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Health Fund

Active Participants

You are considered an Active Participant the first time the Fund receives a contribution on your behalf. (See "How to Become Eligible for Benefits" on page 17.)

Your Eligible Dependents

If you are eligible for coverage under the Health Fund, you may enroll:

  • Your legal spouse
  • Your children younger than age 26, including:
    • Your natural child or stepchild*;
    • Your adopted child or child placed for adoption with you (coverage begins on the date the child was placed for adoption with you or the date the adoption was final, whichever is earlier); and
    • Any other child who depends on you for support and lives with you in a parent-child relationship if you provide proof of these conditions (legal guardianship or foster children);

    As such, coverage is available whether the dependent child is married or unmarried, regardless of student status, employment status, eligibility for or access to other health insurance coverage, financial dependency on the participant (except as noted below), or any other factor other than the relationship between the child and the participant. If, however, your dependent child has other group health insurance including coverage through an employer, the Fund will consider that other coverage to be primary and the Fund's coverage for such child will be secondary.

  • Children age 26 or older who are incapable of self-sustaining employment because of mental retardation or physical handicap, as long as:
    • The mental retardation or physical disability existed while the child was covered by the Fund's health plan and began before the child reached age 26;
    • The child is primarily dependent on you for support; and
    • You provide evidence of incapacity to the Fund within 31 days after the child reaches age 26. (The Fund may ask for proof of continuing incapacity at other times during the child's coverage.)
Enrolling Your Dependents

To enroll your dependents, you must submit to the Fund a completed dependent enrollment form, along with your premium payment and all required documentation, generally within 30 days of the date you become eligible. If you do not enroll your dependent within this 30-day period, you will not be able to enroll them until the next Open Enrollment period unless you experience a Life Event that qualifies you to Special Enroll your dependents in the Fund as described below.

Your spouse A certified copy of your marriage license/certificate
Your child His/her birth certificate (for newborns, since official birth certificates often are not available within 30 days of a birth, the Fund will accept temporary documentation (such as a copy of an official hospital birth record or a certificate signed by the attending or supervising physician, or midwife) along with your completed Dependent Enrollment Form to add a new child to coverage)
Foster child, adopted child, a child placed for adoption with you or a child for whom you're the legal guardian

A copy of the adoption/release, guardianship or placement documents

All of the above Important: you must provide the Social Security number for each dependent you are enrolling, unless they are not a citizen of the United States. If adding a newborn, please submit the social security number to the Administrative Office once it is received by you.


If you choose to cover your dependents and you fail to make a premium payment by the due date, coverage for your dependents will be terminated. Coverage will be reinstated during the next open Enrollment period, effective January 1, provided you prepay the premium for the first quarter (Jan 1 to March 31).

Additionally, if you decline coverage for your dependents because they have other health insurance coverage, and your dependents then lose that coverage (or if their employer stops contributing toward your dependents' other health coverage), you have the right to Special Enroll your dependents in the Fund. In order to do so, you must request and submit a Dependent Enrollment Form to the Administrative Office within 30 days after the other coverage ends (or after the employer stops contributing towards your dependent's other health coverage), and provide proof of the termination from the other health insurance plan. If a Special Enroll request is made due to marriage, your spouse's coverage will be backdated to the date of your marriage. However, due to the fact that there is no daily proration of dependent premiums, you may instruct the Fund to make your spouse's coverage effective on the 1st day of the month after your date of marriage.

If your dependent's Medicaid or State Children's Health Insurance Program ("CHIP") coverage is terminated due to loss of eligibility; or if your dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP, then you may enroll your dependents in the Fund within 60 days of such event. Coverage will become effective the date after the Medicaid or CHIP coverage ends, or your dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP provided that the request for enrollment, the required documentation and the dependent premium, if applicable, is received by the Administrative Office within 60 days of the termination of Medicaid or CHIP coverage.

If you and/or your dependents experience a Life Event, (click here for more information) you have the right to Special Enroll your dependents in any benefit option for which you are eligible under the Fund. (For example, if you reside in California and are enrolled in the Medical PPO Plan and the Dental PPO and subsequently obtain a new dependent, you have the option of enrolling your dependent in the Plan in which you are currently enrolled.)

To enroll your dependents, you will need to provide the following documentation:

Dependent children younger than age 26 His/her birth certificate
Other dependents A copy of the adoption/release, foster placement, guardianship or placement documents
Mentally retarded or physically handicapped dependents over age 26 Proof of incapacity, medical records and proof that you're providing support

If you're re-enrolling a dependent, have previously submitted the appropriate documentation, have not been asked to supply additional or modified information and have not been advised that your dependent(s) is not eligible to enroll, then all you need to do is complete a "Dependent Reinstatement Form" and pay the dependent coverage premium, if applicable.

Paying For Dependent Coverage

In addition to meeting eligibility earnings requirements, you must pay a monthly premium if you wish to cover your dependents.

Your dependents include:

  • Your spouse; and
  • All eligible dependent children.

(See "Your Eligible Dependents" for the definition of "eligible dependents.")

This premium covers all eligible dependents in your household who you enroll for medical, dental and vision benefits. Your own coverage, which you receive when you meet the eligibility earnings requirement, doesn't require a premium payment. The dependent premium amount is listed in the Summary Of Benefits section.

Plan Participants (not including employees of "Named Employer") pay dependent premiums on a quarterly basis, in advance, based on invoices issued by the Fund. Only the dependents you have enrolled will be covered. To enroll dependents, you must complete and submit a "Dependent Enrollment Form" (including all required documentation, if applicable) to the Fund office. If the Fund does not receive the required premiums by the due date, dependent coverage will be terminated, and you will not have another opportunity to enroll your dependents, unless you or your dependents experience a Life Event that allows you to Special Enroll, or until the next Open Enrollment period, with coverage taking effect the following January 1.  (See "Life Events" below for more information).

Newborns of participants who have earned coverage or coverage through any of our COBRA plans are covered for the first 31 days after birth, but lose coverage thereafter, unless:

  • A completed Dependent Enrollment Form is received;
  • The required documentation is provided; and
  • The dependent premium is paid, if applicable.

Note: If you have already paid the dependent premium for your existing dependents, you do not need to submit an additional premium for the newborn.

Health Coverage For Children and Families

If you are eligible for health coverage from your employer (which includes coverage provided through plans sponsored by unions and employers, like the Fund), but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. These are existing state programs and are not related to the Health Care Reform Act.

If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state that offers this program, you can contact your state Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your state Medicaid or CHIP office or dial 1-877-KIDSNOW, or go to to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

Once it is determined by the State that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer's health plan is required to permit you and your dependents to enroll in the plan - as long as you and your dependents are eligible, but not already enrolled in the employer's plan. This is called a "Special Enrollment" opportunity, and you must request coverage from the plan within 60 days of being determined eligible for such premium assistance.

If you would like to request that you be provided with this Special Enrollment opportunity from the Fund, please contact the Eligibility Department at (818) 846-1015 or (800) 227-7863 to request the necessary forms.

To determine which states have added a premium assistance program or to obtain more information on Special Enrollment rights, you can contact either:

U.S. Dept. of Labor Employee
Benefits Security Administration
1-866-444-EBSA (3272), or
U.S. Dept. of Health and Human Services
Centers for Medicare & Medicaid Services
1-877-267-2323, Ext. 61565

Granting Retroactive or Terminating Prospective Coverage

Sometimes Employer Compliance audits uncover cases in which a participant gains or loses eligibility due to misreported earnings and was unaware of his/her correct status. The Fund then makes the appropriate adjustments:

  • Retroactive eligibility will be granted for the period in which you would have been eligible if earnings were accurately reported.
  • Note: you may submit claims for all medical, mental health and chemical dependency, hospital, vision, dental and pharmaceutical expenses that you incurred during the period of retroactive eligibility.

  • If you're awarded retroactive eligibility and want dependent coverage, you'll have to pay monthly premiums retroactively for the number of consecutive quarters for which you want dependent coverage.
  • If the Fund determines that current coverage was granted in error, your coverage will be terminated prospectively, (as opposed to retroactively, except as otherwise provided herein). Coverage will end on the last day of the month following the month in which our notice of termination is dated. For example, if our notice is dated March 15th, your coverage will terminate April 30th.

The collection of any delinquent contributions may result in the granting of retroactive eligibility for Health Fund coverage. Should retroactive eligibility be granted, you will be notified by the Administrative Office of:

  • Your new eligibility period; and
  • The process for submitting receipts for retroactive medical, mental health and chemical dependency, dental, vision and prescription claims. Please save your receipts!
Life Events

If you experience one of the following Life Events, you will be allowed to Special Enroll or drop dependent coverage during the year provided you have notified the Fund within 30 days of the Life Event:

  • Marriage, divorce or legal separation (in the instance of a divorce the Fund must be notified within 60 days of the event);
  • Birth or adoption of a dependent child or placement of a child for foster care or adoption;
  • Legal judgment or court order to cover a dependent child;
  • Death of a spouse or dependent;
  • Any change in a spouse's or dependent's employment status that results in a significant change to benefits, such as the start or end of employment, change from full-time to part-time employment, or start or end of an unpaid leave of absence;
  • Termination of Medicaid or CHIP coverage (Fund notification within 60 days is required);
  • Unmarried dependent's (up to age 26) loss of health insurance benefits provided by their employer; or
  • Change in work-site or residence for the participant or his/her spouse or dependent if that change affects benefits.

Note: If you timely request to special enroll in the Health Plan due to birth, adoption or placement for adoption of a dependent child, coverage will become effective as of the date the event occurred.

Other status changes, such as a change in a family member's coverage, may apply. For example, if your spouse elects family coverage during his/her open enrollment period, you may be allowed to drop dependent coverage. You may contact the Eligibility Department at the Administrative Office if you have questions about any of the Life Events described in this section.

You will not have to pay the entire quarterly premium if your Life Event takes place during the quarter. Instead, your premium will be prorated to the first day of the month in which the most recent Life Event takes place. If you do not make a premium payment at the time of a Life Event, or if you do not make your request to Special Enroll a dependent within 30 days of a qualified Life Event, you will not be able to enroll your dependents until the next annual Open Enrollment period.

When Coverage Begins

Not applicable to eligible Named Employers (e.g., Writer's Guild-Industry Health Fund, Producer-Writers Guild of America Pension Plan, Writers Guild of America East and West, Writers Guild Foundation and employees of the CBS Staff group).

accommodate necessary administrative processes, your coverage will take effect one calendar quarter after the quarter in which you satisfy the eligibility earnings requirement. (See chart below or the Summary of Benefits section for more details). Your coverage will begin on the first day of the month after your one quarter administrative period and will continue for one year.

Once you have established eligibility, it is important to be aware of your personal earnings cycle (the period in which you must meet the Eligibility Earning requirement to continue uninterrupted coverage).

The chart below provides some examples.*

If You Satisfy the Eligibility Earnings Requirement In
Your Coverage
Period Will Be
The Earnings Cycle
for Continued Coverage Will Be
October 1 – December 31
April 1 - March 31
January 1 - December 31
January 1 - March 31
July 1 – June 30
April 1 – March 31
April 1 - June 30
October 1 – September 30
July 1 – June 30
July 1 - September 30
January 1 – December 31
October 1 –September 30

For example, if a writer is hired on March 15, 2013 for a covered writing project and thereafter meets the eligibility earnings requirements by June 15, 2013, his/her coverage cycle will begin October 1, 2013 and run through September 30, 2014. To qualify for another year of coverage, he/she must earn the applicable eligibility earnings requirement in the period July 1, 2013 through June 30, 2014. If the earnings requirement is not met in this period, earned coverage under the Fund will end. He/she may regain earned coverage when the eligibility earnings requirement is met in a subsequent four-quarter earnings period.

When Coverage Ends

Not applicable to eligible Named Employers (e.g., Writer's Guild-Industry Health Fund, Producer-Writers Guild of America Pension Plan, Writers Guild of America East and West, Writers Guild Foundation and employees of the CBS Staff group).

If you continue to meet the eligibility earning requirement, coverage for you and your eligible dependents will continue uninterrupted. If you do not meet the eligibility earnings requirement during your personal earning cycle, your employerpaid coverage will end on the last day of your 12-month coverage cycle.

Your coverage will end if:

  • The Health Fund is modified to terminate coverage for your class of participants; or
  • The Plan ends.

Your dependents' coverage generally ends when your coverage ends. Additionally, dependent coverage will end if:

  • You do not pay the dependent premium by the due date;
  • On the last day of the month that a dependent child reaches age 26 (in the case of a covered child who is mentally or physically disabled who had extended coverage beyond age 26, the last day of the month that such child no longer to have such disability);
  • Your mentally or physically disabled dependent child over the age of 26 loses total disability certification because he/she no longer meets the Fund's definition of total disability (coverage will end on the last day of the month in which the child loses certification); or
  • Your dependent child enters full-time military service.

If you become legally separated or divorced, coverage for your spouse (opposite or same sex) will end on the last day of the month in which:

  • You were legally separated; or
  • Your divorce was final.

Your coverage will end on the last day of the month in which:

  • You fail to pay the required taxes to the Fund by the due date;
  • You fail to pay the required dependent premium to the Fund by the due date; or or
  • The partnership ends.

As required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA),if you or your dependent's health coverage ends under the Fund, you and your dependents are entitled by law to, and will be provided with, a "Certificate of Creditable Coverage." Certificates of Creditable Coverage indicate the period of time you and/or your dependents were covered under the Fund (including COBRA coverage), as well as certain additional information required by law. A Certificate of Creditable Coverage may be necessary if you and/or your dependents become eligible for coverage under another group health plan, or if you buy a health insurance policy within 63 days after your coverage under this Fund ends (including COBRA coverage). A Certificate of Creditable Coverage is necessary as it may reduce any exclusion for preexisting coverage periods that may apply to you and/or your dependents under the new group health plan or health insurance policy.

A Certificate of Creditable Coverage will be provided to you, upon request, up to 24 months after your coverage ends; when you are entitled to elect 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.; when your coverage terminates (even if you are not entitled to COBRA); or when your COBRA coverage ends. Certificates of Creditable Coverage should be kept as proof of prior coverage for you or your dependent's new health plan. To request a Certificate of Creditable Coverage, please contact the Administrative Office.