Section 7
Other Resources

Frequently Asked Questions

Q: How will I know when I've met the eligibility requirement?
A: Once you've met the covered earnings minimum, the Administrative Office will send you an enrollment package with a Notice of Eligibility. The notice outlines your eligibility period and benefit coverage. If you believe you've met the eligibility requirement but don't receive a Notice of Eligibility, you should call the Administrative Office.

Q: What is the reason for the three-month waiting period between the earnings period and the benefit period?
A: The three-month waiting period is needed for employers to submit a report of earnings and for the Fund to process these reports so the Fund can be sure it has a record of all of your earnings.

Q: Can I make up the difference in cash between what I've earned and what I need to have earned to qualify for benefits? For example, if I'm short of meeting the covered earnings minimum by $1,000, can I pay $1,000 so I can qualify?
A: No. The covered earnings minimum is based solely on employment covered by the collective bargaining agreement. You cannot pay to make up for any shortage.

Q: Do I have to accept or use this coverage?
A: The coverage you've earned under the Fund is automatically available to you as part of your collective bargaining agreement. However, you're not required to use the coverage provided by the Fund.

Q: Does my health care coverage include my family?
A: No, it covers you only. If you want to cover your eligible dependents, you must pay a dependent coverage premium. Dependent coverage premiums aren't required for Certified Retirees age 65 and over who do not have active earned coverage.

Q: Does my newborn automatically have coverage?
A: Yes, your newborn is automatically covered for 31 days after birth. But to continue coverage after that time, you must submit a completed dependent card and proof of birth, and pay the required dependent coverage premium.

Q: I plan on adopting. Can my adopted child receive coverage?
A: Yes, if you enroll your child as a covered dependent and pay the required dependent coverage premium. You'll also be required to provide the Fund with a copy of the adoption, guardianship or placement documents.

Q: My spouse has coverage through work. Can my spouse be covered under the Fund as well?
A: Yes. If you cover your spouse, you'll have to pay a dependent coverage premium. Then, your spouse's coverage under this plan can coordinate benefits after your spouse's primary plan has paid.

Q: I'm currently engaged. Is my fiancé‚ covered?
A: No, not until you're married. Then, you'll need to provide the Fund with a copy of your marriage certificate. To cover your same-sex domestic partner, you must provide a signed Affidavit of Domestic Partnership and any additional documentation requested by the Fund. In either case, you must pay the required dependent coverage premium.

Q: Can I cover my parents under the Fund?
A: No.

Q: At what age do my children stop having coverage?
A: Dependent children are eligible for coverage until their 19th birthday. However, coverage may be continued up to age 23 if you provide proof of full-time student status each semester.

Q: Does the Fund offer a senior rate for health coverage?
A: No.

Q: Is there a different rate for COBRA continuation coverage for one person versus a family?
A: Yes. When you receive your COBRA packet, you'll have several options to review for health coverage for one family member or the entire family.

Q: How does The Industry Health Network (TIHN) work for me?
A: All industry participants in the Southern California area have the same opportunity to use The Industry Health Network at any time. If you live in Southern California and enroll in the Regular Plan, you can get medical care at one of the local area health centers established especially for members of the entertainment industry. You don't need to select a PCP. All you have to do is call for an appointment. (See "How The Industry Health Network Works" for details.)

Q: Is there a separate deductible for the prescription drug program?
A: No.

Q: Can I use my health coverage if I'm out of the country?
A: Yes. If you receive care outside the country, submit a claim form for eligible expenses. You must submit itemized bills for your care with all expenses converted into U.S. currency. We recommend that you keep a copy of your records because foreign claims can be difficult to obtain.

Q: How are my claims paid if I also have coverage with another carrier?
A: The Fund will coordinate benefits with other group coverage plans. This is called coordination of benefits (COB). Specific plan rules determine which plan pays first. You cannot decide which plan pays first or second. (See "Understanding Coordination of Benefits (COB)" for details.)

Q: I'm a Certified Retiree. I have coverage through the Fund, and I don't want to enroll in Medicare Part B. Do I have to?
A: Yes. For you to receive health coverage as a Certified Retiree, you must enroll in Medicare Part B. If you fail to enroll, the Fund's payment of benefits will be processed assuming you have Medicare Part A and B benefits.

Q: Why am I asked for accident injury information on certain claims?
A: If a claim has an accident or injury diagnosis, there may be another plan or entity that should legally provide benefits. For example, if the injury is the result of an automobile accident, a third party may be liable. In this case, the Fund must coordinate benefit payments with the auto insurance company. If a third party were liable for the accident, the third party would be responsible for paying the costs incurred as a result of the accident. In these situations, the Fund needs information from you in order to determine how your medical expenses should be paid.