Dear Dorothy - FAQs/Health

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Dependent Coverage
Is my family covered under the Health Fund, or just me? -Family Guy in Fresno My spouse has health coverage through his employer. Can my health coverage under the Health Fund benefit him? -Excess in Eureka My husband and I plan on adopting a child. Can our adopted child receive coverage? -Future Parent in Freetown My daughter is covered as a dependent under the Health Fund. At what age does she stop having coverage under the Fund? -Concerned in Cincinnati	It's a girl! Does my newborn automatically have health coverage under the Health Fund? -Mommy in Manitoba I'm currently engaged and we are planning a wedding in August of next year. Is my fiancé covered under the Health Fund? -Engaged in East Los Angeles My father is divorced, and is no longer working. Can I add him as a dependent for health coverage under the Health Fund? -Son in Saugus

Health Fund
I have searched and searched on the Benefits Website for a basic Physician Claim Form under the Health Fund tab. Where is it located? -Searcher in Sequoia	I know that the Health Fund no longer covers fertility costs. But, my primary care physician at the Motion Picture Health Center sent me a referral to see my in-network gynecologist to get further blood tests to figure out health and fertility issues. Will the visit and lab work be covered? -Wondering in Wichita

COBRA
I'm currently on COBRA coverage and I was just hired to write again for a signatory Employer. When will I have earned health coverage under the Health Fund again? -Wondering in Whittier	I was wondering, is there a different rate with COBRA coverage for one person versus a family under the Health Fund? -Thinking in Tucson

Health Plan Options
I have the Regular PPO plan under the Health Fund. How does the Industry Health Network work for me? -Regular Plan in Reseda I do not choose to use traditional medicine techniques and practices. Do I have to accept or use this insurance under the Health Fund? -Alternative Seeker in Albany	I'm going to backpack through Europe for four months. Can I use my health coverage under the Health Fund if I am out of the country? -Traveler in Tuscany (soon!)

Eligibility
I'm working very hard, trying to earn Health Fund eligibility. How will I know when I have met the eligibility requirement under the Health Fund? -Workaholic in West Hollywood I'm a little short of meeting the minimum required amount to qualify for benefits. Can I pay the difference (the amount that I need) to allow me to qualify for benefits under the Health Fund? -Saving in San Francisco	I finally think I've earned enough to become eligible for health coverage under the Health Fund. But now, there is a three-month waiting period between my earnings and the benefit periods. Why? -Waiting in Westchester

Retiree Coverage
I'm now a senior citizen and I get discounted rates at various businesses. Is there such a thing as a senior rate for health coverage under the Health Fund? -Hopeful in Hackensack	I have coverage through the Health Fund and I do not want to enroll in Medicare Part B. Do I have to? -Wavering in Winnipeg

Claims
I have other coverage with another carrier in addition to coverage under the Health Fund. How are my claims paid? -Double Dose in Downey I need to order a prescription that my doctor prescribed. Is there a separate deductible for the prescription drug program? -Scripted in Scranton	I made a claim to the Health Fund. Why was I asked for accident injury information on that and other specific claims? -Injured in Inglewood
Dear Dorothy: Is my family covered under the Health Fund, or just me? -Family Guy in Fresno Dear Family Guy: When you receive health care coverage, this includes your spouse and children, as long as the Administrative office receives your dependent premium of $150.00 (quarterly paid in advance premium). Go to TOP
Dear Dorothy: It's a girl! Does my newborn automatically have health coverage under the Health Fund? -Mommy in Manitoba Dear Mommy: No, your new baby girl would not have coverage automatically. There is required paperwork to add a dependent onto your health plan. If this newborn girl is the first dependent being added to your coverage, you will need to pay a dependent premium. However, if you have already added dependents and paid your quarterly premium, once the paperwork is processed, the your new baby girl will be added for health coverage under the Health Fund. Go to TOP
Dear Dorothy: My spouse has health coverage through his employer. Can my health coverage under the Health Fund benefit him? -Excess in Eureka Dear Excess: As a matter of fact, yes, it can. Your health coverage under the Health Fund can coordinate benefits after the primary insurance has paid. Go to TOP
Dear Dorothy: I'm currently engaged and we are planning a wedding in August of next year. Is my fiancé covered under the Health Fund? -Engaged in East Los Angeles Dear Engaged: Unfortunately, no, your fiancé is not covered under the Health Fund. You must be married and have a copy of your marriage certificate (or provide a signed affidavit of domestic partnership), and any additional documentation requested by the Health Fund on record with the Fund. Go to TOP
Dear Dorothy: My husband and I plan on adopting a child. Can our adopted child receive coverage? -Future Parent in Freetown Dear Future Parent: Yes! But, you will be required to provide a copy of the adoption release, guardianship or placement documents to the Health Fund. Go to TOP
Dear Dorothy: My father is divorced, and is no longer working. Can I add him as a dependent for health coverage under the Health Fund? -Son in Saugus Dear Son: Sorry, but no you cannot add a parent as a dependent under the Health Fund. Go to TOP
Dear Dorothy: My daughter is covered as a dependent under the Health Fund. At what age does she stop having coverage under the Fund? -Concerned in Cincinnati Dear Concerned: When your daughter reaches age 19, you will be required to provide evidence of full-time student status if you want your daughter to continue health coverage under the Health Fund. Coverage for her will be continued through age 23 if she remains a full-time student (only if your earned eligibility continues). However, if she is not a full-time student (or you do not submit evidence that she is a full-time student), then her coverage would end. Go to TOP
Dear Dorothy: I have searched and searched on the Benefits Website for a basic Physician Claim Form under the Health Fund tab. Where is it located? -Searcher in Sequoia Dear Searcher: Dear Searcher: Actually, there is no such form! In fact, the Health Fund does not utilize claim forms for claims submission. Let me explain! If you use a non-network physician, you can simply send the itemized bill from the provider that includes the patient's name, identification number, provider information (including name, address and tax identification number) as well as the procedure and diagnosis codes. Non-contracted providers can submit paper or electronic claims on behalf of the Participant, however, they are not required to submit. It will depend on the individual providers office/facility billing practices. If you use network physicians, then the rendering physician will submit the bills on your behalf. Keep in mind that you will need to let the Health Fund know whether or not there is other coverage with another health insurance carrier. If other insurance exists, the Health Fund is going to need the name of the carrier, the name of the insured, telephone number, covered dependents (if any), and the effective dates. You'll also need to let the Health Fund know if the insurance is carried as a group health plan or an individual health plan. You can learn even more about the Health Fund by surfing the Benefits Website. Have fun! Go to TOP
Dear Dorothy: I know that the Health Fund no longer covers fertility costs. But, my primary care physician at the Motion Picture Health Center sent me a referral to see my in-network gynecologist to get further blood tests to figure out health and fertility issues. Will the visit and lab work be covered? -Wondering in Wichita Dear Wondering: Dear Wondering: Well, there's some good news, the office visit and labs would likely be considered a covered expense as long as the provider is diagnosing the infertility. But, you are right, once the infertility has been diagnosed; fertility treatment is not a covered benefit. So, with a few more specifics, if the referral to the GYN is to determine whether you are infertile or whether there are other medical indications, then the services performed during that visit would be considered diagnostic and eligible for reimbursement. If, however, you have already been diagnosed as infertile, the services would be considered treatment of infertility and not covered. And of course, no answer would be complete without your friendly disclaimer: This is not a guarantee of benefits. Benefits are determined at the time of service and based on continued eligibility. This response was based on the limited information provided. All benefits quoted herein are governed by the limitations and other information contained in your SPD and its supplements. Go to TOP
Dear Dorothy: I'm currently on COBRA coverage and I was just hired to write again for a signatory Employer. When will I have earned health coverage under the Health Fund again? -Wondering in Whittier Dear Wondering: Once the signatory company has reported the monies and you meet the minimum earnings amount, there is a calendar quarter waiting period. Your effective date of health care coverage under the Health Fund would be the following month after this waiting period and the coverage will extend for twelve months. Go to TOP
Dear Dorothy: I was wondering, is there a different rate with COBRA coverage for one person versus a family under the Health Fund? -Thinking in Tucson Dear Thinking: Why yes, there are different rates. Upon receipt of your COBRA packet, there are several options for you to review for health coverage - for one family member or the entire family. Go to TOP
Dear Dorothy: I have the Regular PPO plan under the Health Fund. How does the Industry Health Network work for me? -Regular Plan in Reseda Dear Regular Plan: Like you, all Industry participants have the same opportunity in the Southern California area to use the Industry Health Network at any time. Don't forget though, to call for an appointment to see a health care professional, as it is required. Go to TOP
Dear Dorothy: I'm going to backpack through Europe for four months. Can I use my health coverage under the Health Fund if I am out of the country? -Traveler in Tuscany (soon!) Dear Traveler: Yes, you can use your coverage in Tuscany and beyond! Under the Health Fund Regular Medical Plan coverage obtained by seeing a licensed provider while out of the country can be submitted for reimbursement at 80%. Go to TOP
Dear Dorothy: I do not choose to use traditional medicine techniques and practices. Do I have to accept or use this insurance under the Health Fund? -Alternative Seeker in Albany Dear Alternative Seeker: No, you are not required to use the insurance coverage under the Health Fund for any reason. The decision is totally up to you! Go to TOP
Dear Dorothy: I'm working very hard, trying to earn Health Fund eligibility. How will I know when I have met the eligibility requirement under the Health Fund? -Workaholic in West Hollywood Dear Workaholic: Once you have met the earnings requirement the Administrative Office will send you a Notice of Eligibility with ID cards. The notice outlines your eligibility period and benefit coverage under the Health Fund. If you believe you have met the eligibility requirement but do not receive a Notice of Eligibility, you should call the Administrative Office. Go to TOP
Dear Dorothy: I finally think I've earned enough to become eligible for health coverage under the Health Fund. But now, there is a three-month waiting period between my earnings and the benefit periods. Why? -Waiting in Westchester Dear Waiting: I know it's not fun to wait, but hang in there! The three-month waiting period is needed for Employers to submit reports of earnings and for the Administrative Office to process these reports so we can be sure we have all of your earnings. Go to TOP
Dear Dorothy: I'm a little short of meeting the minimum required amount to qualify for benefits. Can I pay the difference (the amount that I need) to allow me to qualify for benefits under the Health Fund? -Saving in San Francisco Dear Saving: No. The earnings requirement is based solely on employment covered by the Collective Bargaining Agreement. You cannot pay for any shortage of earnings in order to qualify for benefits. You'll have to save your money for a rainy day! Go to TOP
Dear Dorothy: I'm now a senior citizen and I get discounted rates at various businesses. Is there such a thing as a senior rate for health coverage under the Health Fund? -Hopeful in Hackensack Dear Hopeful: The Health Fund doesn't offer senior citizens discount or special rate, sorry. Go to TOP
Dear Dorothy: I have coverage through the Health Fund and I do not want to enroll in Medicare Part B. Do I have to? -Wavering in Winnipeg Dear Wavering: Not to tell you what to do, but yes, you are required to enroll in Medicare Part B when the Health Fund coverage is your secondary coverage. If you fail to enroll in Medicare Part B, the Fund's benefits are reduced by 80%. Go to TOP
Dear Dorothy: I have other coverage with another carrier in addition to coverage under the Health Fund. How are my claims paid? -Double Dose in Downey Dear Double Dose: The good news is that the Health Fund will coordinate benefits with other plans that are group coverage. The determination of which plan pays first is based on specific Fund rules. And, the bad news is that you cannot elect which plan you want as your primary plan. Go to TOP
Dear Dorothy: I made a claim to the Health Fund. Why was I asked for accident injury information on that and other specific claims? -Injured in Inglewood Dear Injured: Sometimes we need to ask a lot of questions. Like, if a claim has an accident or injury diagnosis, there may be another plan or entity that should provide benefits. For example, if the injury is the result of an automobile accident, the Health Fund must coordinate with the auto insurance company. If a third party were liable for the accident, the third party would be responsible for the benefits. In these accident types of situations, we need information from you to determine how your medical expenses should be paid. Go to TOP
Dear Dorothy: I need to order a prescription that my doctor prescribed. Is there a separate deductible for the prescription drug program? -Scripted in Scranton Dear Scripted: Nope, there's no separate deductible! Go to TOP

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