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Health Fund
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Extended Coverage

Disability Extension

    A Disabled Writer:

  • After completing and returning all required pdf disability application forms, including a physician's statement, and being deemed eligible for disability extension of coverage, the totally disabled participant and their covered dependents are entitled to full medical benefits for 6-months from the date coverage ends.
  • If at the end of the 6-month extension the participantAn individual or that individual's spouse, dependent children who meet(s) the eligibility requirements established by the Fund. is still disabled, he/she will be entitled an additional 12-months of "comprehensive medical coverage" (out-patient medical and prescription benefits only). Dependents are not eligible for this 12-month extension; however they will be offered COBRAThe acronym for the Consolidated Omnibus Budget Reconciliation Act of 1985 which allows for the purchase of coverage after loss of eligibility due to certain qualifying events. Continuation coverage and the COBRA entitlement will be offset by 6-months (the period they were covered under the writers original disability extension).
  • COBRA will be offered to the participant after the 1st 6-month extension of coverage and if elected, the COBRA entitlement will be offset by the 6-months, however if they apply for the additional 12-month "comprehensive coverage disability extension", COBRA will not be offered after the 18-month extension of coverage (6-months "full coverage" & 6-months "comprehensive coverage").

    • A Disabled Spouse:

  • If at the time coverage ends, the covered spouse is totally disabled, the spouse will be offered 12-months of "comprehensive medical coverage" (out-patient medical and prescription benefits only) or COBRA.
  • If the 12-month extension is elected, no COBRA will be offered.

    • A Disabled Child:

  • If at the time coverage ends, a dependent child is totally disabled, the child will be offered 12-months of "comprehensive medical coverage" (out-patient medical and prescription benefits only) or COBRA.
  • If the 12-month extension is elected, no COBRA will be offered.

    • Permanently Disabled Dependent Children

  • If a dependent child qualifies as "permanently disabled" by the Fund (as defined in the Your Eligible Dependents section), the dependent child will be entitled to coverage as long as the writer is covered under the Fund, and claims will be based upon the plan of benefits the writer elects. If the writer has a break in plan coverage, and then regains earned coverage at a later date, the permanently disabled child's coverage would resume. Recertification of total disability is required every two years.

* Dependent premium tax payments may still be required.

Extended Coverage Program

Beginning April 1, 2000 Writers were credited with 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. Under this program, the Health Plan awards points for a Writer's past and future participation 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.

*please refer to the point threshold chart below for all point threshold increases after September 30, 1989.

In summary, a Writer may earn up to three points for each year of employer paid Health Fund coverage earned, beginning January 1, 1990.

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 at any time, the Writer will automatically be placed in the Extended Coverage Program and will be notified of such. 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 RetireeA participant who satisfies certain requirements is designated as a Certified Retiree.; or 3) there are an insufficient number of points available for continuation in the program.

Note: As long as a participant has at least 1.5 points remaining, 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 dependentsAny dependent of a participant who meets the criteria for eligibility established by the Fund. 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.


Excess Earnings Extension

Health Fund coverage will be provided for an additional year to certain Writers who earn $250,000 or more in gross covered compensation in one earnings cycle, but who would otherwise lose coverage because they did not earn enough compensation in the next earnings cycle to be eligible. To provide this additional eligibility, the earnings of $250,000 in compensation shall be deemed allocated equally between each of two consecutive earnings cycles. This extension of coverage is done systematically and no action is required from the Writer.

Excess Earnings Extension with regards to bona fide two-person writing teams

The benefit described in the above paragraph will be extended to cover bona fide, two-person writing teams that meet the same earnings criteria for eligibility cycles beginning on and after January 1, 2005. Only income earned as part of the team will be considered. This is not an automatic extension. If you feel you qualify for this extension, please contact the Eligibility Department of the Fund office.

Disclaimer

NOTE: This is only a brief summary of your benefits. All benefit descriptions contained herein are governed by the limitations and other information contained in your SPD.