DGA-Producer Health Plan Board of Trustees Announces Benefit Changes to Preserve the Health Plan Effective January 1, 2027
For more than a decade, the nation has battled inflation and rising healthcare costs. All U.S. health plans have been impacted by this crisis, including the WGA, SAG-AFTRA, Motion Picture Industry, and DGA health plans. Among the challenges faced by the DGA Health Plan have been employer contributions that have not kept pace with rising healthcare costs and a low eligibility threshold that has never been enough to cover the actual cost of providing benefits. Like all industry plans, to address this shortfall, the DGA Health Plan has been forced to raid its reserves to pay benefits, with additional drawdowns expected in the coming years. As an industry, we have reached the point where without changes, healthcare coverage is threatened, and all the industry plans have made changes, recognizing these conditions.
The bargaining parties and the Plan’s Board of Trustees have also recognized that the Plan itself and contributions to support the Plan had to change and have acted to preserve and protect our essential healthcare benefits. As a result of the last round of bargaining, the employers agreed to make substantial contributions to the Plan to help cover increased costs.
Absent these efforts, the Health Plan’s consultant has projected the Health Plan would run out of money in 2030. These changes by themselves are insufficient to address the challenges faced by the Plan. The Health Plan’s Board of Trustees and its consultants have spent significant time analyzing the Plan’s fiscal situation and options for moving forward and determined that the following benefit changes are needed to return the Health Plan to sustainability.
- New participant premium added and changes to dependent premiums for Earned Coverage, including Carry-Over Coverage. The following premiums go into effect January 1, 2027 for participants and their dependents on Earned Coverage or Carry-Over Coverage. The new premiums will be pro-rated for those with benefit periods that began in 2026:
| Enrollment | Current Annual Premium | New Annual Premium |
|---|---|---|
| Participant Only | $0 | $600 |
| Participant + 1 Dependent | $780 | $1,200 |
| Participant + 2 or more Dependents | $1,200 | $1,800 |
- These premiums are the lowest of the talent guilds in the industry.
- Minimum earnings threshold to qualify for coverage is increasing as follows:
| Current | Beginning January 1, 2027 | |
|---|---|---|
| Minimum Earnings Threshold (for earnings periods beginning January 1, 2027) |
Choice: $41,215
Premier Choice: $133,670 |
Choice: $47,500
Premier Choice: $175,000 |
- Annual deductible increases to $500 per person/$1,500 per family of three or more. The Health Plan’s annual deductible has remained unchanged since 2009, despite the significant rise in healthcare inflation over the intervening period. To bring the deductible into a range more appropriate for this higher-cost environment, the Board of Trustees previously announced an increase in the deductible to $400 per person/$1,200 per family that was to take effect January 1, 2027. However, with the conclusion of the DGA 2026 contract negotiations and a clearer picture of the Health Plan’s cost-sharing needs in this more inflationary climate, it was determined that the previously announced increase would need to be adjusted to better position the Health Plan for long-term stability.
- Co-insurance for network services under the DGA Choice Plan increases. The Health Plan’s network co-insurance rate, or the share of costs that you and the Health Plan pay for a covered service from a network provider after you have met your annual deductible, has not changed since 1978, even as average healthcare spending per person in the U.S. has risen significantly over that time.
Even at these increased earnings thresholds, benefits are substantially subsidized. For comparison, the minimum earnings threshold to qualify for Writers Guild of America (WGA) Health Plan coverage increases from $47,460 to $53,773 effective July 1, 2027.
Effective January 1, 2027, the Health Plan’s calendar year deductible will increase from $325 per person/$975 per family to $500 per person/$1,500 per family. These are the same as the WGA Health Plan’s PPO benefit starting January 1, 2027.
Effective January 1, 2027, the Health Plan will cover network services under the DGA Choice Plan at 80% of the PPO contracted rate. Your share will be 20%. Also, effective January 1, 2027, the co-insurance maximum under the Choice Plan— the maximum amount of co-insurance for network services that you are required to pay per calendar year—increases to $2,500. Again, these are in line with the WGA Health Plan’s PPO benefits. The co-insurance rate (and co-insurance maximum) for covered network services under the DGA Premier Choice Plan remain unchanged.
| Changes to Co-Insurance and Co-Insurance Maximum for DGA Choice Plan | ||
|---|---|---|
| Current | New | |
| Health Plan Pays |
Network
90% of Covered Expenses |
Network
80% of Covered Expenses |
| You Pay |
Network
10% of Covered Expenses |
Network
20% of Covered Expenses |
| Network Co-Insurance Maximum for DGA Choice Plan | $1,000 | $2,500 |
- The Carry-Over threshold and amount of Carry-Over Credit needed for one year of Carry-Over coverage increases.
Effective with benefit periods beginning on or after January 1, 2027, both the threshold at which you begin to accumulate Carry-Over Credit and the amount of Carry-Over Credit needed for one year of Health Plan coverage will increase as follows:
| Summary of Changes to Carry-Over Threshold and Carry-Over Credit | ||
|---|---|---|
| Current | Beginning January 1, 2027 | |
| Carry-Over Credit earnings threshold increased to $175,000 | Covered Earnings in excess of $160,000 will be credited. | Covered Earnings in excess of $175,000 will be credited. |
| Carry-Over Credit balance needed for one year of Health Plan coverage | $160,000 | $250,000 |
| Carry-Over Credit Bank Maximum Balance | $510,000 | $510,000 (no change) – which reduces the maximum number of banked Carry-Over Credits from three to two |
- New Rx co-pays, including added non-preferred brand drug co-pay tier. As mentioned previously, increases in prescription drug costs are one of the top contributors to healthcare inflation, with specialty drugs and new brand name drugs under exclusive patents leading the trend. While the Health Plan continually evaluates the prescription drugs available on its formulary to ensure access to a broad range of brand-name and generic medications across all drug categories, the increasing costs of certain drugs require changes to cost sharing so that these drugs can remain available but with decreased impact to the Plan.
You will be able to bank covered earnings in excess of $175,000 (up to a maximum of $510,000) for use during periods in which you do not meet the minimum earnings threshold for earned coverage. During such periods, $250,000 in Carry-Over Credit is needed to grant one year of the Health Plan’s Premier Choice coverage.
Effective January 1, 2027, brand-name drugs will be divided into preferred and non-preferred categories with different co-payments. Preferred drugs are brand-name medications on the formulary that offer rebates to offset Plan costs. Non-preferred drugs are brand names not on the formulary but that may be covered by the Plan under certain circumstances. This two-tiered system ensures the availability of a broad selection of brand-name medications in different categories while protecting the Health Plan from incurring the higher costs associated with certain brand-name drugs.
The chart below details the changes in effect for prescription drugs covered under the Health Plan beginning January 1, 2027. These changes align the Health Plan’s prescription drug benefit with that of the WGA’s health plan.
| Changes to Prescription Drug Co-Payments | ||||
|---|---|---|---|---|
| Current | New | |||
| Allowable Quantity | 30-day | 90-day | 30-day | 90-day |
| Generic | $10 | $25 | $10 | $20 |
| Preferred Brand | $24 | $60 | $25 | $50 |
| Non-Preferred Brand | $24 | $60 | $50 | $100 |
| Specialty |
$0 PrudentRx drugs
30% if not enrolled in PrudentRx |
$0 PrudentRx drugs
30% if not enrolled in PrudentRx |
||
| Lifestyle | Greater of $40/$60 or 50% | Greater of $60/$100 or 50% | ||
- Reportable Residual earnings for projects aired on or after January 1, 2027 will be credited at 50% for Health Plan purposes, including meeting the minimum earnings threshold and Carry-Over Credit thresholds. Currently, residual earnings are credited dollar for dollar, even though many residual earnings are reported at contribution rates lower than the current rate. This means residual earnings are frequently being credited at a higher rate than contributions based on initial compensation for work performed. Contributions for residuals are based on the Health Plan contribution rate in effect at the time of principal photography. In some cases, the rate is 7% as compared to the current 13.5%.
- Extended Self-Pay Coverage is eliminated. This benefit was established prior to the enactment of COBRA and offered self-pay coverage for up to five years to participants who lost health coverage. The Health Plan is the only industry plan to have offered this extended coverage. COBRA provides participants and their dependents with 18 to 36 months of coverage, depending on the reason for loss of coverage. COBRA is the standard nationwide and within the entertainment industry.
- The Health Plan’s discounted co-payment structure for the UCLA Health Centers/Entertainment Industry Medical Group is terminated, but the centers will remain available as network providers. Participants living or working in the Los Angeles area enjoy access to five health centers, operated by UCLA Health and the Entertainment Industry Medical Group (EIMG). These centers, also referred to as the Industry Health Network, have historically offered medical services and referrals for a discounted rate.
- Retiree Carry-Over Coverage is eliminated. Retiree Carry-Over coverage essentially provides a small reduction in the monthly Certified Retiree premium for retired participants. Currently, that reduction is $25/month or $300/year. Due to the limited benefit and administrative complexity, this benefit is being eliminated. Participants currently enrolled in Retiree Carry-Over coverage as of January 1, 2027 will be grandfathered for a period ending on the earliest of the individual’s: (1) exhaustion of three RCO credits; (2) the date on which you would have otherwise exhausted your RCO Credits; or (3) the date you re-qualify for Earned Active/Earned Inactive coverage.
- Survivor benefits clarified. To inherit a participant’s coverage upon their death, dependents must be covered by the participant as a dependent under the Health Plan at the time of the participant’s death.
If you are enrolled in Extended Self-Pay Coverage as of December 31, 2026, you may continue Extended Self-Pay Coverage through the earliest of: (1) March 31, 2027, (2) the date on which you would have exhausted your Extended Self-Pay Coverage period, or (3) non-payment of the applicable premium.
However, the current agreement disadvantages the Health Plan. Although UCLA Health Centers services and their associated referrals are discounted for Health Plan participants, they are as much as 40% more expensive for the Plan than the regular PPO rates negotiated through Anthem, which in essence incentivizes participants to use facilities that further stress the Plan. Additionally, the centers have not been exclusive to the entertainment industry for some time now.
Similar to changes previously made by the other entertainment industry health plans, the discounted co-payment structure with the UCLA Health Centers/EIMG is being terminated effective January 1, 2027. The centers will be treated as network providers under the Health Plan and subject to Plan rules, including your deductible and co-insurance for covered services.
Below is a formal Summary of Material Modifications (or SMM) that describes the changes in greater detail. If there is any conflict between this summary and the SMM, the SMM will control.
