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The DGA–Producer Health Plan

For purposes of clarity, the Plan’s provisions have been summarized. We emphasize that nothing in this explanation is intended to change the provisions of the Plan and that only the Board of Trustees is authorized to interpret the Plan. In the event any question is raised, the rights of Plan participants will be determined in accordance with applicable Plan language and by the rules and regulations adopted by the Board of Trustees in the course of the administration of the Plan. The Board of Trustees reserves the right to interpret, alter or amend the Plan. Updated copies of the full Plan documents are available to Plan participants and beneficiaries from the Plan Office.

For more information, please refer to the March 2020 Health Plan Summary Plan Description.

Benefits Overview

One of the important benefits of working for DGA signatory employers is the Directors Guild of America – Producer Health Plan. The Health Plan began in 1969, and since then has paid health benefits for tens of thousands of participants and their eligible dependents. The Board of Trustees is pleased to provide one of the finest benefit packages in the industry.

This site provides only a brief description of the eligibility requirements and the benefits. Detailed information regarding the Health Plan can be found in the March 2020 Health Plan Summary Plan Description. If you would like a copy of the Health Plan Summary Plan Description, please call the Health Plan office at (877) 866-2200 ext. 502.

The Health Plan provides benefits for participants and their eligible dependents. After meeting the eligibility requirements, benefits may be payable for:

  • Medical expenses;
  • Hospital expenses;
  • Prescription drugs;
  • Vision care;
  • Dental care;
  • Psychiatric care;
  • Chemical dependency treatment;
  • Preventive care; and
  • Hospice care.

How the Health Plan is funded

When you work in DGA-covered employment, your employer makes a contribution to the Health Plan based on your covered salary. The percentage that is contributed is determined by which collective bargaining agreement you are working under at the time of your earnings. You share in health care costs through the dependent premium, deductibles, co-insurance and co-payments.

It is very important to check that contributions are being paid to the Plan on your behalf when you work in DGA-covered employment. The Plan sends quarterly statements to each participant who had earnings during the quarter. The statement shows the contributions made on your behalf by each of your employers.

If your records differ from ours, contact the Contributions Department in the Plan Office immediately. Non-receipt of contributions can jeopardize your Health Plan eligibility.

Two Plans: DGA Choice and DGA Premier Choice

There are two levels of benefits within the DGA Health Plan: the DGA Choice Plan and the DGA Premier Choice Plan. The services covered under each of these plans are the same, and when network providers are utilized, there is no difference between the DGA Choice and DGA Premier Choice Plans. The only difference in the two plans is the applicable non-network out-of-pocket limit and co-insurance for each plan. For more information on the DGA Choice Plan and the DGA Premier Choice Plan, please refer to the DGA Choice and Premier Choice Plans section of the March 2020 Health Plan Summary Plan Description.

How Much Do These Benefits Cost Me?

There is no premium for participant-only coverage once you have qualified by meeting the minimum earnings threshold. However, the Health Plan does not cover 100% of your medical expenses. The table below lists examples of expenses you will pay while covered under the Health Plan:

Examples of Expenses You Will Pay While Covered Under the Health Plan (subject to out-of-pocket limits)
• Dependent Coverage $780 per year for one dependent
$1,200 per year for two or more dependents
• Annual Deductible $325 per calendar year per person
$975 per calendar year for a family of three or more
• Co-Insurance You will be responsible for any charges in excess of what the Health Plan pays.

After you have satisfied your annual deductible, the Health Plan pays its portion of covered services as follows:

Under the Premier Choice Plan:
Network services: 90% of PPO contract rate
Non-network services: 70% of Reasonable and Customary

Under the Choice Plan:
Network services: 90% of PPO contract rate
Non-network services: 60% of Reasonable and Customary

Network doctors and hospitals are contracted with Anthem Blue Cross’ network. To find a PPO doctor or hospital, check Anthem Blue Cross’ online Provider Finder or call the Plan office at (323) 866-2200 or (877) 866-2200.

For an explanation of Reasonable and Customary, see page 40 of the March 2020 Health Plan Summary Plan Description.
• Services not covered by the Plan You pay in full for any services that are not covered by the Health Plan. Examples include:

  • Any services that are not medically necessary. This includes covered services subject to periodic review, such as physical therapy and outpatient mental health services.
  • Services in excess of Plan limits (such as the $50 per visit/20-visit maximum per calendar year for chiropractic services or the $85 per visit/20-visit maximum per calendar year for acupuncture services)
  • Cosmetic surgery