Obtain the Express Scripts mail order form from the Plan office or fill out the online form at www.expressscripts.com.



If you already have a written prescription from your physician, simply fill out the Express Scripts mail order form and mail it to Express Scripts along with your prescription. If you do not already have a written prescription, fill out the Express Scripts mail order form and give it to your physician. Your physician can fax your prescription directly to Express Scripts (faxes are only accepted from your physician).



You will receive your prescription (up to a 90-day supply) within 14 days. There is no charge for delivery.



If you need a physician-approved refill to your prescription, simply log onto www.expressscripts.com or call 1-800-789-6443.

Combating Fraud and Abuse

The DGA-Producer Health Plan's Board of Trustees is committed to providing the best health plan possible to its participants. Part of this commitment is ensuring that the Plan does not fall victim to fraud and abuse.

Research indicates that ten cents of every health care dollar spent in America is spent in connection with false billings or other illegal activities. As a result, billions of dollars that could be used to enhance benefits and protect the future of health care in this country are squandered.

The DGA-Producer Health Plan is deeply committed to protecting the Plan and its participants from the damaging effects of fraud and abuse. There are currently several programs in place to discover and prevent fraudulent activities and abusive practices. Recently, the Plan added a new senior manager whose responsibilities include overseeing the existing programs and developing new strategies for combating fraud and abuse.

Here's one way you can help:

The Plan sends you an Explanation of Benefits in connection with each health claim. It is important that you review these Explanations of Benefits to ensure that the Plan is only paying for services actually performed. Some participants call their provider when they notice an error on their Explanation of Benefits and receive an assurance that the error will be corrected. However, it is very important that you contact that Health Plan office to report the error. In addition, you may be eligible to receive a cash incentive as part of the Health Plan's recovery incentive program.

The Plan Needs Your Help If you suspect fraud or abuse, you can contact the Plan's Fraud and Abuse hotline at (323) 866-2200, Extension 711 in the Los Angeles area or (877) 866-2200, Extension 711 toll-free outside the Los Angeles area. In addition, you can send a letter to: DGA-Producer Health Plan 8436 W. Third Street, Suite 900 Los Angeles, California 90048-4189 Attn: Special Benefits Projects

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Health Plan Institutes Industry Lifetime Maximum

Currently, the Health Plan has a $2 million maximum lifetime benefit, with a $5,000 annual automatic restoration. In other words, the Health Plan covers each participant's lifetime benefits up to $2 million. Once $2 million in benefits is reached, the participant is only eligible for an additional $5,000 in benefits each year after the year in which the maximum is reached (please see page 40 of the July 1, 2003 Health Plan booklet for more information on the Health Plan's lifetime maximum).

Effective January 1, 2004, the Health Plan is instituting an industry lifetime maximum benefit of $2.5 million in addition to the $2 million DGA-Producer Health Plan lifetime maximum. For the purposes of easing the transition to this rule, any participant who would reach or exceed the new industry maximum effective January 1, 2004, will not be subject to the maximum, but instead will be held only to the DGA-Producer Health Plan $2 million lifetime maximum.

Beginning on January 1, 2004, once a participant reaches a total of $2.5 million in lifetime benefits from the entertainment industry health plans, with no more than $2 million in benefits from the DGA-Producer Health Plan, that participant will no longer be eligible for benefits under the DGA-Producer Health Plan, with the exception of the $5,000 annual restoration. The entertainment industry health plans are the Directors Guild of America – Producer Health Plan, the Screen Actors Guild – Producers Health Plan; the Producer – Writers Guild of America Health Plan; the Motion Picture Industry Health Plan; and the AFTRA Health Plan.

If you have any questions, please contact the Health Plan office.

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Change in how PPO and Non-PPO Out-of-Pocket Maximums are Calculated

For health claims incurred on or after January 1, 2004, there will be separate accumulators for the PPO and non-PPO out-of-pocket maximums. PPO expenses will no longer count toward the non-PPO out-of-pocket maximum and non-PPO expenses will no longer count toward the PPO out-of-pocket maximum. Therefore, beginning in 2004, you must reach $1,000 in PPO out-of-pocket covered expenses before the Plan pays 100% of PPO covered expenses and $3000 (DGA Premier Choice Plan) or $7,500 (DGA Choice Plan) in non-PPO out-of-pocket covered expenses before the Plan pays 100% of non-PPO covered expenses.

If you have any questions, please contact the Health Plan office.

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Cash Refund Option Now Available

Currently, Supplemental Plan retirees now have the option of selecting a lump sum distribution, various monthly annuity options, or splitting their benefit 50/50 between a lump sum distribution and an annuity option. Monthly annuities are paid for the participant's lifetime and, depending upon the option selected, the benefit generally ceases at the participant's death or the joint annuitant's death.

Effective January 1, 2004, certain Supplemental Plan annuity options will offer a cash refund option. The Single Life Annuity with a cash refund will pay a monthly benefit to the participant and, at the participant's death, the amount used to purchase the annuity is paid in a lump sum to the designated beneficiary, less the total amount of monthly payments received by the participant. The Joint & Survivor Annuity with cash refund pays a monthly benefit to the participant then, at the participant's death, a pre-selected percentage (50%, 75% or 100%) is paid to the joint annuitant designated at retirement. After both the participant and the joint annuitant have died, any remaining benefit is then paid in a lump sum to the designated beneficiary.

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New Contraceptive Will Require Three Co-Pays

On September 5, 2003, the U.S. Food and Drug Administration approved Seasonale® Extended-Cycle, a female oral contraceptive that is taken continuously for 91 days (84 days of the contraceptive and 7 days of placebo). Seasonale is designed to reduce the number of menstrual cycles a woman undergoes from 13 a year to four.

When a Plan participant purchases drugs through a retail pharmacy, the participant generally receives up to a 30-day supply of the prescribed drug. However, as Seasonale is only available in a 91-day supply, three co-payments will be required when a participant obtains Seasonale through a retail pharmacy. The current brand name retail drug co-payment is $24. Therefore, Plan participants obtaining Seasonale through a retail pharmacy will be required to pay a total of $72 in co-payments.

Seasonale will also be available through the Express Scripts mail order prescription program. There will be a $60 co-payment for obtaining Seasonale through the mail order program.

For more information on Seasonale, log onto www.seasonale.com.

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Health Net is new Health Plan HMO

Recently, the Health Plan was notified that the Industry Advantage/California Care HMO would soon be discontinued. Effective January 1, 2004, Health Net of California (www.health.net) will be the new provider of the Plan's HMO option.

If you are currently covered under the Industry Advantage/California Care HMO, you should already have received the new Health Net documentation. If you have not received anything regarding the switch to Health Net, please contact the Plan office.

If you are currently covered under the indemnity plan (i.e. the DGA Choice Plan or the DGA Premier Choice Plan) and wish to switch to the Health Net HMO plan, you will receive additional information during your next open enrollment period. Please note that participants age 65 and over are not eligible for the Health Net HMO plan.

If you have any questions, please contact the Health Plan office.

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Retiree Health Plan Changes

Recently, the Board of Trustees made some changes to the Retiree Health Plan:

Premium Changes
Effective January 1, 2004:

• The monthly Certified Retiree and Retiree Carry-Over premium for retirees and surviving spouses under age 65 will increase from $100 ($90 Medical/$10 Dental) to $110 ($99 Medical/$11 Dental);
  
• The monthly Certified Retiree premium for retirees and surviving spouses age 65 and over will increase from $60 ($55 Medical/$5 Dental) to $65 ($59.80 Medical/ $5.20 Dental);
  
• The monthly Retiree Carry-Over premium for retirees and surviving spouses age 65 and over will increase from $30 ($27.50 Medical/ $2.50 Dental) to $32.50 ($29.90 Medical/$2.60 Dental).
  

Retiree Carry-Over Coverage Prior to Reaching Medicare Age
Effective January 1, 2004:

• Retirees on Retiree Carry-Over coverage with less than 20 years of earned coverage will be covered under the DGA Choice Plan until Medicare age, unless qualified for Certified Retiree coverage at the time of their Retiree Carry-Over coverage.
  

If you have any questions, please contact the Health Plan office.

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Changes to the Plan's Mental Health Benefits

Effective January 1, 2004, PacifiCare Behavioral Health (PBH) will replace EIRAC (in California) and The Actor's Fund (outside California) as the DGA-Producer Health Plan's inpatient mental health and substance abuse benefit manager.

In addition, the Board of Trustees has enhanced the Plan's existing outpatient mental health benefit, which will also be managed by PBH.

Please see the PacifiCare Behavioral Health article for additional information on PBH and the new enhancement to the Plan's outpatient mental health benefit.

If you need inpatient mental health or substance abuse services, or to inquire about the new enhanced in-network outpatient benefit, please call PBH at (888) 502-4502. Or you can contact the Plan office.

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Plan Institutes New Credit Card Fee

In the year 2003, the Health Plan paid nearly $200,000 in credit card convenience fees on behalf of participants that made premium payments to the Plan via Visa, MasterCard or American Express. For each charge, the credit card companies impose a fee between 2.46% and 2.62%. Due to rising health care costs and as part of the effort to maintain the level of Health Plan benefits, the Plan is passing these charges onto participants. Effective January 1, 2004, all premium payments processed through credit cards will be assessed a charge equal to 2.5% of the amount being charged.

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Important News about your Mental Health and Chemical Dependency Benefits

The Directors Guild of America - Producer Health Plan has selected a new behavioral health provider effective January 1, 2004 — PacifiCare Behavioral Health (PBH).

Inpatient Care

There is NO change to your inpatient benefit plan design other than calling a new phone number. Plan participants who are currently undergoing treatment through EIRAC/Actor's Fund will be able to complete their authorized course of treatment uninterrupted. Effective January 1, 2004 — ALL mental health and substance abuse services must be pre-authorized by calling PBH toll free at (888) 502-4502. Note: this number replaces services previously managed by EIRAC and The Actor's Fund. Please remember all inpatient services must be pre-authorized and performed by a PBH in-network provider:

Mental Health Inpatient Benefit

• 1st episode 90% (up to 45 days)
  
• 2nd episode 80% (up to 45 days)
  
• 3rd episode 70% (up to 45 days)
  
• 4th episode 50% (up to 45 days)
  
• 5th and subsequent episodes 50% (up to 90 days lifetime maximum)
  

Chemical Dependency Inpatient Benefit

• 1st episode 90% (up to 45 days)
  
• 2nd episode 75% (up to 45 days)
  
• 3rd episode 60% (up to 45 days) $30,000 lifetime maximum
  

Outpatient Care

While there is no change to your outpatient out-of-network benefit, a newly created "in-network enhancement" has been added for 2004. This new option offers you a cost savings and allows for additional annual visits. Take advantage of this new benefit by calling to see if your current provider is included in the PBH network. If he or she is, call for pre-authorization and start taking advantage today.

Out-of-Network Option — No Change

You have the same freedom to continue to see any provider at your existing benefit level.

• 20 visits per year*
  
• 50% of reasonable and customary charges, subject to deductible
  

In-Network Option — NEW for 2004

You can access this new option by selecting a PBH network practitioner and calling (888) 502-4502 for pre-authorization.

• 30 visits per year*
  
• $25 copay per visit
  

*out-of-network and in-network visits cross-accumulate.

What to expect when you call PBH

When you need help, one of our caring, qualified customer service associates will ask some questions, carefully assess your needs and provide you with a referral to a licensed counselor or other behavioral health professional in your area. During your course of treatment, a PBH care manager will monitor your progress and, if necessary, will assist in your treatment plan by coordinating care with your family physician.

We're here to help!

There may be times in your life when you feel overwhelmed. Maybe you have a personal or workplace issue that consumes your thoughts. Perhaps you, your child, or another family member is struggling with depression, alcohol or drugs.

Whatever the problem, you don't need to handle it alone — PBH can help.

PacifiCare Behavioral Health offers:

• Year-round access to professional counseling, 24 hours a day, 7 days a week
  
• Referrals to practitioners proven to have the best treatment results
  
• Chemical dependency (drug and alcohol) treatment, including detox and relapse prevention
  
• Immediate access for urgent or emergency intervention with a licensed care manager
  

We can help with issues that interfere with your life:

• Depression
  
• Emotional stress
  
• Family problems
  
• Drug abuse
  
• Anger management
  
• Suicidal thoughts
  
• Relationship problems
  
• Divorce or separation issues
  
• Anxiety
  
• Domestic violence
  
• Alcohol abuse
  
• Child/adolescent problems
  
• Work-related issues
  

Call PBH toll-free 24 hours a day, 7 days a week (888) 502-4502 Or visit them online: www.pbhi.com

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