Coverage Extensions

This section briefly summarizes COBRA/Self-Pay Coverage with the DGA–Producer Health Plan. For a more detailed explanation of COBRA/Self-Pay Coverage, refer to the “When Your Earned Coverage Ends” section of the March 2020 Health Plan Summary Plan Description beginning on page 11.

What is COBRA?

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you are eligible to self-pay for health coverage for yourself and/or your eligible dependents for a period of time that is determined by certain qualifying events. The qualifying events are summarized below, along with the duration of COBRA continuation coverage available as a result of each qualifying event.

*Please see the “COBRA Continuation Period” section beginning on page 15 of the March 2020 Summary Plan Description for information on the requirements for obtaining an extension of COBRA coverage because of disability.

What is Extended Self-Pay Coverage?

Participants who have completed at least 10 years of Earned Coverage may self-pay for five years of health coverage immediately upon losing Earned Coverage. This means that instead of having only 18 months of COBRA coverage, the participant may self-pay for up to 60 months. This type of coverage is referred to as extended self-pay coverage.

If the participant returns to work and has sufficient covered earnings to re-qualify for Earned Coverage, the participant may be entitled to self-pay for another 60 months of health coverage if the participant later loses Earned Coverage.

Extended self-pay coverage runs concurrent with the COBRA continuation period. In other words, the 60 months of self-pay referenced in this section includes the COBRA continuation period.

The premiums for extended self-pay coverage beyond the initial COBRA continuation period are higher than those during the COBRA continuation period. Assuming the participant’s COBRA coverage period lasts 18 months, this means that the participant’s self-pay premium will increase beginning on the participant’s 19th month of self-pay coverage.

This section briefly summarizes Certified Retiree Coverage with the DGA–Producer Health Plan. For a more detailed explanation of Certified Retiree Coverage, refer to the March 2020 Health Plan Summary Plan Description beginning on page 21.

What is Certified Retiree Coverage?

Certified Retiree coverage is health coverage at a significantly reduced premium for the participant and
eligible spouse.

The participant qualifies as a Certified Retiree if the participant:

• Is at least age 60;
• Has at least 20 years of Earned Coverage; and
• Has retired from either the DGA–Producer Basic Pension Plan or the DGA–Producer Supplemental
  Pension Plan.

If the participant is totally disabled (receiving disability benefits from Social Security), the age 60 requirement does not apply, but the participant must still meet the other two requirements.

Years of COBRA coverage or self-pay coverage do not count towards the 20-year requirement.

Participants on Certified Retiree Coverage will be covered under the DGA Premier Choice Plan (see the “DGA Choice and Premier Choice Plans” section of the March 2020 Health Plan Summary Plan Description beginning on page 42).

Certified Retiree coverage includes medical coverage, prescription drug coverage and vision coverage. Dental coverage is also available for an additional monthly premium. The participant may choose not to elect dental coverage. However, once the participant drops dental coverage, the participant may not re-elect it. In addition, the participant cannot receive dental coverage without medical coverage.

This section briefly summarizes Retiree Carry-Over Coverage with the DGA–Producer Health Plan. For a more detailed explanation of Retiree Carry-Over Coverage, refer to the March 2020 Health Plan Summary Plan Description beginning on page 19.

What is Retiree Carry-Over Coverage?

The participant may use Retiree Carry-Over credits to extend the participant’s coverage after the participant has retired and has exhausted the participant’s Earned Coverage.

Effective for earning periods beginning on or after January 1, 2009, if the participant generates at least $375,000 in covered earnings during an earning period, the participant will receive a Retiree Carry-Over credit.

One Retiree Carry-Over credit provides coverage for one 12-month benefit period. Coverage through Retiree Carry-Over credits can start at the first of the month in which the participant turns age 65.

Retiree Carry-Over credits can only be used by participants who:

• Have at least 10 years of Earned Coverage;
• Are at least age 65 (this requirement is not waived for participants determined to be totally disabled); and
• Have retired from either the DGA–Producer Basic Pension Plan or the DGA–Producer Supplemental Pension Plan.

Each Retiree Carry-Over credit is used in full at the time the participant’s Retiree Carry-Over Coverage begins. Therefore, if the participant subsequently qualifies for Earned Coverage before the end of the 12-month Retiree Carry-Over coverage period, the participant will not be credited for any unused Retiree Carry-Over Coverage.

Years of coverage through Retiree Carry-Over credit will not be credited as Earned Coverage years and will not count towards Certified Retiree status and extended self-pay coverage eligibility.

Participants on Retiree Carry-Over Coverage will be covered under the DGA Premier Choice Plan (see the “DGA Choice and Premier Choice Plans” section of the March 2020 Health Plan Summary Plan Description beginning on page 42).

Retiree Carry-Over Coverage includes medical coverage, prescription drug coverage, and vision coverage. Dental coverage is also available for an additional monthly premium. The participant may choose not to elect dental coverage. However, once the participant drops dental coverage, the participant may not re-elect it. In addition, the participant cannot receive dental coverage without medical coverage.

This section briefly summarizes Regular Carry-Over Coverage with the DGA–Producer Health Plan. For a more detailed explanation of Carry-Over Coverage, refer to the March 2020 Health Plan Summary Plan Description beginning on page 10.

What is Carry-Over Coverage?

Participants can accumulate carry-over credit that can be used to qualify for health coverage in a future earning period in which the participant’s covered earnings are below the minimum earnings requirement for Earned Coverage. When you have covered earnings during a benefit period in excess of the carry-over threshold, you earn carry-over credit.

The following rules apply:

• The threshold after which covered earnings will be credited is $150,000;
• There is no maximum amount of covered earnings that can be credited in any year (subject to the overall maximum balance in an individual’s carry-over account as described below); and
• The overall maximum balance of covered earnings permitted in an individual’s carry-over account is $510,000.

If the participant does not meet the minimum earnings requirement for Earned Coverage during an earning period and the participant has sufficient carry-over credit in the participant’s account, the Health Plan will automatically deduct $150,000 in earnings from the participant’s carry-over account for 12 months of Health Plan coverage. Then, if necessary, an additional $150,000 in earnings will automatically be deducted for a second year of coverage, etc. The full $150,000 will be deducted regardless of how close the participant is to meeting the minimum earnings requirement.

There is no expiration date on the amounts credited to the participant’s carry-over account.

The amount of carry-over credit required for 12 months of Health Plan coverage is subject to change. Any years of eligibility earned through carry-over credit will be credited as earned coverage years and count toward Certified Retiree status and Extended Self-pay Coverage eligibility in the same manner as Earned Coverage.

Participants qualifying for health coverage through carry-over credit will be covered under the DGA Premier Choice Plan. (See the DGA Choice and Premier Choice Plans section of the March 2020 Health Plan Summary Plan Description beginning on page 42.)