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Directors Guild of America – Producer Pension and Health Plans
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Medical Benefits Overview


For full details about the medical benefits available from the DGA–Producer Health Plan, refer to the March 2020 Health Plan Summary Plan Description, beginning on page 37.

Medical Provider Network

Anthem Blue Cross is the Health Plan’s medical provider network.

To locate a network doctor, click here to go to our Network Provider Finder.

For more detailed provider information, including quality ratings and patient reviews, visit the Anthem Blue Cross Benefits Management Portal at www.anthem.com/ca. (Registration required.)

To reach an Anthem Blue Cross representative by phone, call (800) 810-2583.

Below is a summarized schedule of medical benefits under the Health Plan.

Network Provider Non-Network Provider
Calendar Year Deductible* $325/person; $975/family
Percentage Payable 90% of covered expenses DGA Premier Choice Plan
70% of covered expenses
DGA Choice Plan
60% of covered expenses
Calendar Year Out-of-Pocket Limit
(in excess of deductible)
$1,000 per person DGA Premier Choice Plan
$3,550 per person
DGA Choice Plan
$8,900 per person
All Inclusive Network
Out-of-Pocket Limit
(includes deductibles, co-insurance and co-payments [including prescription drug co-payments])
$8,550 per person
$17,100 family
Not applicable

*Co-payments and network preventive care services do not count towards the calendar year deductible.

Dependent Premium Amounts

Enrollment Annual Premium
Participant Only No premium
Participant + 1 Dependent $780
Participant + 2 or more Dependents $1,200

Non-Covered Services

Most medically necessary services are covered by the Health Plan. However, not all services provided by a doctor are covered (cosmetic surgery, for example). You are responsible for 100% of the cost of non-covered services.

Do not assume that all services performed by a network doctor are covered. Some network doctors offer non-covered, medical services.

The best way to determine if a treatment is covered is to refer to the March 2020 Health Plan Summary Plan Description or contact the Plan office at (877) 866-2200 ext. 402.

Reasonable and Customary Charges (R&C)

When you visit a non-network doctor, the Plan office will only consider charges up to the reasonable and customary (R&C) amount for that service. You will be responsible for all charges over the R&C amount.

For example, if your doctor bills you $400 for an office visit, but the R&C is $100, you will be responsible for the entire $300 that is in excess of the R&C amount, plus the applicable co-insurance on the initial $100 and any deductible.

The R&C amount is calculated based on the average charge for a medical service by a percentage of doctors in a given area.

Network doctors will not charge you more than the their contracted rates for covered services.

Additional Information about Network Doctors

Network doctors are not required to refer you to other network doctors. In a non-emergency situation, you should check to see if your referral is for a network doctor. You can do so by contacting the doctor directly or by checking the Anthem Blue Cross Network Provider Finder.

Services in a network hospital may be performed by non-network doctors.

We cannot guarantee that there will always be a network provider available for the medical service that you need. Some areas do not have network providers. In other areas, a network provider in a specific field of medicine may not be available at all times.

More on the Health Plan

HIPAA Notice of Privacy Practices

Benefits Overview

About the Health Plan

Medical

Dental

Prescription Drugs

Vision

Preventive Care

MPTF

Qualifying for Coverage

Eligibility Requirements

Open Enrollment

Adding Dependents

Coverage Extensions

Types of Self-Pay Coverage

Self-Pay Plans

Pay Your Premium

Find a Network Provider

Filing A Claim

Filing a Claim

Dental Claims

Medical Claims

Prescription Claims

Vision Claims

Claims for Services Received Outside the U.S.

Medicare

Affordable Care Act Information for Participants

Resources for Non-Covered DGA Members

 

About Us

Created as a result of the Directors Guild of America's collective bargaining agreements with producer associations representing the motion picture, television and commercial production industries, the DGA-Producer Pension and Health Plans provide excellent benefits to participants.

The DGA-Producer Pension and Health Plans are separate entities from the DGA and are administered by a Board of Trustees made up of DGA representatives and Producers' representatives.

RECENT NEWS

COVID-19 Vaccine Rollout and Distribution

COVID-19 Vaccine Rollout and Distribution

By DGA-PPHP Communications  /  February 1, 2021
Winter 2020 Spotlight on Benefits Newsletter Now Available

Winter 2020 Spotlight on Benefits Newsletter Now Available

By DGA-PPHP Communications  /  December 18, 2020
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

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

By Peggy Bottger  /  November 24, 2020
Fall 2020 Spotlight on Benefits Newsletter Now Available

Fall 2020 Spotlight on Benefits Newsletter Now Available

By DGA-PPHP Communications  /  November 3, 2020

Contact Us

Main Phone: (877) 866-2200

Faxes:

Address Change: (323) 866-2389
Contributions: (323) 866-2311
Health Plan Claims: (323) 782-9287
Health Plan Eligibility: (323) 866-2399
Pension: (323) 866-2372

5055 Wilshire Boulevard
Suite 600
Los Angeles, CA 90036

Office Hours:
Monday through Friday
8:30 a.m. to 5:00 p.m. Pacific Time

More contact options

HIPAA Notice of Privacy Practices

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