Screen Actors Guild – Producers Pension and Health Plans

1. Screen Actors Guild – Producers Pension and Health Plans Amanda Bernard Executive Director Benefits Operations

2. Agenda • Background • The Health Plan • Operations • Benefits • Eligibility • Affordable Care Act Benefits • Get the most from your benefits • Questions

3. Screen Actors Guild – Producers Pension and Health Plans Created in 1960 during a strike against the producers. First opened doors in 1961. Covers Actors and Background Performers in television, commercials, theatrical films.

4. Screen Actors Guild-Producers Pension and Health Plans • 36 member Board of Trustees • 18 Producer • 18 Union • Separate entity from SAG-AFTRA • No Union dues paid into Plans. • Multiemployer Plan governed by Federal and not state law

5. Regulation Internal Revenue Code ERISA Department of Labor IRS Affordable Care Act Other legislation

6. Operations 26,000 participants 1,100 calls per day 55,000 claims processed per month

7. “Self-Funded” Health Plan • Similar to an insurance company, but completely administered by the Health Plan. • Use insurance company for networks and to make payments to providers. • Claims are paid directly from income based on claims experience. • Fraud comes out of Health Plan assets and not an insurance company’s profits. • Governed by federal and not state law

8. Health Plan Benefits Medical/Hospital – BlueCard Prescription Drug – Express Scripts (formerly Medco) Dental – Delta Dental Mental Health – Value Options Vision – VSP

9. Eligibility • Base Earnings Period, Eligibility Period, and the “lag quarter” • Qualifications for benefits: • Plan I: $30,750 • Plan II: $15,100 or 76 days of employment or $10,900 if at least 40 with at least 10 years of Health Plan eligibility • Coverage dependent on payment of Health Plan premium

10. Affordable Care Act • Not “Grandfathered” • No cost share for preventive services USPTF • Appeals regs • Emergency care at network level • Physician choice • No lifetime benefit maximums • No annual dollar limits on “essential benefits” • Children to age 26 – 26th birthday

11. Be Informed • Read SPD and Take Two • Exclusions, covered/not covered services, limited coverage, pre-cert requirements • Register for interactive website • Track earnings toward eligibility • Print annual earnings statements • Track claims and view and print EOB’s • Pension estimates • Questions – call the Plan Office

12. Be a Good Consumer • Use Network physicians and hospitals • Higher reimbursement – 90% vs. 70% • If in Southern California, use IHN and MPTF clinics • You know what your bill will be - Network providers should not require payment up front or balance bill • Ask providers periodically or check Provider Finder on website • Important note: Non-network emergency and RAP paid at in-net benefit

13. Be a Good Consumer • Prescription Drug Benefit • Use generics whenever possible • Use Preferred brand • Express Scripts website, special website • Express Scripts mail order pharmacy – have dollar maximums on out of pocket, if paying %, then cost is cheaper • If you lose coverage, you now have a choice between COBRA and the Marketplace

14. Questions