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Preventive Care Benefits Overview

List of Covered Preventive Care Services

The co-insurance for the following preventive care services from a network provider will be paid at 100%, with no deductible. Covered Preventive Care Services are subject to change. For more information see Preventive Care on pages 61-62 of the March 2020 Health Plan Summary Plan Description.

Children and Adolescents

Newborns
  • Screening all newborns for
    • Hearing
    • Congenital Hypothyroidism
    • Phenylketonuria (PKU)
    • Hemoglobinopathies or Sickle cell disease
  • Gonorrhea preventive medication for eyes of all newborns
Childhood/Adolescent Immunizations
  • Diphtheria, Tetanus, Pertussis
  • Haemophilus influenza type B
  • Hepatitis A and B
  • Human Papillomavirus (HPV)
  • Influenza (Flu)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal (pneumonia)
  • Inactivated Poliovirus
  • Rotavirus
  • Varicella (chickenpox)
Childhood Screenings
  • Medical history for all children throughout development
  • Height, weight and Body Mass Index (BMI) measurements
  • Developmental screening for children between age 9 months through 30 months
  • Autism screening for children at 18 and 24 months
  • Behavioral assessment for children of all ages
  • Vision screening for children age 3 to 5 years
  • Oral health risk assessment for young children
  • Hematocrit or Hemoglobin screening for iron-deficiency anemia
  • Obesity screening and weight management counseling for children age 6 or older
  • Iron supplements from a network-pharmacy for children 6 to 12 months who are at higher risk for anemia (submit with a physician’s prescription directly to the Prescription Drug Plan)
  • Fluoride supplements from a network pharmacy for children starting at age 6 months without fluoride in their water source (submit with physician’s prescription directly to the Prescription Drug Plan)
  • Lead screening for children less than age 7 at risk of exposure
  • Dyslipidemia screening for children at higher risk of lipid disorder
  • Tuberculin testing for children at higher risk of tuberculosis
  • Hearing Screening
Additional Screenings for Adolescents
  • Depression screening
  • Alcohol and drug use assessment
  • Cervical dysplasia screening for sexually active young women
  • Counseling to prevent sexually transmitted infections (STIs) and screening for STIs for sexually active adolescents
  • HIV screening for adolescents at higher risk

Health Screenings for Adults

Miscellaneous Health Screenings
  • Blood pressure screening for adults
  • Diabetes screening for type 2 diabetes as part of cardiovascular risk assessment for adults age 40 to 70 and are overweight and obese
  • HIV and sexually transmitted infections (STI) screenings for adults at higher risk
Cancer Screenings
  • Breast cancer mammography allowed biennially for women aged 50 to 74 years
  • Breast cancer chemoprevention counseling for women at high risk for breast cancer
  • Cervical cancer pap test every three years for women age 21 through 65
  • Colorectal cancer screening for adults age 50 through 75 including colonoscopy every 10 years or sigmoidoscopy every 5 years with high-sensitivity fecal occult blood testing (FOBT) every 3 year, or annual FOBT
  • Low-dose computed tomography in adults age 55 to 80 who have 30 pack-year smoking history and currently smoke or have quit within the past 15 years
Other Preventive Services for Adults
  • Counseling to promote a healthy diet for adults with risk factors for cardiovascular and diet-related chronic disease
  • Obesity screening and – with a Body Mass Index of 30 or greater – behavioral interventions to promote sustained weight loss
  • Tobacco use cessation-counseling, with or without tobacco cessation medication (submit claims for tobacco cessation medication from a network pharmacy directly to the Prescription Drug Plan with physician’s prescription and current letter from the prescribing physician to certify concurrent participation in tobacco cessation counseling)
  • Alcohol misuse screening and behavioral counseling interventions in primary care to reduce alcohol misuse
  • Screening for depression
  • Counseling for prevention of STIs
  • Counseling for use of aspirin to prevent cardiovascular disease, for males age 45 through 79 and females age 55 through 79 (submit claims for aspirin with physician’s prescription directly to the Prescription Drug Plan)
  • Counseling to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk
Adult Immunizations
  • Hepatitis A and B
  • Herpes Zoster (Shingles) from age 60
  • Tobacco use cessation-counseling, with or without tobacco cessation medication (submit claims for medication from a network pharmacy directly to the Prescription Drug Plan with physician’s prescription and current letter from the prescribing physician to certify concurrent participation in tobacco cessation counseling)
  • Human Papillomavirus (HPV)
  • Influenza (Flu)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal (pneumonia)
  • Tetanus, Diphtheria, Pertussis
  • Varicella (chickenpox)
Screenings for Men
  • Abdominal aortic aneurysm one-time screening for men age 65 to 75 who have ever smoked
Screenings for Women
  • Osteoporosis screening for women age 65 and older
  • BRCA counseling about genetic testing for women at higher risk and BRCA test if appropriate
  • Well-woman visits, including prenatal care, to obtain recommended preventive services
  • Domestic and interpersonal violence screening for all women
  • Human Papillomavirus (HPV) screening every 3 years for women with normal cytology results, age 30 and over
Specifically for Pregnant Women
  • FDA-approved contraceptive methods (generics only, when available). Submit claims for contraceptive drugs, devices and supplies from a network pharmacy directly to the Prescription Drug Plan, with physician’s prescription
  • Folic acid supplements from a network pharmacy for women who may become pregnant (submit claims with physician’s prescription directly to the Prescription Drug Plan)
  • Anemia screening for iron deficiency in pregnancy
  • Tobacco cessation counseling for all pregnant women who smoke with or without pharmacotherapy (submit claims for FDA-approved medication from a network pharmacy directly to the Prescription Drug Plan with physician’s prescription and current letter from the prescribing physician to certify concurrent participation in tobacco cessation counseling)
  • Hepatitis B screening during the first prenatal visit
  • RH incompatibility blood type screening at first prenatal visit and 24-28 weeks
  • Bacteriuria urinary tract infection screening in pregnancy at 12 to 16 weeks
  • Breastfeeding education to promote breastfeeding, and breast pump and breast pump supplies
  • Gestational diabetes screening for women after 24 weeks pregnant and those at high risk

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

Important Notice Regarding the American Rescue Plan Act – 100% COBRA Subsidy

Important Notice Regarding the American Rescue Plan Act – 100% COBRA Subsidy

By DGA-PPHP Communications  /  April 1, 2021
Spring 2021 Spotlight on Benefits Newsletter Available Now

Spring 2021 Spotlight on Benefits Newsletter Available Now

By DeLon Howell  /  March 30, 2021
Board of Trustees Approves 13th Check for Basic Plan Retirees and Beneficiaries in Pay Status as of December 2020

Board of Trustees Approves 13th Check for Basic Plan Retirees and Beneficiaries in Pay Status as of December 2020

By DeLon Howell  /  March 26, 2021
New Federal Law Provides 100% COBRA Premium Subsidy to Eligible Individuals, Beginning April 1, 2021

New Federal Law Provides 100% COBRA Premium Subsidy to Eligible Individuals, Beginning April 1, 2021

By DGA-PPHP Communications  /  March 18, 2021

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

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