All right. Good evening everybody. My name is Sam Wheeler and it is my privilege to welcome you to our Writers Guild East Health Fund/Centivo webinar.

It’s also my privilege to be the executive director of the Writers Guild of America East. Thank you so much for being here today. So tonight is an opportunity to hear from the staff of the health fund in addition to vendors from our new health option, Centivo.

Just for those of you who are just a brief refresher so we’re all on the same page. The health fund is a separate legal organization that is managed by a group of management and union trustees who jointly administered the fund under the superb leadership of Jim Hedges, the fund CEO, who I’ll be handling handing this over to earlier.

As you all know, our most recent our most recent negotiation resulted in a number of changes to the health fund. In addition to s in addition to significantly more contributions from the employers, there were also cost-saving measures that were implemented in order to keep the fund healthy and on a path towards sustainability for the foreseeable future.

So we’re going to walk through those today. I’m sure you’re going to have a lot of questions. I would encourage you to hold your questions until the end of the presentation, which is when we’re going to take them. I would also just say that if you have a question about a specific individual health issue this is maybe not the forum for that. There are about 70 people on the Zoom right now.

And so, if you have a specific question about your health situation that the tools that these guys are going to walk through doesn’t answer, you can always call the fund. They’re there to help you. One thing just to keep in mind about the fund is that our health fund is self-insured, which means that while we rent Anthem’s network, the fund pays the claims directly and administers these claims directly, which means that when you call the health fund, you’re not calling an insurance company.

You’re calling people who work for you and want to solve your problems and want to make sure that you’re covered. Just want to say that I see a lot of guild leadership in the attendees room today. So, thank you all for everything that you do. I also see our former president, Lisa Takayuchi Cullen. Hey Lisa, how you doing? We miss you. And the last thing I’ll just say is look, this health fund is a tremendous benefit that our members have.

It’s one that we are extremely proud of, but it is a benefit that has been fought for by writers for 60 years. This was this was a health fund that was established through writer strikes that has been sustained through work actions. And the reason that we have this is because of the strength and solidarity of our membership. So, for those of you who are here today, thank you so much for being here, but also please consider being involved in the guild.

We need you and we need activism, leadership, and solidarity to sustain the health fund for the next 60 years. So, with that, I will turn it over to Jim Hedges, the CEO of the health fund. Thank you so much for being here. Thank you, Sam. And hello, everybody. Good evening. We have a couple slides that I’d like to just take you through that hopefully will get you prepared for open enrollment which begins tomorrow.

And I want to also thank Sam again for that nice introduction. That was that was perfect. If we could go to the next slide please. So today you have from the PWGA team Willard Woods and myself. Will is our COO. And we’ve worked together now for oh 14 years or so on on the plan.

And what Sam said is is really how we feel about our roles. We are here to serve you, the writers, and to look after you and your families and your health needs and pension needs. So that’s that’s our sole purpose of being is to is to help you. Also on the Zoom today are a couple of our partners.

From Centivo, we have John Watson and Elle Koagedal is here also. And from Budgie Health, we have Rohit Kabra here. Let’s go to the next slide. So, starting in January 1st of 2027, you will for the first time have an option in medical your medical benefit.

The first option is the same Anthem PPO plan that we’ve had for many many years. And the second brand new option that we’re going to talk about today in some detail is is called Centivo. Centivo is a narrow network. This slide says it’s in the East Coast region because it’s directed to you specifically on the East Coast.

There it is also in various places around the country including Los Angeles. It is in New York at Northwell Health, Mount Sinai, Summit Health, Atlantic Health, and RWJ Barnabas in New Jersey.

The benefit of Centivo from a financial point of view is it’s lower premiums, no co-insurance, no deductible for in network care, free primary care visits. But it is not an option if you are Medicare age certified retiree. If you are in that category then Centivo is not available to you.

You’ll have to stay with Anthem. Let’s go to the next slide please. All right. So we’ve put together a couple of things that will hopefully will help you make your decision between Anthem and Centivo. I mentioned Budgie. Budgie we partnered with that can give you a comparison of the cost differential between Anthem and Centivo since the plan details are different in terms of deductibles and premiums and so forth.

It’s a little hard to do that math on your own at least it would be for me. So Budgie is a tool that we partnered with so you can log in securely and compare the Anthem and Centivo cost to you. If you have claims from 2025 in our system, they will be used to do a an initial cost comparison and then you can tweak that up or down based on what you anticipate might happen during the course of 2027 to make that cost comparison even more accurate as a projection.

So we hope that’s a useful tool for you as you as you think about the option of Centivo versus Anthem. Where can you ask your questions? Well, you can ask them tonight. There are a bunch of different things we’ve put together for you. In addition to Budgie, Centivo has a great website.

You can also call Centivo directly and ask them questions. They’re prepared for those kind of questions from you. We’ve had a number of live events, including this one. We have another health fair on Saturday, which we’re happy to do. You can always call the fund office and our team is ready to answer any questions you might have. You can do that be by phone, schedule a Zoom time with us if that’s your preference or if you happen to be in the Burbank area and want to stop by and ask in person, you can do that as well.

So when you’ve made the decision of which plan is right for you, which medical plan, then you’ll go to the to our MyPlans site, which about 85% of our participants have already registered in. MyPlans is our website that has all kinds of information specific to you. It shows contributions, EOBs, you can do pension calculations, and you’ll also complete your open enrollment in MyPlans as well as set up your autopay.

So, that’s that’s ready for you starting tomorrow. And that’ll go through December 15th of this year. So, you have quite a few weeks to make your decision. Let’s go to the next slide. So I mentioned some of these already. The PWGA open enrollment tool is on our wgaplans.org website.

There’s all kinds of information. The FAQs that you’ll find there are very detailed. Hopefully, they’re organized in a way that make it easy to find the answer to the question you’re looking for. It’s a bit of an accordion. So, there’s key categories and as you click on that, you get more detail. We’ve kind of used initially the FAQs that were sent around during the collective bargaining agreement last year and we’ve added to it more detail from the live events and questions that have been asked by by members like yourselves.

So it’s it’s it’s a very robust tool for you. Budgie Health I mentioned also is available. We want to make sure you’re registered in MyPlans. It should take about one or two minutes for you to register if you’re not already. And then you’ll be ready to sign up. Let’s go to the next page. So, just to be clear, you’re making a decision between Anthem and Centivo for your medical benefit.

Every other benefit is exactly the same regardless of whether you pick Anthem or Centivo. So, we’ve listed here kind of the key benefits that come along with your medical benefit, including Lantern, which is a surgery care benefit where you can you have access to top surgeons and surgery centers at no cost to you.

Hinge Health is a personalized digital physical therapy and exercise tool. That’s available to you as well. Carrot, which is a comprehensive support for family building and reproductive health needs tool. Express Scripts, that’s your pharma benefit. Rula helps you find a therapist if you need one.

Delta Dental for dental work and VSP for eye care. Those are all the same regardless of which medical benefit you choose. All right, next page. Here’s kind of a calendar of where we are. So, sitting here today, the day before open enrollment, we’re all ready at the plan office to to get you signed up with the medical benefit that’s right for you and your families.

And that’ll go through December 15th. Again, if you have any questions that you need help on we’re here at the fund office. Centivo is here. There’s all kinds of information available on the website if that’s easier for you to access, FAQs and so forth. But open enrollment will begin tomorrow and everyone will need to sign up and make a medical benefit election.

All right, I think that’s it for me for now. Let’s go on then to John and Elle and they’ll take you through the Centivo benefit. Sounds great. Thank you, Jim. Appreciate the opportunity to meet with you all this evening and share a little bit more about Centivo. We’re really excited to be partnering with the Writers Guild to offer you a new plan for consideration for upcoming year.

So I’ll share a little bit more on some of the different features of this plan to hopefully help you make a decision on whether it could be a good fit for you. So why don’t we go to the next slide. So maybe just a little bit more on who is Centivo because we’re probably a newer name to most of you. So just to give you some background we’re a new health plan.

We’ve been around for nine years and we actually started in New York City. That was our first market, but we were founded because we wanted to make healthcare more affordable to the average person, average family. And we felt like health care could also be delivered in a way that is simpler to navigate. I think most people when they think of health insurance don’t necessarily probably say simple, easy to use.

And for us at Centivo, that really is our goal. And this time of year, quite honestly, is one of my favorite times of year cuz I’m traveling throughout the country, meeting with members who are on the plan at other organizations outside of the Writers Guild who are considering their open enrollment decisions. And we’re probably one of the few health insurance companies where we have members that are coming up to us and saying, “I love Centivo. It’s so easy to use. I’m able to get the care that I need. The doctors are great.” So, it makes me really proud to be at a company where that is the experience we’re delivering.

And hopefully as you’re kind of thinking about what makes sense for your family, we’ll you’ll give us, you know, even though we’re a newer name, a consideration. So maybe just a little bit more if we move to the next slide. Things that make this plan different compared to a traditional health plan. Jim touched on some of these things, but one of the key benefits to you is all primary care is free on this plan.

That is both preventative care, but also sick care. You know, if you have a reason that you might need to go see your doctor, you don’t need to worry if you know you have to meet a deductible. You don’t need to worry if it’s preventative or not. All primary care is free. And we’ll get into more of that, but one of the main reasons is we think it’s really important to have a primary care provider. And we want to make it easy for you to find a primary care provider in the network.

In addition to that, the plan has no deductible. So, you get first dollar coverage. You’re getting a great benefit from the Writers Guild. And we’ll go into more detail on why we’re able to make this plan so affordable. Sometimes we get the question on like what is the catch? You know, what am I missing here? But there really is no deductible and you’re paying predictable first dollar coverage for other services such as specialist visits, mental health visits and you pay a fixed co-pay amount if you stay in the network.

The other piece is the network. So we have built that from the ground up with leading health systems who we have vetted based off of both quality data and cost data. And as I mentioned, New York and kind of the broader Northeast was actually one of our first markets that we launched. So, we’re really proud to be partnering with health systems like Mount Sinai, like Northwell, like RWJ Barnabas, Atlantic Health Newance Health up in Connecticut, PenMed in the Philly area.

So, names that you likely recognize and potentially already use in the greater Northeast area. And then the last piece is we also have an great added benefit for those of you who are open to virtual primary care. Centivo has our own virtual primary care team. And this is not your traditional virtual care.

Most people when they think of virtual care, I think probably think of oh like I get connected to a doctor I’ve never met before in 30 seconds and it’s a different doctor each time. This is you build the same relationship with the same provider. We have very small dedicated care teams and you’re building a true primary care relationship, but you’re doing so with a virtual first lens.

And it can be a great benefit for folks who maybe have been putting off going to the doctor because of having to jump on a subway, fight New York traffic, get to doctor’s office in person. And so it can be a great option if you or someone in your family wants a primary care doctor but wants to access that from the convenience of your home. If we go to the next slide, just a bit more on kind of the value of having that primary care relationship.

We have seen and for those of you who have found a good primary care doctor, you’ve probably experienced this, but having a trusted primary care doctor is really important not only in the times where you’re sick or something comes up, but it’s helpful to have that relationship so that you can really work on, you know, managing your care proactively, doing your preventative screenings.

And it also is a great resource for when something comes up and you think you might need to see a specialist, but you don’t really know where to start. Having a primary care doctor that you can go to that understands you, your care history, can help connect you to a specialist that is in network and going to be best equipped to help you with that care need. We also know that, you know, if you have a primary care doctor relationship, you know, you’re less likely probably to feel like you need to go to the urgent care or the emergency room for a last minute care need because you have that medical home where you can start when things come up.

And one of the things that we do at Centivo is we make it really easy to find a primary care doctor. We’ll give you some information on how you can do some research during open enrollment of doctors in the network, but also once you do choose the Centivo plan, there’s a really easy two-step process of basically choosing your primary care doctor, you can do that online or you can call us and we can help you based off of, you know, specific parameters you might be looking for to pick that primary care doctor.

Why don’t we go to the next slide? So, a couple things if you do choose to pick the Centivo plan that you’ll you’ll do kind of post January. Like I mentioned, you will actively choose that primary care doctor. That can be an in-person primary care doctor in our network. It can be a virtual primary care doctor through Centivo Care.

And it includes pediatricians. We have pediatricians in the network for children. And we make it really easy where you can filter on preferences, things like gender, things like specialty, how far you’re willing to travel, and we’re also happy to speak to you as well if there’s some unique parameters that you’re looking for. We’re happy to give some additional white glove support once you pick your primary care doctor.

You know, the couple of additional steps from there are pretty easy. We would want you to hopefully have your annual visit making sure that your provider understands any care needs that have happened in the past or anything that might be coming up now. That way they really have a good ground level of how to support you should something come up later in the year. And then we’ll get to this on the plan design slide, but when you do stay in network, you get a really great benefit.

And so staying in network with working with your primary care doctor is going to be a really simple and affordable experience for you. Let’s move to the next slide. So let’s talk a little bit about coordinating care with your primary care doctor. How does that work? Honestly, some of this comes naturally cuz good primary care doctors, when you think something is happening with your health and you think you need to see a specialist, they’re automatically going to want to give you a referral to a specialist.

In this plan you are required to work with your primary care doctor to get a referral for specialty care. Like I mentioned earlier, if you have an established relationship with your primary care doctor, that doesn’t always need to be a visit. It can be a quick message to them. It could be a quick video visit if they do want to talk to you about something going on.

But it is really important cuz we find that, you know, having your primary care doctor be in the loop on your care needs and what might be going on can be a benefit to you and also to them as they continue to work with you and partner with you on your health. There are a few specialties that do not require referrals. So things such as mental health, you can access those directly.

No need for a referral. OB/GYN, women’s health. Of course, emergency and urgent care. Something’s urgent going on, we want you to go, you know, to the appropriate care to get the care that you need. And then other services such as chiropractic care, physical and occupational speech therapy, other alternative medicines, and then lab work. Other things though, like an example might be a dermatologist or an orthopedic surgeon that might have some more complex care needs.

You know, we want you to be able to sync with your primary care doctor to get the right recommendation for the care that you need. And on the health plan side, we auto approve all of those. So, there isn’t an additional administrative step for the health plan. It’s really about making sure that you and your primary care doctor are connecting on appropriate care needs.

Why don’t we go to the next slide? So I I mentioned this earlier. Sometimes we get this question around this sounds too good to be true. So John, why don’t you jump in here and share a little bit more on kind of what is underlying some of the great benefits on the Centivo plan? Yeah, sure. So when when I think about this slide, it’s really these are the building blocks of Centivo as a company and the Centivo plan.

These are sort of our fundamentals. It’s one better care starts with primary care. So we were created with that idea of if you are able to meet with your primary care doctor and get ahead of any underlying concerns or underlying conditions, it really drives better outcomes over time.

So that’s why we do require you to select a primary care doctor and I can get into some options on that in a slide or two. And work with that primary care doctor on any health concerns that you have. We also give you the option of visiting with a virtual primary care doctor and I’ll I’ll tell you a little bit more about that Centivo Care virtual primary care in a little bit.

Second, and how we actually save money. This is really the foundation of how we save money is we partner directly with local providers. So we you’ll notice that there are some health systems in certain markets that are not in our network. And there’s reasoning behind that. So we have the data on clinical outcomes and cost.

And what we’ve done is we’ve kind of molded that data together and we’ve hand selected the highest quality lowest or lower cost health systems in these areas. So that’s why you’ll find that for example in New York Montafior Mount Sinai Northwell and New Jersey Atlantic Valley and RWJ are in our network.

Those are health systems that are really known for their high quality of care. And so what that means for you is you get that exclusive discounted rate that we then pass on to the guild and to you as members. Next slide, please. So I want to kind of walk you through what this means in terms of the actual providers that you can see.

So if you scan that QR code on the screen or if you visit pwga.centivo.com, there’s an orange button and you can see that on that screenshot there in the upper right corner. It says find a doctor or facility. And that’s where you can search located, you know, with your zip code.

You can type in your home zip code, your work zip code. You can type in any type of specialty or condition that you might have and it will show you all of the facilities and doctors that are in the Centivo network in your area. I’ll just kind of walk you through some of the main health system partners. So in New York Manhattan specifically, we have Mount Sinai.

In the Bronx we have Montafior. In Westchester and on Long Island, we have Northwell Health, New Jersey, Atlantic Valley, and RWJ Barnabas PenMed, as Elle had mentioned, in the Philly area. And that’s really just our And then we also have partners in Connecticut as well.

That’s really just our metro New York area. And some of the questions that we got when I was at the event in New York was, “That’s great, but I also travel to Los Angeles.” So if you flip to the next slide, I’ll kind of show you the entirety of the Centivo network. So if you’re back and forth between LA and New York, or if you spend some time in Wisconsin, for example or in Orlando, this is sort of an overview of all of the geographies that Centivo has a network.

All of these are available using that search tool. So, if you, for example, you know that you live in LA a month out of the year, you can go there and search for providers that are in that area. If you have any questions on whether or not a provider is in the network, again, I encourage you to go to that pwga.centivo.com site and use the provider search tool.

But this is kind of a a main overview of where Centivo operates our proprietary network. We’ll sort of cover I’m guaranteed there’s going to be a question about, well, if I’m traveling and I’m going to be at a shoot in Atlanta for maybe four or six weeks then what should I do?

We could probably cover that in the FAQ. But there’s there’s certainly a solution for that on this plan as well. But in general this is where we operate in our core markets. Next slide please. So in that sort of same theme of where can I get care if I’m traveling.

Centivo Care is really a dedicated primary care practice that’s virtual. Everything is done via the Centivo Care app. And going back to what Elle said earlier, this is not your typical telehealth. So if you’ve experienced, you know, TEAD do before, you thought you had a sinus infection or, you know, you had an ear ache, this is not that.

So this is truly a dedicated primary care doctor that you meet with every time that you have an appointment. You can chat with them in the app. I believe they get back same day or next day. There are also same day and next day appointments available. Centivo Care sends out a survey after every patient appointment.

We have a 99.7% patient satisfaction rate. These are real quality primary care providers and you can meet with them as often as you want and every time you meet with them it’s free. I think that’s, you know, one of the most important parts parts of it. It goes back to our belief in primary care as really your primary care doctor as the quarterback of your care.

If you need, let’s say for example, you need to get lab work done, they can work with you to find a local lab to get that done. We get that question a lot of, well, how do I have a like an annual physical if I’m doing my physical virtually via virtual primary care? So, they can do things like work with you on a blood pressure monitor and you can take your results at home and upload them into the app.

They can manage any ongoing conditions that you have, simple ones like high blood pressure or high cholesterol. They can manage your medications. So there’s a lot of benefits of utilizing Centivo Care as your virtual primary care provider beyond just the fact that it’s free and you can meet with them as as often as you want.

They are available Monday to Friday, 9:00 a.m. To 8:00 p.m. For standard appointments. And they do have a nurse line in off hours. Next slide. All right, Elle, I’ll turn it over to you to go through the plan design. Perfect. Thank you, John. So, just to kind of go over the plan design and benefits.

So, I’ll start at the highest level. This plan has both in network coverage and out of network coverage. You will see you get a much stronger benefit when you stay in network. So, what that means is on the in network side, you have no deductible and you have certain services that are actually free. So, primary care is free, coverage with Centivo Care is free, and then if you do need to see a specialist, you’re paying a $25 flat co-pay.

So, very predictable, clear, upfront cost when you need to go to the doctor. Other services, if you’re a I’m a worst case planner. What if I have to, you know, get surgery for the year? I would direct your attention to a little bit lower in the design where you can see for if you had to do that in the hospital, you’re paying a $400 co-pay for the surgery.

If you’re doing that in an outpatient setting, you’re paying $250 for that surgery, but still really affordable. Many plans, you know, that’s going to cost thousands of dollars in terms of your cost. So, you’re getting a great predictable upfront co-pay for when you do need to see the doctor or you know have something more complex going on.

The other thing I will point to your attention to is there what is called an out-of-pocket maximum on the plan. So for in network, the most that you will ever pay, and you would have to honestly probably have multiple surgeries, multiple babies in one year to meet this, but would be 2,000 if you cover yourself or 4,000 for a family if you stay in network.

On the out of network benefit, you do have coverage. So you can still see an out of network provider. You know, examples of this. And we’ll get more to answer some of the network questions in the Q&A section, but maybe you have most of your providers that are part of our network and you have one specialist or oftentimes it could be a pediatrician that’s, you know, not in network.

You can still see that provider and you’ll pay a little bit more. So you’ll see the out of network benefit has a $500 deductible and a $1,500 deductible for out of for or for family. And so you pay that amount first and then once you meet the deductible you will pay a percentage of the bill. So that’s the 40% co-insurance which is a percentage of the total bill that you will pay.

So you will pay a little bit more. You know what I would generally recommend is try to stay in network where possible. For things such as surgery, definitely want to stay in network. But if you’re on the fence, for example, on this plan because of one provider, a general office visit is not going to be very expensive. So, you can still use your out of network benefit for that.

So, hopefully that’s helpful just in terms of how to think about the plan design. We’ll get into a little bit more in terms of different scenarios as you’re thinking about options for you and your family. But you know welcome you to reach out to our team if you have specific questions on coverage and we’ll give you more information on how to do that as well.

Let’s move to the next slide. So a little bit more on pharmacy coverage. This is still covered through Express Scripts who you work with today on the Anthem plan. So we coordinate and integrate with Express Scripts. That is not changing in terms of the pharmacy benefit and in terms of pharmacies that you can go to. They have a very broad network on pharmacies that are in their network.

And then in terms of the cost for pharmacies for different drugs, it will depend on kind of whether it’s a certain tier. And so you’ll see here for generic medication, you know, you’ll pay a $10 co-pay. For 30-day supply, if it’s a preferred brand, that will be a $25 co-pay. If it’s a non-preferred brand, it’s a $50 co-pay.

And then there is a specialty program through Express Scripts. If you enroll and that will be a $0 co-pay if you enroll in that specialty program. So much of this is not changing very similar in terms of the benefits that you have on the Anthem plan as well. Let’s jump to the next slide. So I love kind of these what-if scenarios.

But I feel like it just makes things real and I I mean quite honestly is striking in terms of the amount that people are paying on the Centivo plan compared to a traditional plan that’s going to have a higher cost share. So let’s walk through a knee surgery example. In this case you would pay a total of $620 out of pocket.

The other thing I will note this doesn’t factor in what you pay out of your contributions. So, that’s another factor and we are lower on a contribution perspective as well. But that $620 you’ll see is pretty easy to calculate. So, for a knee surgery, we’re expecting probably in addition to a primary care visit, an MRI, two specialist visits, that surgery, and then hopefully some physical therapy to help you rehab as well, as well as some medication.

So, you can see kind of how that totals and adds up. And I think one of the things that our members give us great feedback on is both the affordability in terms of what they’re paying on this plan, but knowing because so many other plans it’s hard to get that predictability because of the deductible and co-insurance and other items. So you have a really clear understanding of what you’re going to pay out of pocket.

Let’s walk through the pregnancy example. I actually went through this myself about a year and a half ago and I’m on the Centivo plan out here in Colorado. So really affordable in terms of the cost that you’re going to pay. I think the biggest thing I I probably jump to is the cesarean delivery and hospital stay on a typical plan.

That’s likely, you know, in the thousands of dollars range. And in our plan that would cost you $600. So really affordable coverage if you are planning to expand your family. And then you can see similarly the cost for some of the other services related to a pregnancy getting to that total of $790.

So you could take examples like this and multiply it across multiple care journeys. We’re happy to talk to you as you’re contemplating, you know, your decisions for next year. And if you have specific health care questions that you want to walk through, we’re happy to walk through those with you in a one-on-one setting and give you a sense of what that could look like.

Let’s go to the next slide. So just a little bit more in terms of the people and kind of different, you know, scenarios that could make sense on whether this plan is a good fit or not. So walking through this Sean for example, he knows that he wants to work with doctors that he loves already and he’s doing his research and actually they’re in the Centivo network.

I think in that instance, it’s a little bit of a no-brainer because you’ll get to keep the providers that you’re working with, but you’re going to pay a lot less in terms of both your out-of-pocket and what you’re paying out of your contributions as well. Let’s take Sarah for example. She is using different providers today but maybe open to switching providers because of both you know maybe she hasn’t found the right fit with her PCP or maybe she really is open to switching because of the difference in terms of the cost that she’s going to pay and I will say we get a number of members who are in this bucket and you know we’re able to help them get established with a new care team and because our model is really centered around working with high-quality health systems who are used to navigating their care in the system were able to do that pretty quickly.

So, this could still be a great option to you if you’re interested and open to switching providers. Miles, for example, maybe doesn’t have that established primary care relationship, but needs some help finding someone. And I think in that instance, this is a great plan for him. He’s been using urgent care when things come up because he doesn’t have that primary care medical home to start with.

And so this plan can actually be a really great option for Miles because we can help them get established with a primary care doctor really easily and set up for care when things does do come up in the middle of the year. And then lastly, Jen she wants, you know, predictable costs for her and her large family of four children and, you know, the expense of having to go to I’ve experienced this pediatrician for multiple things throughout the year can really add up.

And so knowing that she has a plan that has really affordable costs for that larger family and just more health care needs popping up, she is really interested in picking this plan to make sure she has accessible but affordable health care for her family. So hopefully that’s helpful just in terms of a few different examples and some of these maybe resonate as you’re thinking about you and your situation.

All right, John, I’ll turn it over to you to just kind of round us out here on the next few slides. Yeah, sure. So Centivo Member Care is really available during open enrollment. And what that means for you is if you have a specific health related question or you’re having trouble finding your doctor in our network or anything like that if you visit that pwga.centivo.com website.

You can schedule a one-on-one call with Centivo Care or Centivo Member Care during open enrollment. You could also call the number on the screen, the 855 number during open enrollment from 8 a.m. To 8:00 p.m. Eastern time. They can walk you through things like what are the benefits on the plan, who’s in the network, what happens if I’m traveling, and things like that.

But again, if you have those personal questions, I totally recommend you call in or you can schedule that 30 minute call. You can schedule that right on the homepage of pwga.centivo.com. Next slide. Great. So lastly before I hand it over I think I’m I’m handing it over to Budgie, Jim.

Is that correct? We’ll continue to answer some of the questions that are in the Q&A. And then we can open it up for additional questions towards the end. All right, great. Thanks, Elle and John. Appreciate it. We have Rohit here from Budgie and if you want to take it away.

There you are. Hi. Thank Thank you so much, guys. Hi. I’m Rohit. I’m actually one of the co-founders here at Budgie, responsible for product and operations and just feeling very you know feeling very great to have worked with both the PWGA team and the Centivo team to bring this tool to all of you over the last few months and you know we’ve had a few hundred folks go through it already talked to a bunch of different members through chat and support and and just excited to see how this is helping folks with their decisions and that’s really our goal here and that’s why Jim and the team brought us on is what Budgie is essentially a very simple tool to help you make the best benefit decision.

Obviously this year the big one with the introduction of Centivo and you want to just make sure is Centivo the best plan for you or is your existing Anthem plan the best for you and the way we do that really easily is actually pull in your health claims data and your personal information at your behest. You can choose to use it or not. And then it goes through and actually allows you to price those options against each plan to give you a pretty accurate estimation as to what the total year is going to cost you on either option.

And to what the Centivo team was talking about, I mean there’s so many great benefits in that plan. Particularly if you can take advantage of the network options and we help you make sure you understand those very quickly and easily. In addition to understanding the core benefits and what’s the right price and fit for you, we also have a chatbot available that can answer pretty deep amount of questions both about the benefits and how to best navigate them.

And wherever we can answer, we either feed you over to the Centivo team or to experts on our side where we’re going to try and make sure you have the best options possible. If we slip over the next slide, I think it just kind of goes over again how quick this is. I think the average person is around 3 to 5 minutes on this platform that it takes to get you from login to recommendation or sorry to plan comparison.

And from the beginning you already have accounts set up with us. And so all you have to do is enter your email and you’re going to be sent a one-time passcode to that email. And you’ll be able to log in, go through the flow. Most of your information is already going to be uploaded so it’s just a breeze. The whole focus and friction we try to remove from this process is you know we just want you to focus on the things that really matter in your decision and all of your time to just be like okay do I really how many how many PT visits do I need this year what kind of mental health treatment do I need this year what are the drugs that I’m taking and make sure you make those decisions and then we take care of all the math and decisions for you and give you a a clear side-by-side comparison as to how those benefits will best suit you both financially as well as how those benefits work in terms of care throughout the year.

And yeah, we’re available all open enrollment and beyond and we continue supporting you all in whatever way we can, but please feel free to reach out to us. Again, the best way to reach out is through the chat. And if you ever need to talk to someone, you can just ask, “Hey, I want to talk to a human and not the AI chatbot.” But I think the AI chatbot’s doing a pretty great job. So we’re happy on both ends there. So if there’s any questions, obviously let us know.

But the best way to go through is just go through get a few minutes and you’ll get that plan comparison at the end and then happy to have any shots that we can to support you all. All right, thank you. There was one question I want to just address maybe quickly before we go to the the rest of the question and that is how do I find the Budgie tool?

If you go to our wgaplans.org website. There’s a big blue button in the center of the first page that says go to open enrollment hub. If you click on that, you’ll see all kinds of great information. FAQs, a question, what is Centivo? That describes it in detail, the health benefit changes that are being made January 1st of 27.

And then on the right, there’s a thing that says Budgie Health decision tools. If you click on that, it will take you to the Budgie site and you log in with either your phone number or email address that we have on file for you at the plan office. All of the data we sent to Budgie was de-identified. So there’s no there’s no name associated with all that claims information that goes to help do the comparison between Anthem and Centivo.

So I’ve done it myself a couple times. It works super fast. And I hope you find it to be a really, really useful tool as you’re having to make this decision between which medical plan is right for you. Okay, let’s go through I’ll I’ll kind of I’m going to do the play-by-play and rest of you can do the color commentary here.

So I’m just reading through the open questions. Do Colombia, New York Press providers take Centivo? Yeah, I can take this one. And and there’s actually Jim a few similar questions. We got I think another one around NYU Lagoon later on as well. So to answer that question, they are out of network.

So you could still see them, but you would pay the out of network benefit. But I wanted to maybe just give a little bit color context as to why. Because I think it’s important and it relates to the is this too good to be true on the cost and the benefits that we’re able to offer. So in Manhattan, I’m actually in New York City today.

I was here for a few minutes. There’s a a number of really high-quality health systems. So you have NYU, you have New York Presbyterian, you have Mount Sinai. They’re all really great quality, but they actually vary quite significantly from a cost perspective. And oftentimes that’s hidden to the average user until you get your medical bill.

But one great example just from some data that we have to get for example a hip and knee joint replacement done at NYP in New York City that on average costs 75,000 in terms of the total billed allowed amount. You obviously pay your portion. PWGA would pay the other portion versus that same procedure done at Mount Sinai with Centivo costs about 38,000.

So that just gives you some one data point. You know, there’s many other examples like that on why we’ve chosen to center our network around specific providers. And you might have, you know, care established with providers that are not in in the network and it’s working for you. And I would say we’re not trying to disrupt that. You still have an option through Anthem.

You will pay a little bit more, you know, through the Anthem plan. But if you use providers in in our network or majority, you will pay a lot less on the Centivo plan. And it’s one of the reasons why we’re able to make the benefit much more affordable. So just wanted to share a little bit more on kind of the reason as to why some of those providers aren’t in the network.

Okay, thanks Elle. Let’s go to the next question then which is in a nutshell is Centivo an HMO and is Anthem the PPO? Elle you want to or John you want to address that? Yeah. I would say we’re not quite either. So the reason why is we do have out of network coverage on the plan.

So similar to a PPO, you can go in network, you can go out of network, you pay a little bit more if you go out of network. But there is another element to our plan that might feel like an HMO, which is typically HMO plans do ask that you choose a primary care doctor and work with a primary care doctor. So, you do have that component in our plan.

But we make it, I would say, much easier to navigate from a health plan perspective and you still have out of network coverage like a PPO plan. And Elle, if you could expand on the primary care physician how often can somebody change? Do they have sort of waiting period? Yeah, you can choose a primary care doctor and if for whatever reason you want to change at another point in the year, you can do so at any time.

You can update that easily in the app or give our member care team a phone call. So, you do not need to stay with the same primary care provider if you do want to make a change. Great. All right. Next question. We’ve had this question a bunch of times. What about international coverage if they’re traveling internationally? Yeah. So, similar, I think, to the Anthem plan today, if you’re traveling internationally and something comes up and you have to, you know, go to an urgent care internationally, for example you know, we want you to make sure you’re getting the care that you need and you would share with our member care team a copy of the bill so that we can pay that towards the out of network benefit and translate it and all of that.

So there’s no problem if something were to come up if you’re traveling internationally. Let me turn my audio back on here. All right. Next one is after the 20,000 out of pocket max is all care then free? Yes, that is correct. And to be clear, that’s for the out of network benefit.

So you actually have a lower out-of-pocket maximum if you’re staying in network where everything is free. But for out of network care, that is correct. Yep. So in network let’s say you enroll as an individual your out-of-pocket max let’s say for example you get all of your care at Mount Sinai and Northwell and within the Centivo network is only $2,000.

So that $20,000 out of pocket max is only if you go outside of the Centivo network. Okay, thank you. Next one is what is the tier 4 pharmacy plan with Centivo? Not sure what that’s referencing. Maybe there was a I think if we Yeah, I think it’s the same for but yeah, there is a slide where we showed some of the pharmacy benefit tiers.

Yeah, and those are the same. Yeah, no changes. Okay, next question. Excuse me. Why are certified retirees being forced into a Medicare related program? The description what this is is a vague with the ominous warning that some previously covered meds may not be covered.

Well, that’s that’s probably referring to the EGWP plan. Until now, the WGA health coverage was wonderful. We are losing excellent coverage and access to an advocate when needed. Very troubling. Thanks for I can’t I can’t quite tell what that says for past first rats coverage. I don’t know what that means. If the references to EGWP there is a chance when you switch to an EGWP that the formularies don’t match up exactly and so you may have to change from either a brand or a different generic and so that’s called disruption.

When we looked at switching to the EGWP, we thought it would affect some of our participants. And as it turns out, now that we’re really close to the switch, there are zero participants that are certified retiree Medicare that will have to change their drugs. Zero. So there will be no change based on the formulary move to EGWP.

So I hope that answers that question. Okay. Would let’s see do we the questions are moving a little bit. Do do Colombia New York press providers take Centivo? I think we addressed that. Would we still use the my health portal if we keep doctors at UCLA?

That would be if you stay with Anthem. The answer is yes. Actually also on the Centivo plan, UCLA providers use the same my health portal. So, that’s kind of where you’re probably used to sending messages to your doctor scheduling. It will be the same. Awesome. That’s great.

Thank you, Elle. Okay. Next is, if I choose Centivo for 2027 but don’t have a good experience, are we able to change to the Anthem PPO in 2028? The answer is yes, you can. By the way, if if you happen to move your your permanent residence out of the Centivo network area during 2027 you can change that’s that’s considered a life event and you can change to Anthem at that point if you want to.

Okay, here’s another one. Is Virtua in New Jersey part of the Centivo network? I don’t believe Virtua is in network. In that area, I want to say it’s probably with one of the New Jersey health centers or maybe even Princeton if that’s kind of close. I would have to need to look up that geography, but I would recommend you go to the pwga.centivo.com website and you can search for providers in your zip code.

Great. Thank you. Next question is so Budgie doesn’t have access to our social security numbers and personal identifying info. No, they do not. How long will Budgie have access to this info in their systems and just concerned about site integrity? So are we. That’s why we made sure it was de-identified when we moved the claims data over so that if you know and we checked Budgie security it’s very very very robust security but it just to protect your data which is HIPAA protected we wanted to make sure that that claims data was de-identified.

Okay. Next question. Do both plans allow for coordination of benefits if we have existing coverage through a spouse? Yes, for Centivo, we will manage coordination of benefits. Great. And same same as for Anthem. And if we decide not to take WGA coverage, is there a special opt out process we need to go through?

Yes, just contact the fund office. If you don’t want your health coverage through PWGA, you can you can opt out. Okay. The website says, “My zip code is not eligible for Centivo, but I tried one the next town over and it says it is eligible.” Yeah, we just talked about this earlier this afternoon.

If you are close to the radius that Centivo sets for being in their range and you still want Centivo just contact us and we’ll make sure you can you can choose Centivo. We just want to make sure that everybody knows that signs up for Centivo if they’re outside. What was the radius LA? 50 miles.

It varies depending on what type of area you live in in a more rural or urban area. But we set certain parameters to make sure the care is really accessible. So there are some zip codes that might fall out of that parameter. But if you live there, you look up and you might see I have some providers that are a little bit closer, but I might have to travel a little bit further for another specialty.

And if you’re comfortable with that, we’re working closely with the fund office to review those zip codes and we can we can make that available to you and to other members as well. So just reach out to us. Yeah, the key is we just want to make sure you know if you’re going to choose Centivo, you know what the radius is and how far you might have to go to see a doctor.

We don’t want you to pick it if you’re in a state that doesn’t have Centivo at all. That’s that’s why you have that radius. Okay. Next is make above first rate coverage without standing support from health fund staff. Okay. I think that’s a just a comment thanking us for the time today.

You’re welcome. Next one is if you have a kid in college. We’ve heard this question a number of times. And there isn’t Centivo coverage nearby. What are the options? Telehealth? Yes. Out of network? Yes. Some combo? Yes. Centivo Care could be a great option for them as well if they’re over the age of 18. Because we’re available in all states and that’s more than just telehealth.

You would work with the same provider. And oftentimes we find if the if the dependent wants in-person care, they’re probably going to their primary care doctor when they’re at home and then when they’re away at college, they will have coverage for urgent care. As well as obviously if something were really to happen, emergency room is always covered out of network.

So, there are options for dependents who live out of state as well. Thank you. Okay. How does Lantern, Hinge, VSP, Rula, Delta Dental coordinate with Centivo? Also, how many points do you need to use per quarter for Centivo versus Anthem? Centivo is two and a half points per quarter.

Anthem is four starting January 1st. And Lantern, Hinge, VSP, Rula, Delta Dental. Do you want to address that? I don’t Some of those have no connection at all with Centivo. They’re just available to you as a benefit. For example, Delta Dental. Yeah. Elle, anything else you want to say? Nothing really different between us and Anthem on that point.

It’s the same. You access them. You know, they’re they’re provided outside of the health plan, right? Outside of the medical benefit, right? Next question. Are there restrictions on pre-existing conditions? No. That’s went away with I think the Affordable Care Act like 16 years ago. So, no restrictions on pre-existing. It’s against the law now, which is a wonderful thing.

Next, my primary care physician is at Northwell Health as well as a few specialists I’ve seen over the last few years. Can I assume all Northwell Health doctors and procedures such as MRI are part of Centivo? Yeah. So, any procedures done at a Northwell Health facility are in network. So if you get you know an MRI done surgery on providers I would say generally yes but always double check on the website because you can get weird scenarios where you have an anesthesiologist or someone who’s maybe practicing at that facility for the day but is not employed by Northwell Health.

But generally yes. And you can always check providers by going to pwga.centivo.com or call our team if you have questions. Right. Okay. I am a Medicare retiree. I understand that I have to move into the EGWP drug plan. That’s correct. But do I have to fill out any new forms?

Do I need to sign up for autopay? Will, you want to take that one? I think the answer is no. No, you would not have to sign up for autopay because you are a certified retiree over 65. There’s no premiums for for those members there. Okay. Right. All right. The next one is the monthly COBRA cost for Centivo cheaper than Anthem?

Yes, it is. Yeah, we just set that rate with the board in September and it is cheaper than Anthem. Okay. Does Centivo have any providers in the Hudson Valley, upstate New York? I think once we get into the Hudson Valley area, it is a bit more limited. So would encourage you to just research, you know, based off of the pwga.centivo.com website.

Obviously Centivo Care is an option, but I would encourage you to do some more research because our our network is more kind of in the New York metro area specifically. Okay, good. Thank you. Next one is at the moment I see an allergist at UCLA and everything is covered.

All my shots, if I stay with Anthem, are my shots still 100% covered? If they were before, they will be starting next year. So, no change to that in the Anthem plan. Okay. Will Centivo be looking to expand to the Chicago area? On our radar.

We have other clients that have members in the Chicago area. So, nothing confirmed, but it’s on our radar. More to come and we’ll continue to work with the fund office as we expand in in more markets. Got it. Next one is looks like a question about extended coverage points. The point accrual is very concerning.

One point for 200,000 annual earners, second point at negotiated screen cap 325. And then up from there, this is moving the ability to obtain points and therefore health care farther and farther out of reach of folks in a scarcity-driven landscape. This is being re-examined by the WGA.

I I don’t know whether that’s being re since we’re, as Sam kind of mentioned at the start, the health plan and the guild are two separate entities. Frankly, I don’t have anything to do with negotiations. So, that would be a good question to ask the guild office on that or just let them know your concern. Next is I live in Connecticut and have doctors through Nuvance Health.

They were recently purchased and merged with Northwell. Does that mean all the old Nuvants Health doctors are now covered? I think the answer is they should go and check for sure on this. But both Northwell and Newvants are in our network. So, odds are yes to your answer. Great. Okay. Next is any of our data fed into or used to train AI?

No. And we know that folks are very sensitive about AI. So we we no, the answer is no. What are the COBRA rates? COBRA is federally required. If you lose coverage, plans like ours have to offer you continued coverage for a certain period of time.

And there are rates that are established for that extended coverage should you wanted should you want it. What is active coverage versus points? Active coverage is if you’ve earned the minimum required to get a year of coverage. You accrue points through various ways and you have you can utilize those points that you might earn over some period of time to get extended coverage once your active coverage ends.

Okay. Is a is a pediatrician considered a primary or a specialist? Primary. Yep. Primary. Are the pharmacy exclusion list for pharmacy through Express Scripts the same on Centivo and Anthem? Yes. Or does one have more drug exclusion than the other? No, they’re the same. And what are the rates?

The cost. I presume that means maybe the monthly premiums. So for Anthem it’s 751 150 200 a month that’s individual you and your spouse you and your family and for Centivo it’s 2550 5075 same same groupings there can you tell us the COBRA cost for both plans actual money figures I don’t have them in front of me at the moment but they are on our those are going to be updated shortly on the website and in the FAQ Q.

Yeah, because new rates will go into effect. Yeah, January 1st. The COBRA and then somebody wrote again the COBRA cost. Again, those are going to be updated January 1. So, you can either find them on the website or call the fund office and we’ll give them to you. Okay. Can you possibly drop a link here for those of us who want to register for or attend the West Coast Health Fair on Saturday?

It’s on our website. Well, the website says registration information to come. That’s because the Writers Guild West is managing that. So if you contact the Writers Guild West office, they can tell you where to sign up for that. And then let’s see, last one.

Can a comment with typos be deleted? Fine with me. I’m sure it can. I’m not sure how to do it, but I’m sure it can. Okay, have one more question. Let’s see. If I have active coverage currently, then can I continue to use Anthem without accruing extra costs?

I know Anthem costs more points than Centivo for people on points. If I have active I’m not sure how to take that. If I have active coverage currently, can I continue to use Anthem without accruing extra costs? If you have active coverage currently, when you go through open enrollment, you’ll want to choose if you want to stay with Anthem, choose Anthem, and that’ll be your coverage starting January 1st.

I’m not sure I answered that question well. But if I didn’t, just reach out to our office and we can we can get that question answered for you. All right, we’re a little bit over time. Are there any I’m just waiting to see. It looks like we’ve answered all of the questions. Yep. Okay, good. Well, I want to thank everybody.

Thank our panelists for being here to answer your questions and take you through it. Open enrollment starts tomorrow. If you have any questions, hopefully you have now some idea of how to get answers and go to the Budgie tool and do the comparison and then go to MyPlans, log in and make your choice. Sign up for autopay and you’ll be done.

Easy peasy. All right. Thank you everybody. Sam, you want to say anything before we go? Just a thank you to everybody who attended and thanks and thanks to everybody at the health fund. I really do encourage you to take a look at the FAQ and to contact the fund directly. They you know they work for you so just like we do. So have a good night. Good to see everybody. Thank you so much. Great. Thank you everybody.

Thanks everybody.