Effective January 1, 2004

• PacifiCare Behavioral Health (PBH) replaced EIRAC and The Actor's Fund as the Plan's inpatient mental health and substance abuse network provider. PacifiCare's 24-hour toll-free telephone number is (888) 502-4502. For more information please refer to the Winter 2003 Spotlight on Benefits newsletter.
  
• A new in-network outpatient mental health benefit was added to the Health Plan, featuring 30 visits per year and a $25 co-paymant. This benefit is managed by PBH. For more information please refer to the Winter 2003 Spotlight on Benefits newsletter.
  
• PPO and non-PPO out-of-pocket maximums will be calculated separately.
  
• HealthNet replaced The Industry Advantage/CaliforniaCare as the Health Plan's HMO.
  
• A 2.5% fee will be assessed on all credit card transactions to offset credit card company convenience fees.
  
• Certified Retiree premiums increased:
  
  • Certified Retirees and surviving spouses under 65: $110 ($99 medical/$11 dental)
    
  • Certified Retirees and surviving spouses over 65: $65 ($59.80 medical/$5.20 dental)
    
• Retiree Carry-Over premiums increased:
  
  • RCOs and surviving spouses under 65: $110 ($99 medical/$11 dental)
    
  • RCOs and surviving spouses over 65: $32.50 ($29.90 medical/$2.60 dental)
    
• Retirees on retiree carry-over coverage with less than 20 years of earned coverage are placed in the DGA Choice Plan until Medicare age (or, if earlier, until retiree carry-over coverage runs out), unless the retiree is qualified for Certified Retiree coverage at the time of their retiree carry-over coverage.
  
• Health Plan institutes new industry lifetime maximum (see the Health Plan Institutes Industry Lifetime Maximum article in the Winter 2003 Spotlight on Benefits newsletter).
  

Effective April 1, 2004

• Participants on carry-over coverage are covered under the DGA Premier Choice Plan.
  
• The maximum bankable amount in a participant's carry-over account was increased from $360,000 to $390,000.
  
  

Effective April 16, 2004

• Ambulatory surgical center facility charges will be reimbursed up to a maximum allowable charge of, and not to exceed, $1,500. If the actual charge is less than $1,500, the allowable charge will be the actual charge. Please note that deductibles, co-payments and co-insurance, where applicable, still apply.
  
• Dependent children of retirees in existence and covered by the Plan at the time of retirement will be offered self-pay coverage at a special rate (see the Dependent Children of Retirees Now Eligible for Special Self-Pay Rate article in the Summer 2004 Spotlight on Benefits newsletter).
  
• The recovery incentive limit was raised to $2,500. The threshold for the Benefits Committee to consider recovery incentive appeals was raised to $5,000.
  
• The Health Plan amended dependent notification rules (see the Recent Health Plan Changes Announced article in the Summer 2004 Spotlight on Benefits newsletter).
  

July 1, 2004

• Medco Health replaces Express Scripts as the Health Plan's prescription drug benefit manager.
  
• The Specialty Drug tier in the prescription drug plan will include all erectile dysfunction drugs.
  

January 1, 2005

• The Health Plan's deductible carry-over provision (detailed on page 38 of the July 1, 2003 Health Plan Booklet) will be eliminated.
  

Effective January 1, 2005

• The Health Plan's deductible carry-over provision (detailed on page 38 of the July 1, 2003 Health Plan Booklet) is eliminated.
• New Certified Retiree Premiums
  • Under 65 - $130 ($117 Medical/$13 Dental)
  • 65 and Over - $70 ($64.40 Medical/$5.60 Dental)
    
• New Retiree Carry-Over Premiums
  
  • For Retirees Qualified for Certified Retiree status
    
    • Under 65 - $65 ($58.50 Medical/$6.50 Dental)
      
    • 65 and Over - $35 ($32.20 Medical/$2.80 Dental)
      
  • For Retirees Not Qualified for Certified Retiree status
    
    • Under 65 - $200 ($180 Medical/$20 Dental)
      
    • 65 and Over - $70 ($64.40 Medical/$5.60 Dental) Note: this premium will remain at $35 ($32.20 Medical/$2.80 Dental) for participants who commenced Retiree Carry-Over Coverage prior to January 1, 2005.
• The Health Plan will cover self-donated (autologous) blood drawing and storage, but only for a scheduled surgery that is normally covered by the Plan.

Effective August 12, 2005

• The Plan will extend coverage for an additional 120 days for full-time students, following the last day of class as a full-time student, therefore creating a COBRA qualifying event on the 121st day following the last day of classes. This does not apply to graduating students.
• The following paragraph was added to the Retiree Carry-Over section of the July 1, 2003 Health Plan booklet (which begins on page 20):
  
  If you continue your health coverage through retiree carry-over credits, and also qualify for Certified Retiree coverage, you must enroll in Certified Retiree coverage at the time of your retirement. After your coverage through retiree carry-over credits ends, you will be automatically covered under Certified Retiree coverage and responsible for paying the monthly premium rates in effect for Certified Retiree Coverage at the time your Certified Retiree coverage begins.
  
  
• The following sentence was added to the end of the Retiree Carry-Over section of the July 1, 2003 Health Plan booklet:
  
  If you are eligible for Retiree Carry-Over coverage and fail to elect such coverage, or if your coverage ends before the maximum duration of coverage for any of the reasons listed above, you will lose all accumulated Retiree Carry-Over credits.
  
  
• The sentence on page 20 of the July 1, 2003 Health Plan booklet that reads:
  
  If you have a lapse in coverage, you and your spouse or domestic partner may become permanently ineligible for Certified Retiree coverage.
  
  was amended to state:
  
  If you have a lapse in coverage, after becoming eligible for Certified Retiree coverage, you and your spouse or domestic partner will become permanently ineligible for Certified Retiree coverage.
  
  
• The Health Plan has adopted guidelines based on Aetna's guidelines for determining the medical necessity of gastric bypass surgery. The Plan's guidelines are available in writing from the Health Plan office.
  

Effective January 1, 2006

• The minimum earnings threshold for earned active health coverage under the DGA Choice Plan will be $30,400.
• The minimum earnings threshold for earned active health coverage under the DGA Premier Choice Plan will be $95,100.