dependent children under age 19 is also covered at 50%. There is a $1,500 lifetime maximum for orthodontia treatment.

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This Sounds Great. But Who Pays for All This?

When you work in DGA Covered Employment, your employer contributes a percentage of your covered salary to the Health Plan. The percentage that is contributed is determined by which collective bargaining agreement you are working under at the time of your earnings. You share in health care costs through the dependent premium, deductibles, co-insurance and co-payments. It is very important that you check that contributions are being paid to the Plan. The Plan sends quarterly statements to each participant who had earnings during the quarter. Look over your quarterly statements! The statement shows the contributions made on your behalf by each of your employers. If your records differ from ours, contact the Contributions Department in the Plan Office immediately. Non-receipt of contributions can jeopardize your Health Plan eligibility.