New Premium-Free Benefit Created for Eligible Participants. For those who Lost Earned Active Coverage on June 30th, September 30th or December 31st, 2020, the Board of Trustees has created the Bronze Plus Plan as an Alternative to COBRA Continuation Coverage
Recognizing the pandemic’s continued impact, the Board of Trustees has created a new limited benefit plan in order to continue to be able to provide premium-free health benefits for eligible participants who lost Earned Active Coverage in 2020. The new Bronze Plus Plan will provide coverage for the period January 1, 2021 to March 31, 2021 only, as an alternative to COBRA Continuation Coverage. It is only available to those participants for whom the Health Plan is their primary coverage, and who lost their Earned Active Coverage on June 30th, September 30th, or December 31st, 2020.
This premium-free Bronze Plus Plan includes the same level of benefits as the DGA Bronze COBRA Plan, as well as prescription drug coverage, and will only be effective January 1, 2021 through March 31, 2021. Qualifying participants will have the choice of choosing either the: (1) premium-free Bronze Plus Plan or (2) COBRA Continuation Coverage by paying the applicable premium amount.
Who qualifies for the premium-free Bronze Plus Plan option?
To qualify for the premium-free Bronze Plus Plan, you must meet the following criteria:
Any one of the following:
- You had Earned Active Coverage that terminated June 30, 2020.*
- You had Earned Active Coverage that terminated September 30, 2020.*
- You have Earned Active Coverage that terminates on December 31, 2020.
*Regardless of any periods of premium-free COBRA Continuation Coverage offered after Earned Active Coverage terminated.
AND:
- The DGA-Producer Health Plan is your primary coverage.
How is the Bronze Plus Plan different from COBRA Continuation Coverage?
The premium-free Bronze Plus Plan is different from COBRA Continuation Coverage in several key ways.
| Premium-Free Bronze Plus Plan | COBRA Continuation Coverage | |
| Premium Amount | None. | You must pay the premium amount applicable for the level of coverage you elected. |
| Choice of Plans | None.
Your coverage will be set at the DGA Bronze Plan level and includes prescription drug coverage. Refer to the table at the bottom for details about the Bronze Plus Plan option. |
You are given a choice of Self-Pay plans at or below the coverage level you had at the time your Earned Coverage terminated. |
| Duration | Effective January 1, 2021 through March 31, 2021, and will not run concurrent with your COBRA Continuation Coverage eligibility. This means you will be eligible to elect or resume COBRA Continuation Coverage at the applicable premium after your premium-free Bronze Plus Plan terminates on March 31, 2021.
For example, participants who lost Earned Active Coverage on June 30, 2020 will have had 6 months of premium-free COBRA Continuation Coverage when the Bronze Plus Plan is offered. If you elect the premium-free Bronze Plus Plan, you will still have 12 months of paid COBRA Continuation Coverage remaining when the premium-free coverage terminates. |
Generally, a total of 18 months, including any periods of premium-free COBRA Continuation Coverage approved by the Health Plan’s Board of Trustees. |
| Dependents | Eligible spouse and dependent child(ren) are covered provided the Health Plan is their primary plan. | Eligible spouse and dependent child(ren) are covered provided the applicable premium for the level of coverage elected are remitted. |
What is covered under the premium-free Bronze Plus Plan?
Like the current DGA Bronze Plan, the premium-free Bronze Plus Plan will have higher cost-sharing amounts (co-insurance, deductible and out-of-pocket limits) compared to the other Self-Pay plans. Unlike the current DGA Bronze Plan, however, this premium-free coverage includes prescription drug coverage. The premium-free Bronze Plus Plan is summarized below:
MEDICAL COVERAGE
| Network Provider | Non-Network Provider | |
| Calendar Year Deductible | $750 per person
$2,250 per family |
$750 per person
$2,250 per family |
| Percentage Payable | 70% of Covered Expenses
*Essential health benefits listed under the Patient Protection and Affordable Care Act are covered at 100% |
50% of Reasonable and Customary Charges |
| Calendar Year Out-of-Pocket Maximum | $8,550 per person
$17,100 per family |
$12,500 per person |
| What’s Not Included with this Coverage | · Vision;
· Dental; and · Special arrangements with UCLA Health/EIMG |
|
PRESCRIPTION COVERAGE
| Co-Payments for | Up to 30-day supplies from Participating Retail Pharmacies | Up to 90 day supplies from the Express Scripts Pharmacy or Walgreens1 |
| Generic Drugs | $10 | $25 |
| Brand Name Drugs | $24 | $60 |
| Lifestyle Drugs2 | Greater of $40 or 50% of the cost of the medication | Greater of $60 or 50% of the cost of the medication |
1The Plan participates in a Smart90 Walgreens program with Express Scripts. Smart90 Walgreens allows patients to obtain up to two 30-day fills of their maintenance medication at any participating retail pharmacy. After these two fills are exhausted, patients must pay the full cost for their prescription unless they transition their maintenance medication to Walgreens or the Express Scripts Pharmacy for a 90-day supply. Acute medications may be filled at any participating retail pharmacy.
2Erectile dysfunction drugs, proton pump inhibitors, and sleep aids are covered under the Lifestyle Drug tier, in certain cases, these drugs require a coverage review.
How do I elect the premium-free Bronze Plus Plan?
The procedures for electing the premium-free Bronze Plus Plan option will depend on when your Earned Active Coverage terminated as follows:
- If your Earned Active Coverage terminated June 30 or September 30, 2020: When your period of premium-free COBRA Continuation Coverage ends on December 31, 2020, you will be offered the option of either: (1) electing the premium-free Bronze Plus Plan, or (2) electing to continue your COBRA Continuation Coverage at the applicable premium for the level of coverage you choose. If you enroll in the premium-free Bronze Plus Plan, you will have the option to resume your remaining paid COBRA Continuation Coverage once the premium-free coverage terminates on March 31, 2021.
- If your Earned Active Coverage terminates December 31, 2020: Your Open Enrollment materials will offer the option of electing either: (1) the premium-free Bronze Plus Plan, or (2) COBRA Continuation Coverage at the applicable premium for the level of coverage you choose. If you enroll in the premium-free Bronze Plus Plan, you will have the option to start your COBRA Continuation Coverage once the premium-free coverage terminates on March 31, 2021.
For more information, contact the Eligibility Department at (323) 866-2200, Ext. 502 or eligibility@dgaplans.org
