Earnings, Contributions and Qualifying for Healthcare Eligibility – Timing Is Everything
Sometimes an employer can misreport earnings, and this can have a significant effect on the timing of when health benefits become available for your clients. In some cases, a reporting error can result in the loss of health coverage. You can make sure this doesn’t happen to your clients by taking a few simple precautions.
It is very important that you keep track of when your client performed their covered services: when a rewrite commenced, when a final draft was delivered, or when a purchase occurred.
The work dates for earnings should correspond to the time-period in which the services were performed (and per the terms of the writing contract) – not necessarily when the writer is paid for the services or the contributions are made to the PWGA.
In the event of a reporting error made by your client’s employer, we can adjust your client’s earnings to reflect the correct time-period in which the services were rendered. In order to correct errors such as these, the PWGA requires correcting information from the employer. It is also helpful if you have supporting information to confirm the correct earned dates.
The bottom line is this: incorrect reporting can cost your clients’ health coverage, affect the timing for when coverage begins, and in some cases, necessitate the retroactive provision of coverage. If you make it your practice to keep the PWGA apprised of when clients perform covered services, we can make sure your clients receive all the benefits due to them.
For more information, please contact Employer Compliance at: (818) 846-1015 ext. 603 or email us at: [email protected]
The Easiest Way to Make Dependent Premium Payments
Dependent premiums are so important to the lives of your clients and their dependents that you would think this would be one of the first bills to get paid. Unfortunately, every quarter, there are dozens of writers who lose health coverage for their dependents because they forgot to pay the premiums. Whether you are paying the premiums or your clients are, there are a few things worth noting that can help you avoid this unfortunate circumstance.
Dependent premiums are billed on a quarterly basis, and must be paid in advance. In order to ensure timely processing, statements have a quarterly due date on the 20th of the month: 3/20, 6/20, 9/20, and 12/20.
Payments are accepted (online & mail) through the end of the month. We have been asked by business managers if they can pay with a check online – this payment method is not currently available.
Because the consequence of missing Dependent Premium payments is significant, the PWGA sends out reminders proactively:
- Email blasts and post card payment reminders are sent on the 15th of the month prior to the new quarter. (If a reminder is received and the business manager believes the payment has been made, please contact the Eligibility Department to verify (818-846-1015 x189).
- Payments for more than one quarter (for example, paying for the entire year) must be mailed to the Fund office. We will accept a business check, personal check or money order only.
- We encourage Participants to pay online. As a third-party, business managers will need to use the instructions below.
(Note: A business manager may also set up bill pay with their client’s bank account. However, it is highly recommended that they contact the Fund office to verify that payment has been received.)
How to Make an Online Payment Without Logging into The Participant’s Account:
- Go Pay Premium
- Enter the Participant’s ID number (numbers only – no letters)
- Enter the Participant’s last name
- Enter the Participant’s birth date
- A prompt will appear: “Do they live in U.S.A.?” – Click Yes
- Enter last 4 digits of the SSN
- Enter Credit or Debit Card Information
- Response will be “Payment Pending”
For more information, please contact the Eligibility Department at: 818-846-1015 x189 or by email at: [email protected]
In Network vs. Out of Network Providers
Beginning January 1, 2018, the Health Plan has made substantial changes to how it handles Out of Network (OON) benefits. If you or your client are unaware of the new policies it can result in much higher than expected medical costs.
While there are some new benefits (online psychological services for example), and slightly higher annual deductible costs and drug costs, the policies regarding out of network benefits have changed significantly.
Out of Network Changes:
- Out of pocket maximums (the most a writer can pay in a given year) rise from $2,500 to $20,000
- Co-Insurance (the amount the Health Plan pays) is reduced from 70% to 60%
What You Need to Know:
In-network health care providers are doctors and hospitals that have agreed to be part of a Preferred Provider Organization (PPO) and to charge a reduced rate when used by Health Plan participants.
Our Preferred Provider Organization (PPO) Plans give members access to one of the largest provider networks in California, with over 62,000 physicians and over 400 hospitals.
Out-of-network providers are doctors and hospitals not affiliated with the Health Plan’s PPO, which means they can charge whatever they deem appropriate. Your client is responsible for amount over R&C, non-covered expenses, any copays, the deductible, and the coinsurance amount. Out-of-network health care providers often collect fees at the time services are rendered and do not bill the insurance carrier on your behalf.
If your client uses an out-of-network provider, the Health Plan pays a lower percentage (60% instead of 85%) of covered expenses, and your client is responsible for any amount over the R&C (Reasonable and Customary – a standard amount in a given area for a given service) limit. To minimize your client’s out-of-pocket expenses, they should use in-network providers whenever possible.
To locate a contracted provider (in-network), you can call Anthem at: (800) 810-2583 or go to : Find A Participating Provider
If your client is contemplating incurring a major medical expense from an out-of-network health care provider, you may want to find out whether the provider’s charges fall within R&C limits for that service. You can call Participant Services at: (818) 846-1015 or (800) 227-7863 or email us at: [email protected] and we will be happy to answer any questions you may have.