In the 2026 MBA negotiations, the WGA and the companies agreed to increased funding for the health plan and to implement a number of cost-saving measures. As an alternative to the Anthem PPO, starting in 2027 the Health Fund will also offer a new plan option for active participants and pre-Medicare retirees (as well as participants who are Medicare eligible, but still working) through a network called Centivo.

These changes are intended to make the Fund more sustainable, generating savings while preserving member choice and access to high-quality benefits, and limiting out-of-pocket costs as much as possible.

Beginning July 1, 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.

Participants will pay 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 match the reimbursement rates for all other out-of-network care.

With these changes, the Anthem PPO plan will continue to provide access to a broad national network of providers with low participant cost-sharing compared to most plans in the U.S. For comparison, the Mercer Benchmark 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 all at once.

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

Medicare-primary post-65 Certified 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.

The Plan will treat 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 for both Anthem and Centivo (more below) participants when they go out-of-network.

When you see an out-of-network provider, the Fund determines your cost-sharing based on the “Allowed Charge” for the service, which is defined in the SPD under “Allowed Charge (Out-of-Network Services)”.

Starting January 1, 2027, the Fund will determine the Allowed Charge for out-of-network behavioral health services based on 150% of the Medicare rate for the services, which is the same benchmark the Fund uses for other out-of-network covered services.

You will always have the lowest out-of-pocket costs by using in-network providers. Participants enrolled in either the Anthem or Centivo option can access in-network virtual mental health providers through Rula. For more information, visit www.wgaplans.org/rula. Should you choose to go out of network for services, we recommend against paying out-of-network providers up front. The Plan works to negotiate discounted payments with out-of-network providers where it can, but is unable to do so when a participant has already paid the provider.

You will reach out to Rula through their website as you did before. The one difference – and it is a critical difference – you must use your Centivo ID # when searching for a therapist if you are a Centivo Plan participant, OR you must use your WRXA ID # when searching for a therapist if you are an Anthem Blue Cross participant.

Getting started is easy. Go to the Rula website and answer a brief set of questions:

Once you’ve answered the questions about your needs and location, Rula will use your responses to find therapists that meet your needs in your local area. They have in-person and video sessions available, at your discretion.

You will see information about the therapists’ professional accreditations and the type of work they do, as well as their next available appointment. If someone interests you, you can click to see a more detailed profile.

You will also get a list of similar providers.

You can call Rula at: (323) 205-7088 if you have any questions. If you have a problem with your therapist, you can contact Rula by phone at: (323) 205-7088 or you can reach out to Participant Services at the PWGA, either by phone: (818) 846-1015 x602, or via Contact Us on our website.

The Plan’s Industry Health Network clinics, which have for years provided participants in the Southern California geographic area affordable access to UCLA Health, will terminate on December 31, 2026. One of the reasons for discontinuing TIHN is that they now charge rates above Anthem Blue Cross.

For Anthem PPO participants, TIHN clinics and associated referrals will no longer be discounted beyond the rest of in-network providers but will instead be reimbursed 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. Participants should confirm that their TIHN providers are in the Anthem PPO Network; most are, but there may be exceptions.

Out of network TIHN providers will be reimbursed at the same rate as other out of network services. Also, see below for the description of Centivo, which offers a program similar to TIHN, that includes most of the UCLA Health providers.

Writers who do not reach the eligibility threshold for coverage in a given year can continue their coverage through use of Extended Coverage Points they have banked from prior years. Extended coverage currently costs 2.5 points per quarter, and 1.5 points per quarter for low option coverage.

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.

Starting January 1, 2027, the first Extended Coverage Point will be earned at $200,000 in annual earnings, and the second point will be earned 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.

After January 1, 2027, 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. Consistent with the current rule, these points can be used once a participant has accrued 10 points, but only one time during the course of a career.

Writers who do not have enough points for a final quarter of coverage will be provided with a point subsidy up to 1 point. If Anthem PPO is elected, you must have a minimum balance of 3 points to receive the subsidy. If Centivo is elected, you must have a minimum balance of 1.5 points to receive the subsidy. The maximum amount of ECP points that a participant can accrue is 50.

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. More information can be found HERE.

No. There will be no change to Low Option plan ECP rules regarding points per quarter needed in 2027, but the Low Option is only available for the Anthem Blue Cross PPO plan. The Low Option Plan is an option that covers only catastrophic needs and is only a relevant choice for a few participants. It has been retained so that those truly in need still have access to it.

No.

Centivo is a new health plan option available to most current Health Plan participants in the U.S., effective January 1, 2027. Centivo is a narrow network plan with fewer in-network providers. All current Anthem PPO plan benefits are covered under Centivo, but at lower cost to participants than the Anthem PPO plan, which will also continue to exist.

Centivo offers a similar lower cost fixed co-pay structure to The Industry Health Network (TIHN) which currently serves Southern California participants until December 31, 2026, at which time it terminates.

Centivo offers a far wider network than the expiring TIHN network, and offers participants similar low costs for services. The network is wider because it includes most UCLA Health primary care doctors (including the TIHN clinic physicians) but also includes doctors at other UCLA Health locations in the LA area, along with certain non-UCLA Health doctors. In total, Centivo covers 50 primary care locations in Southern California, rather than 5 available through TIHN. TIHN referrals included most UCLA Health specialists, and so does Centivo.

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

Specifically, in Los Angeles, Centivo includes:

• UCLA Health
• MemorialCare
  • Long Beach
  • Orange County
  • PIH with care to the east, including the San Gabriel Valley
  • Whittier
  • 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

Centivo offers care in a number of other states, as well. 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 where they negotiate with the specialty provider for the care. Virtual care is also available nationwide. Primary care visits are free. There are fixed co-pays for referrals, no deductible, and no percentage co-insurance in-network.

Centivo observed that traditional health networks, such as Anthem, often don’t negotiate lower prices with the big providers. 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.

Centivo’s objective is to offer significant savings to the Health Fund 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. Additionally, Centivo is available to most participants across the country, whereas TIHN was only available within the Southern California area. The participants residing outside of Southern California could not access TIHN and their only option was Anthem, with its higher deductibles and co-insurance payments.

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.

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 the 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. In addition, TIHN was only ever available to participants in Southern California.

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

Yes. UCLA Health Pediatrics are included in the Centivo network.

To enroll as a Centivo plan participant, participants select Centivo as their plan option during the fall annual open enrollment period, which this year will be from November 11, 2026 through December 15, 2026. Coverage on the Centivo plan will be effective January 1, 2027. At that time, you will be asked to select a primary care physician from the Centivo Partners Network.

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 getting married or divorced, the birth or adoption of a child, switching from active status onto Extended Coverage points, moving to a location that does not offer Centivo, or switching from Extended Coverage back into active status. When you choose Centivo, 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 add or confirm dependents to be covered and to pay participant and dependent premiums.

Yes. Centivo offers Centivo Care and MD LIVE as virtual options for participants for medical care.

Centivo offers its own virtual network called Centivo Care. Centivo Care allows participants to select a virtual primary care provider. Centivo Care physicians are available in all 50 states. A participant with a Centivo virtual primary care provider will utilize the services of their specifically selected virtual care physician for their primary care needs. But many doctors in the Centivo network offer telehealth appointments also. You will find options in the Centivo app.

In addition to telehealth sessions for accessing a virtual primary care provider for medical services provided by Centivo, you can also reach out to them when you are traveling or need help after hours. They call this service MD LIVE. MD LIVE operates in a very similar fashion to Anthem’s Live Health Online, in that a participant can reach out to receive virtual care for one-off virtual care urgent and behavioral health needs.

MD LIVE is available in all 50 states, and works like Live Health Online. It’s one-time only care, for each individual transaction.

Centivo doctors can support both medical conditions and behavioral health concerns; these services are primarily for one-time semi-urgent matters.

MD LIVE physicians can also prescribe medications if needed.

Urgent Care/Emergency services are available in all 50 states.

Urgent Care will require a $75 co-pay when a participant/dependent is away from home.

Emergency Room Care is treated as in-network no matter where you are and will result in a $300 co-pay.

If you enrolled in Centivo but move out of the network area, you are allowed to enroll back into Anthem PPO, as this is considered a life event. However, this only works if your original election was Centivo. If you enrolled in Anthem PPO and move out of state, you are not allowed to elect a new medical plan, as Anthem PPO is available in all 50 states.

If your dependent moves out of the Centivo network area, they can utilize virtual PCP and have access to emergency care anywhere. If a procedure is required by a specialist, they are encouraged to travel to a Centivo network area. The only instance where a household can return to Anthem is if the primary participant moves to a non-Centivo covered geographic area.

Centivo medical care is available in all 50 states in the following ways:

• When the student establishes their Centivo coverage, they will select a personal care physician (PCP), selecting either a traditional in-person PCP or a virtual care PCP (Centivo Care). They can access that PCP remotely at no charge. They can also get a referral to a physician nearest them if they are in need of in-person care.
• MD LIVE is available in all 50 states, and works like Live Health Online. It’s one-time only care, for each individual transaction.
  • Centivo doctors can support both medical conditions and behavioral health concerns; these services are primarily for one-time semi-urgent matters.
  • MD LIVE physicians can also prescribe medications if needed.
• Urgent Care/Emergency services are available in all 50 states.
  • Urgent Care will require a $75 co-pay when a participant/dependent is away from home.
  • Emergency Room Care is treated as in-network no matter where you are and will result in a $300 co-pay.

As a practical measure, for normally scheduled PCP services, it is best to schedule appointments when the student is home for the holidays, summer. Or other such period.

You may change your Centivo primary care physician at any time 365 days a year through the app, or the customer service line (during standard service line business hours).

Centivo offers an app or a phone number for finding your medical providers. To choose your primary care physician, you will find information about doctors convenient to you that are taking new patients. You can book your appointment right in the app. For specialists, once your doctor’s office makes a referral, you can choose your specialist of choice based on descriptive information in the app.

In most cases, yes. Under 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 and book your appointment. Centivo is available to help, but you can manage your care yourself through the Centivo app.

PCP referrals are required for all services with Centivo, not just for specialists, except for the following:

• OB/GYN care
• mental health substance use disorder care
• emergency medical care
• urgent care
• diagnostics, including labs and imaging (however these must be ordered by the member’s selected PCP or a physician for which the member has a referral or is referral exempt)
• chiropractic care
• acupuncture
• rehabilitative services

If you are actively receiving treatment for a serious, complex, or acute health condition (e.g., pregnancy in the second or third trimester when the new plan starts, ongoing cancer care, terminal illness, transplants under active treatment or recent major surgery), you may qualify for Continuity of Care/Transition of Care benefits.

1. How to Apply: Submit Centivo’s Continuity of Care form no later than 30 days after your coverage effective date. Requests must be member-initiated.
2. Approval Process: Centivo will review your application and send a formal determination letter. If approved, the letter will specify the approved timeframe (typically up to 90 days) to continue seeing your current provider while transitioning to an in-network provider.
3. Coverage Details: Approved care is typically covered under a single-case agreement based on negotiated rates. Services received from an out-of-network provider without prior approval will not be covered. If you choose to remain with a non-network provider without approval, standard out-of-network rates apply.
4. Finding New Care: Centivo and your new PCP can assist in finding in-network specialists and providers.

This is a situation where you need to exercise caution. Not all TIHN physicians will be covered by Centivo. You should check first. If your physician is not in the Centivo network you will be subject to higher costs. Please verify each provider before selecting Centivo, so that you are aware of these implications. You may or may not wish to select Centivo in these cases, unless you are ok with either changing your providers, or wish to accept out of network reimbursement rates for those outside of the Centivo network.

If you have questions about Centivo or medical services you may require, Centivo Member Care is available to answer your concerns.

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, book your appointment, and track your appointments and medical records.

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. Basic diagnostic care (e.g., basic labs, x-rays, etc.) is $10, while more complex/advanced diagnostics is $150 (e.g., MRI, CT scan, etc.). The co-pay for an in-network specialist visit is $25, urgent care is $75, lab work and imaging are $10, ER visits are $300, outpatient surgery is $250, inpatient surgery is $400, and an in-network hospital stay is $600. These payments are made up to the out-of-pocket max of $2,000 for an individual or $4,000 for a family.

Your cost-sharing for covered services provided by Centivo network providers will be limited to a fixed copayment—no deductible or coinsurance. The copayment schedule for in-network services for the 2027 plan year is shown below:

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

There is no deductible for the Centivo plan for in-network care. The OON deductible is the same ($500/$1,500).

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. 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, as are some of the other 3^rd party services to which you have become accustomed. That said, when searching for a provider the participant should identify themselves as Centivo-covered when searching through Rula or one of the other providers listed below.

Additionally, there are new providers available to you as well:

Pre-age 65 Certified Retirees can use Centivo, but age 65+ retirees who have Medicare as primary can only use the Anthem Blue Cross PPO plan. If you are an over 65 certified retiree, who achieves the earnings minimum in covered earnings, you will receive active coverage for 1 year. While on active coverage, you will be eligible for the Centivo plan. Once you cease to achieve the earnings minimum in a subsequent year, you will return to inactive status, and only be eligible for the Anthem PPO plan.

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 where 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 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%. This is same OON rate as used by Anthem Blue Cross.

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

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.

It is most common for the claim to be made by the primary provider. For example, if another plan paid primary and we are paying secondary, we would receive the claim from the provider and/or the participant with the other carrier’s EOB for what was covered as primary.

Centivo would follow their own network status, so the OON would apply for that example.

Dual writer households, where both writers have their own earned coverage, can each select their own health plan (Centivo or Anthem Blue Cross). They can also select which plan will cover their dependents.

Centivo does not operate as a Medicare Part A or B policy, but there could be instances when a participant is covered by Medicare and Centivo would coordinate as secondary (i.e. ESRD, SSDI). If a participant is 65 or older, working, and in Active status, Centivo will act as primary coverage. The participant will return to Medicare and Anthem once their Active status terminates.

Yes. The Health Fund will always be available to assist you. However, you should contact Centivo first for any issues because they are the primary providers.

You will be able to find your EOBs in the MyPlans App as well as the Centivo app.

For this year, Open Enrollment (including Centivo as an option) will run from November 11 to December 15, 2026 to allow participants more time to make their decision about what health care provider to select.

You will be able to select a plan and pay premiums during open enrollment online through MyPlans, on the www.wgaplans.org website and mobile app. Over 90% of our health plan eligible participants are already registered users of MyPlans, and you will need to register for MyPlans in order to complete the process.

You will be able to select your medical plan (Centivo or Anthem PPO), confirm the dependents who will be covered, and complete your AutoPay processing, which will enable automatic payment of your premium payments effective January 1, 2027.

Be on the lookout for additional information regarding the open enrollment process, along with how to get assistance in the coming weeks.

If you have any questions, you can reach the Health Fund through the MyPlans app, by the website at: https://www.wgaplans.org/contact-us/, or via phone: (818) 846-1015.

The decision to elect Centivo or Anthem Blue Cross rests solely with the primary participant. Dependent coverage will always follow primary participant’s election.

There are some restrictions. If a participant, or their spouse, is a Certified Retiree on Medicare, then Centivo is not available as a plan option. Participants outside of Los Angeles and New York should also confirm that Centivo has covered providers in their area.

The COBRA election process will remain the same as it is now. You can choose either single or family, however, you must also elect the medical plan (either Centivo, Anthem, or Low Option) – only available through Anthem – as each will have different COBRA rates.

Newly added dependent(s) will automatically be covered under your current medical plan election.

If you do not make an election during the Open Enrollment period, you – and your dependents – will automatically be enrolled in Anthem Blue Cross along with the concomitant automatic premium payments.

Yes, you and your spouse may each elect a medical plan of your own.

Health Fairs and Webinars: The Health Fund will be holding health fairs on August 29 and November 14, 2026 in Los Angeles so that you can have a chance to meet with staff and ask questions. A similar health fair will be held in New York on October 22. There will also be Zoom sessions available on September 17 and November 10, 2026. Additionally, the Health Fund will send materials provided by Centivo and the Health Fund to help participants make the best use of the resources available to them on an ongoing basis.

Decision-Support Tool: If you want to compare your costs under Centivo versus what you would pay using Anthem Blue Cross, you can do so on a forthcoming new app, Budgie Health. Budgie Health will load your previous year’s medical claims and then provide you with information about what those same services would cost under Centivo. Instructions regarding how to access Budgie for health plan selection decision support will be provided in a future communication to all participants.

Because Centivo is working with the UCLA Health system in Los Angeles, many of the medical professionals available under TIHN are also part of Centivo. You can find out whether your current TIHN provider is within the Centivo network by using their app which also allows you to select a Centivo primary care physician (PCP) who will be responsible for referring you to medical personnel inside the Centivo system. Instructions regarding how to access the Centivo app for primary care physician verification/selection decision support will be provided in a future communication to all participants.

You can also reach out to Centivo for answers to your open enrollment questions:

Yes. Participants will now have to pay a premium for coverage. The amount of your premium payment depends on the program you choose, either Centivo or the existing Anthem Blue Cross PPO Plan, along with the number of dependents you elect to cover within your household.

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

Yes. All participants must re-enroll in autopay during this year’s open enrollment in support of their plan election, and to confirm their associated premium payments effective January 1, 2027.

No. Your coverage automatically defaults to the medical plan selected during the immediately preceding coverage period.

After your active health coverage ends, it is considered a “life event” and you will continue your health coverage if you have enough Extended Coverage Points (ECP). If you do not have enough ECPs, you may be entitled to COBRA coverage to temporarily continue your health insurance plan by paying the monthly COBRA fees.

If you become a retiree and are under age 65, you will continue coverage under your existing medical plan election. If you are at or above age 65, your coverage will default to Medicare, with the Anthem PPO secondary and all dependents fall under the same medical plan.

If your coverage is changed to Extended Coverage Program or COBRA, it is considered a “life event” and you are allowed to elect a new medical plan.

If you lose coverage for one full quarter or longer and then become reinstated, you are allowed to elect a new medical plan.

If you lose coverage due to an error and then become reinstated, you are automatically placed back into the medical plan selected during the immediately preceding coverage period. The only exception occurs if the break in service coincides with Annual Open Enrollment, in which case you can elect the plan option of your choice.

EGWP stands for the “Employer Group Waiver Plan” which is a prescription drug program administered by Express Scripts (ESI) for participants covered by Medicare. Effective January 1, 2027 Medicare-eligible participants and Certified Retirees over 65 years of age who do not have earned coverage from employment will be required to enroll in the EGWP Medicare drug formulary, which will result in a more generous federal rebate. This change will primarily impact behind-the-scenes Health Plan administrative processes, and your coverage will continue to be administered by ESI and have the same cost-sharing design as for Anthem PPO prescription drug coverage, meaning your copayments and tier structure will not change. Under EGWP, a small number of prescribed drugs will be reviewed for possible generic alternatives.

All Medicare eligible individuals and certified retirees over 65 years of age, enrolled in the current CMS plan, will be automatically enrolled into the EGWP, as part of the open enrollment process. Your default medical plan will be Anthem PPO. (Centivo is not an available plan option for Medicare eligible participants and Certified Retirees over 65 years of age who are inactive writers.) Medicare eligible participants and Certified Retirees over 65 years of age will be sent an advance notice that provides more information about the EGWP.

You can only be enrolled in one Medicare Part D plan at a time. Since the EGWP is a Medicare Part D plan, you should not enroll in another Medicare Part D plan if you want to maintain your prescription drug coverage under the Plan. If you do enroll in other Part D coverage, this will result in loss of your Anthem PPO coverage along with the Plan’s prescription drug coverage (EGWP).

Yes. If you are an over 65 Certified Retiree, who achieves the earnings minimum in covered earnings, you will receive active coverage for 1 year. While on active coverage, you will be eligible for the Centivo plan. Once you cease to achieve the earnings minimum in a subsequent year, you will return to inactive status, and only be eligible for the Anthem PPO plan.

You must be enrolled in Medicare Part A and Part B in order to maintain prescription drug coverage through this program. If you are Medicare-eligible and you are not enrolled in Medicare, you will not have prescription drug coverage. For important details about Medicare coordination of benefits, see the SPD.

In order to be eligible for Anthem PPO, the default medical plan available to Medicare-eligible individuals and Certified Retirees over 65 years of age, EGWP is your PWGA-sponsored Part D prescription drug coverage.

There may be different outcomes depending on the scenario:

• If a retiree declines PWGA’s Part D coverage and enrolls in a Medicare Part D plan immediately, there will be no late enrollment penalties with Medicare.
• If a retiree declines PWGA’s EGWP prescription drug coverage and does not enroll in Medicare Part D, they may incur a lifetime Medicare Part D late enrollment penalty when they do enroll in Medicare Part D if they go 63 or more consecutive days without coverage.

Because PWGA offers creditable coverage, retirees should either enroll in the PWGA EGWP plan or an alternative Part D plan to avoid late enrollment penalties.

Depending on your income, you may also be required to pay an additional Medicare Part D monthly surcharge in addition to your monthly Medicare prescription drug Part D coverage premium. The Social Security Administration (SSA) will notify you if you owe a monthly surcharge and what you will pay in addition to your regular Part D premium. If you do owe the additional premium, it is paid directly to SSA, not to ESI or the Plan. However, if you do not pay the surcharge and are disenrolled from Medicare Part D, your Plan prescription drug coverage would end as well.

If your income is above $109,000 for an individual or $218,000 for married filing jointly, premiums may range 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.

Yes. If you are Certified Retiree over 65 years of age, and elect to opt out of EGWP, you will be able to resume coverage, but have to wait until the next open enrollment period in November, 2027, at which time you must opt-in to EGWP as your Part D prescription drug coverage.