Summary of Coverage Plans
The table below summarizes the applicable deductibles, co-insurance rates and out-of-pocket limits for each plan offered under the DGA-Producer Health Plan. Additional details on each plan are available in the March 2020 Health Plan Summary Plan Description, pages 41-43, and its updates, which are available at www.dgaplans.org. For questions, please call Participant Services, Monday through Friday from 8:30 a.m. to 5:00 p.m. Pacific Time, at (877) 866-2200, Ext. 401.
|
Premier Choice/ |
Choice/ |
Silver |
Bronze |
||
|---|---|---|---|---|---|
|
Deductibles |
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|
Individual |
$325 |
$325 |
$325 |
$750 |
|
|
Family |
$975 |
$975 |
$975 |
$2,250 |
|
|
Co-Insurance Rates |
|||||
|
Network Network co-insurance rate is based on amount of Covered Expenses |
90% |
90% |
90% |
70% |
|
|
Non-Network Non-Network co-insurance rate is based on Reasonable and Customary amount of Covered Expenses1 |
70% |
60% |
60% |
50% |
|
|
1If you use a Non-Network provider, other than for Emergency Services, Emergency or Non-Emergency Services received from a Non-Network provider at certain Network facilities, or air ambulance services by a Non-Network provider, you will be responsible for either 30% or 40% (or 50% under the DGA Bronze Plan) of the remaining Covered Expenses depending on your plan of coverage, as well as any amount above the Reasonable and Customary amount. |
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|
Out-of-Pocket Limits |
|||||
|
Individual Network |
$1,000 |
$1,000 |
$1,000 |
$8,700 |
|
|
Individual Non-Network |
$3,550 |
$8,900 |
$8,900 |
$12,500 |
|
