Board of Trustees Approves Updates to the 2020 Pension and Health Plans Summary Plan Descriptions
The Board of Trustees of the Directors Guild of America-Producer Pension and Health Plans has approved the following updates to the 2020 Pension and Health Plans Summary Plan Descriptions. These updates include clarifications on maternity care coverage, therapy coverage and cost-sharing for COVID-19 testing; a new provision regarding the application of contributions on covered earnings for work delayed due to the coronavirus pandemic and limitations on endorsements on payment instruments remitted to the Plans office.
Clarification of Government-Mandated Waiver of Cost-Sharing for COVID-19 Testing
As result of updated guidance on the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act—two laws originally passed in March 2020—the 2020 Health Plan Summary Plan Description has been amended to clarify the application of the cost-sharing waiver for coverage of COVID-19 related services.
This amendment clarifies that patient cost-sharing (i.e., deductibles, co-pays, co-insurance and prior-authorizations) will be waived for all testing received for the detection and diagnosis of the COVID-19 virus and COVID-19 antibodies on or after March 18, 2020. This applies to in-person or telemedicine/telepsychology visits, regardless of whether they are network or non-network. Additionally, the cost-sharing waiver only applies to visits that result in an order for a COVID-19 diagnostic test.
There are some important things to keep in mind regarding these clarifications:
- The waiver of cost sharing only applies to items and services furnished to an individual during visits that result in an order for, or administration of, a COVID-19 diagnostic test, but only to the extent that the items or services relate to testing for the virus or the evaluation of the individual to determine if he or she needs testing.
- The waiver of cost sharing only applies to diagnostic and antibody testing that has been determined to be medically appropriate, as determined by the individual’s attending healthcare provider. The cost sharing waiver does not apply to testing conducted for the purpose of returning to work or school, for public health surveillance, or for any other purpose that is not primarily intended for the diagnosis of the COVID-19 virus. You must provide the Health Plan with a copy of the attending healthcare provider’s orders for any COVID-19 testing.
- The waiver of cost sharing does not apply to medical treatments following a diagnosis of COVID-19. Those treatments are subject to all other Health Plan rules.
If there is no order from your healthcare provider, the claims are processed with cost sharing, subject to your deductible, co-insurance and/or co-pay. Additionally, there are various scenarios that are not covered at all by the Health Plan and any testing for the reasons stated below will be denied:
- Testing for work.
- Testing for school.
- Testing for public health surveillance or for any other purpose not primarily intended for the individualized diagnosis or treatment of COVID-19 or another health condition.
Clarification of Maternity Care Coverage for Dependent Children
The 2020 Health Plan Summary Plan Description has been amended to clarify that maternity care coverage is available to dependent children only under the following two circumstances:
- For preventive care services, as mandated by the Affordable Care Act.
- For services directly related to Complications of Pregnancy experienced by the dependent child. The newborn child will be covered for the first 31 days after birth.
Clarification of Therapy Coverage
The 2020 Health Plan Summary Plan Description has been amended to clarify that no benefits are payable for fees for a masseur, masseuse, massage therapist, dance therapist or art therapist.
Limitations of Endorsements on Payment Instruments
The 2020 Health Plan Summary Plan Description has been amended to clarify that the Health Plans’ acceptance and deposit of any payment or partial payment from any employer or participant for contributions, premiums or any other amounts owed, shall not release or discharge the employer or participant from their obligations to the Health Plan for the balance of any amounts that are still owed, notwithstanding any statement, condition, restriction, or any other qualification appearing on the instrument or any accompanying communication.
Application of Contributions on Earnings for Work Delayed Due to the Coronavirus Pandemic
The Board of Trustees has approved the following provision: any contributions on compensation paid to a Director covered under the Basic or Freelance Live and Tape Television Agreements for an earnings period for which the Director was scheduled to commence working between March 1, 2020 and ending December 31, 2020, will be recognized in the earnings period in which the Director would have commenced work, but for the fact that production was delayed due to the coronavirus pandemic.
For example, if a director was scheduled to commence work on a project on April 1, 2020, but does not commence work on the project until November 1, 2020, due to the coronavirus pandemic, the contributions received on that director’s covered work on that production will be applied beginning with the April to June earnings period.
For more information on these changes, refer to the March 2020 Health and Pension Plans Summary Plan Descriptions.
