Health Fund Changes FAQ

Since 2003, the eligibility qualifying threshold for coverage has been set at the one-hour network primetime story and teleplay minimum, which increases each year with MBA minimums; that amount is currently $47,460, roughly one-quarter of the cost of coverage under the Plan. In contrast, a writer must currently earn nearly $190,000 in a year to generate contributions that cover the actual average cost of care.

In July 2027, the earnings threshold to qualify for coverage will increase to 110% of the one-hour network primetime story and teleplay minimum, or $53,773, and thereafter will continue to increase with MBA minimums. This threshold for earning coverage remains below the minimum for a 13-week comedy-variety job, 10 weeks for a staff writer in a development room or 20 weeks in a post-greenlight room, and below the newly negotiated page one rewrite minimum.

Participants will have to pay some increased amounts in out-of-pocket expenses related to premiums, deductibles, co-insurance and their out-of-pocket maximums in the Anthem PPO plan. To address rising out-of-network expenses, the Plan will be adjusting its reimbursement of out-of-network behavioral health care to be in line with reimbursement for all other out-of-network care.

With these changes, the Anthem PPO offering will continue to provide access to a broad network of providers with low participant cost-sharing compared to most plans in the U.S. For comparison, the Mercer Benchmark¹ estimates that typical premiums for employer-sponsored healthcare are $185 per month for single coverage and $682 per month for a family.

Yes, the cost of the premiums is listed monthly, but premiums will continue to be paid quarterly, with the option to pay for the full year at once.

Pre-65 retirees will have the same changes as Active participants.

Medicare-primary post-65 retirees will see the same increased deductibles, out-of-pocket maximums, and coinsurance changes as Active participants, but will not pay any participant or dependent premiums as long as they are not on active coverage. The Plan will also make changes to the drug benefit that will cause minimal disruption while saving the Plan and many participants money on their prescriptions.

For 2026, “high income” is defined as above $109,000 for an individual or $218,000 for married filing jointly, with premiums ranging based on income from $14.50 per month to $91 per month. Information about the premiums and earnings brackets can be found on the Centers for Medicare/Medicaid Services website, in the charts labeled “Part D”: 2026 Medicare Parts A & B Premiums and Deductibles | CMS.

When participants go out-of-network for non-behavioral health care, the plan reimburses at 150% of what Medicare pays for the service. The plan then covers 60% of that 150% of Medicare price and the participant pays the remainder. For out-of-network behavioral health (mental health), the plan reimburses at a different metric known as Fair Health 80, which is higher than 150% of Medicare. To address rising out-of-network costs where the plan is unable to negotiate a better rate (as it does with Anthem) as of January 1, 2027, the plan will reimburse for out-of-network behavioral health the same way it does the rest of out-of-network care: the plan will pay 60% of 150% of the Medicare rate. This will be consistent across both Anthem and Centivo (more below) participants when they go out-of-network. The plan also offers a service called Rula, which helps participants find more in-network behavioral health providers. Participants on both Anthem and Centivo will have access to Rula.

The Industry Health Network clinics (which have been part of the UCLA Health system for years) will remain available and in-network under both the Anthem PPO and Centivo. For Anthem PPO participants, the change will be that the clinics and associated referrals will no longer be discounted beyond the rest of in-network for participants but will instead be paid as regular in-network care. In the PPO, instead of the current $10 copay, participants will pay 20% of the negotiated rate for the services after the member meets their deductible. Under Centivo, there is no co-pay for primary care and fixed amounts for specialist care.

The 2026 Agreement does not change the Fund’s Excess Earnings rule.

Writers who do not reach the eligibility threshold can continue their coverage through use of Extended Coverage Points they have banked from prior years to maintain coverage. Extended coverage currently costs 2.5 points per quarter.

Since 2014, writers have been able to earn up to three Extended Coverage Points per year, with the first point accrued upon qualifying for coverage, the second point earned at $125,000 in covered compensation, and the third at $250,000. The current system of Extended Coverage Points is unsustainable and the bargaining parties have agreed to certain changes to reflect the increased cost of healthcare.

Starting January 1, 2027, the first Extended Coverage Point will be earned at $200,000 in annual earnings, and the second point once earnings reach the compensation cap for screen, which will be $325,000 on January 1, 2027 and will increase along with the negotiated increases to screen caps. 

Extended Coverage under the Anthem PPO plan will cost 4 points per quarter, while Extended Coverage under the new Centivo plan option will cost 2.5 points per quarter starting January 1, 2027. Consistent with the current rule, these points can be used once a participant has accrued 10 points. This will set the Extended Coverage program on a more sustainable path going forward. 

The point accrual changes will take effect for eligibility cycles beginning on or after the effective date. If your eligibility cycle begins in 2026, you will accrue ECP points under the current accrual. For eligibility cycles starting between January 1, 2027 and December 31, 2027, a participant would accrue 1 point for covered earnings of at least $200,000 and 2 points for covered earnings of at least $325,000. For eligibility cycles starting between January 1, 2028 and December 31, 2028, a participant would accrue 1 point for covered earnings of at least $200,000 and 2 points for covered earnings of at least $375,000. For eligibility cycles starting between January 1, 2029 and December 31, 2029, a participant would accrue 1 point for covered earnings of at least $200,000 and 2 points for covered earnings of at least $400,000.

The number of points required to use the Low Option plan did not change under the 2026 MBA, and the 2026 deal did not include any specific changes to the Low Option plan at this time. To the extent discounted participant rates for the Industry Health Network have been available on the low option, those discounts will not be available in 2027 and regular cost-sharing will apply for doctor visits.

The Extended Coverage Program is not a vested or guaranteed benefit and can be modified by the bargaining parties or the Health Fund Trustees. The WGA has worked to maintain this program but recognized that changes had to be made to allow it to continue.

Centivo is an alternative to the Anthem PPO and is also a replacement for the Los Angeles-area The Industry Health Network (TIHN). 

Centivo’s target is to save the Health Fund 18% to 25% when compared to Anthem. With Centivo, the Fund will no longer pay the premium above the Anthem rates that UCLA Health has been charging for TIHN. And it is available to members who could not access TIHN and whose only option was Anthem, with its higher deductibles and co-insurance.

More broadly, the most important factor in selecting Centivo as an alternative for PWGA participants is that Centivo has a strategy that seeks to limit the inexorable rise in healthcare costs to about half of the overall industry rate. That’s 5% per year rather than 10% per year. That’s a cost reduction that saves money for both the Fund and WGA families.

TIHN was historically operated by the non-profit Motion Picture and Television Fund as a subsidized independent medical practice and referral network. But since 2014, it has been operated by UCLA Health. Only DGA and WGA continue to use TIHN. SAG-AFTRA and IATSE discontinued it several years ago. The TIHN clinics are no longer exclusive to the entertainment industry and are open to anyone who wants to use UCLA Health. 

Centivo offers a wider network than TIHN and similarly low costs for services. The network is wider because it offers all UCLA Health primary care doctors, including all the TIHN clinic physicians, but also includes other doctors at UCLA Health locations in the LA area along with non-UCLA Health doctors. That’s 50 primary care locations rather than 5. TIHN referrals included UCLA Health specialists, and so does Centivo. 

While TIHN was offered only in Los Angeles, the Centivo network is available in a number of areas throughout the country, including the NYC metro area, and is actively expanding its network. MemorialCare and Scripps are both in-network. Virtual care is also available nationwide. Primary care visits are free. There are fixed co-pays for specialist visits following a referral, no deductible, and no percentage co-insurance in-network. 

The TIHN clinics, operated as part of UCLA Health, and the TIHN referrals are discounted for members, but are more expensive for the Health Fund than PPO rates negotiated through Anthem. In effect, the Health Fund has been creating an incentive for participants to use an insurance option that costs the Fund more.

The Centivo network includes all of the primary care physicians in the TIHN clinics for a zero dollar co-pay. Anyone with a TIHN primary care physician can continue seeing their doctor without interruption with Centivo, and without the $10 co-pay. In addition, all UCLA Health primary care physicians are part of the network and referrals are available to UCLA Health specialists.

Centivo saw that traditional health networks, such as Anthem, often don't negotiate lower prices with the large provider groups. Anthem and its large network peers lack leverage because they have to include most providers to appeal to a wide range of consumers. Centivo creates leverage by choosing certain partners. It picks a large provider group in areas where it operates and excludes other big provider groups. That exclusivity allows Centivo to negotiate lower prices. They also pay providers more quickly than Anthem.

Mostly, as did TIHN. On Centivo, women’s health, mental health services, and physical therapy do not require a referral. Once the referral for a specialist is made, you can pick a provider with the app or Centivo is also available to help.

PWGA participants can use network.centivo.com to view providers in the Centivo network. A permanent website with the directory of Centivo Providers for PWGA participants will be available by the end of August.  

Yes. UCLA Pediatrics are included in the Centivo Network.

Centivo offers both the app and phone consultations to find providers. Mostly, though, you work through your primary care physician and their office for referrals and then use the app to find a specialist you like.

Yes. This is still WGA insurance and the Fund office is at your service.  If you have a question or an appeal about coverage, call the Health Fund at (818) 846-1015 or (800) 227-7863.

To use Centivo, participants opt in during the fall annual enrollment period for coverage in Centivo for the following year. If you remain on active coverage, you can switch back to the Anthem PPO plan during the next open enrollment for the next calendar year. You will also be able to switch between Anthem PPO and Centivo if you have a qualifying “life event” such as switching from active status onto Extended Coverage points, or switching from Extended Coverage back into active status. When you choose the Centivo network, you pick your primary care physician at the start of the year, and most of your medical services start with an appointment with them. Note that Anthem PPO users will also use open enrollment to confirm they wish to stay in the Anthem PPO and to set up payment of participant and dependent premiums.

You may change your Centivo primary care physician at any time through the app or the customer service line.

Centivo offers an app and a phone number for finding your medical providers. To choose your primary care physician, you will find information about doctors near you that are taking new patients. For specialists, once your doctor’s office makes a referral, you can choose your specialist of choice based on descriptive information in the app. Referrals are not required for emergency or urgent care. OB/GYN care, mental health care, physical, occupational or speech therapy, or chiropractic care.

Yes. Centivo offers its own virtual primary care through Centivo Care. And many doctors in the Centivo network also offer telehealth appointments. You will find options in the Centivo app.

Yes, the premium is $25 per month for the participant only, $50 per month for the participant and one dependent, and $75 per month for the participant and more than one dependent. Dependent coverage follows the participant, whether it is Anthem or Centivo. Centivo premiums are lower than the Anthem PPO premiums of $75 per month for the participant only, $150 per month for the participant and one dependent, and $200 per month for the participant and more than one dependent. For both Centivo and Anthem, these premiums will increase 3% in January of 2028, 2029 and 2030.

For in-network primary care visits, there is no co-pay. The visit is free. The co-pay for an in-network specialist visits is $25, urgent care is $75, lab work and imaging are $10, ER visits are $300, outpatient surgery is $250, inpatient surgery is $400, an in-network hospital stay is $600. These payments are made up to the out-of-pocket maximum of $2,000 for an individual or $4,000 for a family.

There is no percentage co-insurance with Centivo for in-network care. All the co-pays are standard, predictable, and shown in the app.

There is no deductible for the Centivo plan for in-network care.

With Centivo, the out-of-pocket maximum for in-network care is $2,000 for an individual and $4,000 for a family. This will be lower than the limits for the Anthem PPO plan of $2,500 per person. But, with the low co-pay structure, and no percentage co-insurance, most Centivo patients never reach the out-of-pocket maximums.

For out-of-network care under both Centivo and the Anthem PPO, the out-of-pocket maximum is $20,000.

Yes, both of these options are available through Centivo.

Pre-age 65 retirees can use Centivo, but age 65+ retirees who have Medicare as primary are not eligible.

Yes, and it uses fewer points—2.5 points per quarter, rather than 4.0 points per quarter for the PPO.

Yes. Prior to the quarter in which coverage will switch from active to points, a member can select to switch to Centivo.

Yes. If a member has earned active coverage, they may select Anthem prior to the quarter in which active coverage begins again.

Yes. You will pay the existing out-of-network 40% co-insurance after your deductible is satisfied, with the plan paying 60%.

Yes, Centivo offers mental health care. You can find providers and costs in their app. 

Also, you can use the Rula app that the PWGA is publicizing. It allows you to search for mental health providers for either the Anthem network or the Centivo network where you will be able to find both in-network and out-of-network providers. If you go out of the Centivo network, you pay the out-of-network costs, as you would for any other out-of-network provider.

And, remember, you can self-refer for mental health care with Centivo (i.e., you do not have to get a referral from your primary care physician).

85% of WGA West and East members live in areas with access to Centivo doctors. 

Specifically, in Los Angeles, the Centivo network includes not only UCLA Health, but also MemorialCare, which offers care in Long Beach and Orange County, PIH with care to the east, including the San Gabriel Valley and Whittier, and Scripps in San Diego. 

In the New York area, Centivo offers care through Mount Sinai, Northwell, Atlantic Health, Griffin Health, Middlesex Health, Montefiore, Nuvance Health and others. Virtual care is offered nationwide. 

In the case of rare illnesses requiring specific treatments that are not offered in the Centivo network, Centivo can do single-case agreements under which they negotiate with the specialty provider for the care.

ER care is covered as in-network regardless of where you go.

No, you still use Express Scripts and the co-pays are the same.

Yes, a member can continue coverage on Centivo with COBRA after moving off of active coverage or points.

During bargaining in 2026, the WGA negotiated hundreds of millions of dollars of additional contributions for the Fund. But increased funding alone was inot sufficient to ensure the plan’s survival.

Like all American health plans, ours has seen skyrocketing healthcare costs, which have driven up our in-network plan costs 13% per year since 2019. Currently, a writer must earn nearly $190,000 in a year to generate contributions that cover the actual average cost of care. The majority of writers who qualify for coverage earn less than this amount in fringeable compensation. The Health Fund also allows members to qualify for retiree coverage and to earn Extended Coverage Points to extend their coverage during periods between jobs. No contributions are paid into the Health Fund when points are used. 

In recent years, the Health Fund has been strained further by the combination of the industry contraction, which has both reduced the number of jobs and increased the number of writers relying on Extended Coverage Points. The Fund has taken a number of steps to manage costs, such as directing participants to generic drugs, negotiating lower rates for out-of-network services, and, most recently, introducing no-cost surgical procedures through a curated network of providers called Lantern. While each of these measures has saved money, they have not been enough to address the Fund’s deficits in the face of exorbitant medical cost inflation. The companies proposed to make other benefit changes prior to negotiations, but the WGA insisted that further changes needed to happen in conjunction with increased employer contributions to the Fund.