Articles from Take 2
Winter 1998
Volume XI, Number 3


 

1998 - A RECORD YEAR OF BENEFIT ENHANCEMENTS

The end of the year is an appropriate time to both reflect on the accomplishments of the year behind us and set our goals for the coming year. Looking back over 1998, the Board of Trustees approved a number of new benefits and enhancements to the Health Plan: coverage for orthodontia, hearing aids, eye exams and domestic partners just to name a few. Under the Pension Plan, pensioners received a 7.5% increase to their monthly benefit and the monthly maximum benefit increased to $5,000. These and other enhancements have been discussed in previous issues of TAKE 2 and are detailed in your new SPD supplements which you should receive by the first week of January. Capping the year of benefit enhancements, the Trustees are very pleased to announce two additional benefit improvements which become effective January 1, 1999: coverage of birth control and expansion of the biofeedback therapy benefit.

Coverage of Birth Control

While the Plan currently covers birth control pills when prescribed for medical conditions such as endometriosis, it does not pay for birth control pills or other contraceptive devices to prevent pregnancy. However, over the last year - with input from Participants and changes in federal health policy - birth control has emerged as a key woman’s health issue.

The Trustees have always maintained a leadership position in women’s health issues. In balancing the needs of our Participants with the overall fiscal integrity of the Plan, the Trustees decided the time was right to move ahead in this important area. We are pleased to announce that effective January 1, 1999, the Plan will cover the following methods of birth control when prescribed by a physician:

Birth control pills and diaphragms are covered under the PAID Prescription Drug Card program. Present your prescription and your PAID drug card to the participating pharmacy. Reimbursement is subject to the prescription drug deductible and copayment.

Norplant, IUD’s and Depo-Provera, are covered under the major medical program subject to the applicable deductible and copayment or coinsurance. These claims should be filed with the Plan Office.

 

Coverage of Biofeedback Therapy

The Trustees are pleased to announce that beginning January 1, 1999, the Plan’s biofeedback benefit is expanded by adding coverage for the following medical conditions when prescribed by a physician:

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NEW I.D. CARDS AND SPD BOOKLET SUPPLEMENTS MAILED

Watch your mail! We are sending you important information about your Pension and Health Plan benefits. All eligible Participants will be sent new I.D. cards as well as the Summary Plan Description supplements for both the Pension and Health Plans. You should receive this information by January 1, 1999.

New I.D. Cards

The new Health Plan I.D. cards reflect both California and out-of-California network providers on the same card. This change makes it easier to locate and use a network provider when you or your dependents travel out of the area in which you normally reside. On the back of your Health Plan I. D. cards you will find the phone numbers of both California and Non-California networks.

The general rules to follow when seeking participating providers outside of your regular network area are outlined below:

•When you need hospital or major medical services, use the network for the state where the services are performed.

•When you need dental care, use the network for the state in which you reside.

SPD Booklet Supplements

The Plans publish two Summary Plan Description booklets - one for the Pension Plan and one for the Health Plan. Periodically we publish supplements to these booklets which detail new benefits, enhancements to existing benefits and rule changes. Supplements for both Plans will be mailed before the end of the year.

If you do not receive new I.D. cards or the SPD supplements, please call the Plan Office.

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SENIOR PERFORMER HEALTH BENEFITS FOR OCCUPATIONAL DISABILITY PENSIONERS

Effective January 1, 1999, the Plan will provide Senior Performer Health Plan coverage for Disability Pensioners whose disability was the result of an injury incurred while working under a Screen Actors Guild contract and who meet the Pension Credit requirement for Senior Performer coverage. The Plan’s coverage begins when Medicare Disability coverage begins and will be secondary to Medicare. The pensioner must be enrolled in Medicare Part B to be eligible for full Plan coverage.

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IMPORTANT NOTICES FOR OUT-OF-CALIFORNIA PARTICIPANTS

New Customer Service Number for MetLife Dental

MetLife, the company that administers dental benefits for Out-of-California Participants, has a new toll-free Customer Service phone number. Effective immediately MetLife’s new number is: (800) 942-0854. The new number serves as a source of claim and benefit information. The number for a directory of providers remains unchanged at (800) 474-PDP1.

PHCS Participant Satisfaction Survey Requests Your Input

In a continuing effort to improve our benefits and services we are asking all Out-of-California Participants to help us by completing a survey of the Plan’s services, in particular, the Private HealthCare Systems’ (PHCS) network. Your feedback is not just appreciated but important and we encourage you to take a few minutes and respond to a short questionnaire about services of the Plan and PHCS. You should receive the survey in the mail by the middle of January.

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MEDICARE PRIVATE CONTRACTING PROVIDERS

If you are currently enrolled in Medicare you know that Part A of Medicare, which covers hospitalization, costs you nothing. Part B, which covers doctor’s bills and other medical care, involves a monthly fee. If you or your spouse are not covered by Medicare Part B when this Plan is secondary to Medicare, this Plan’s benefits are reduced by 80%.

Effective January 1, 1999, there is another instance in which this Plan’s benefits are reduced by 80%: when you use a doctor who has privately contracted outside of Medicare.

Medicare now allows doctors the opportunity to opt out of the Medicare system and contract directly with patients to provide treatment outside of Medicare. A doctor who has opted out of Medicare must inform the patient that his or her services will not be covered by Medicare. The physician and the patient must sign a written contract in which the patient agrees that the doctor’s charges will not be paid by Medicare.

A doctor who has completely opted out of Medicare is not the same as a doctor who does not accept Medicare assignment. Doctors who do not accept assignment from Medicare, are limited to charging no more than a certain percentage of the Medicare allowance. Medicare will reimburse these doctors up to the medical allowance and your Health Plan will provide secondary coverage.

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THREE WAYS TO CHANGE YOUR ADDRESS

Keeping a current address on file with the Plan Office has never been easier. You now have three ways to notify the Plan Office of a change in address.

1. Write to the Plan

Notify the Plan Office in writing via mail or fax. Correspondence must include the Participant’s signature and Social Security number.

2. File a Change of Address Card

On the back of your SPD Booklet Supplements there are, for your convenience and future use, three Change of Address cards. Fill out a card anytime you move and mail it to the Plan Office. Cards are also available at the Plan Offices and Guild branch offices.

3. Call the Plan Office

Call the Plan Office and ask for the Participant Services Department. To verify your identity, you will be asked for certain key information and your address will be changed right over the phone.

It is important that we have your current address so we can send you information about your Pension and Health Plan benefits, including your right to enroll in the Self-Pay Program should you lose Earned Eligibility. The new procedures are for address changes only. To change beneficiary or dependent information, you must complete a new Master Data Card.

Remember, the Screen Actors Guild is a separate entity from your Pension and Health Plans and requires a separate notice for a change of address.

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IN MEMORY

Philip Sterling
1922 - 1998

It is with great sadness that we say goodbye to Philip Sterling who passed away on November 30, from complications of myelofibrosis, a bone marrow disease. Mr. Sterling served as a trustee of the SAG-PPHP since 1986 and actively participated on several Board of Trustee committees. Mr. Sterling's commitment to the Plans and the Participants they serve will be greatly missed.

 

 

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