CONTRIBUTION AND DEPENDENT VERIFICATION PROGRAM

Contribution Verification Audits
Periodically the Plan discovers that eligibility for Health Plan benefits has been established through falsified reporting of earnings. In essence, signatory companies are fraudulently contributing on behalf of members who do not perform services covered by a SAG collective bargaining agreement. They are “buying” health coverage for participants by contributing the bare minimum necessary to obtain coverage.

The verification of contributions to the Health Plan is an important aspect of the Plan’s integrity because fraudulently obtained benefits deplete the Plan’s assets and affect the benefits available to the rest of the participants.

Each Plan participant should maintain and be prepared to supply, upon the Plan’s request, copies of employment contracts, proof of payments, including payroll stubs, W-2 forms, income tax returns and bank records. Participants are advised to maintain these records and documentation for at least four years.

Dependent Verification Audits
You may be selected for an audit to verify the eligibility of your dependents under the Health Plan. Failure to comply with an audit request can lead to a loss of benefits for your dependents.

When you become eligible for benefits under the Health Plan, you must file a Performer Information Form with the Plan Office. This confidential legal document must be signed by the participant. If the participant is under the age of 18, the parent or legal guardian must sign for the child.

In order to verify the eligibility of the dependents listed on your Performer Information Form, the Plan performs routine
audits. This includes verification of full-time student status for dependent children age 19 through 22. These audits are for your protection to assure that Plan benefits are reserved for eligible participants and their eligible dependents.

If you are selected for an audit, the Plan Office will send you an initial inquiry specifying the documents needed for dependent verification. For example, a copy of a recorded marriage certificate to verify your legal spouse or a recorded birth certificate for a child. If you cannot locate a requested document, contact the Plan Office which can assist you in contacting the issuing agency.

If the Plan Office does not receive a response to its initial request, a follow-up notice will be sent. If there is no response to our second request you will receive a Notice of Termination of Benefits for the unverified dependents. Additionally, you will be responsible for paying back any medical expense paid out by the Health Plan on behalf of non-qualified dependents.

If you need to update your Performer Information Form, contact the Plan Office.

Recovery and Offset of Benefit Overpayments and Suspension of Benefits
The Plan is obligated to take whatever steps are legally permissible in order to recover any overpayments of benefits made on behalf of you or your dependents resulting from any findings of audits conducted by the Plan’s Contribution Compliance Department and Participant Eligibility Department. If reimbursement attempts are unsuccessful, the Plan will withhold any reimbursement otherwise due you and your qualified dependents under the Health Plan and offset that amount against the amount you owe the Plan. As soon as the Plan has recovered the entire amount that you owe, irrespective of the source of recovery, your Health Plan benefits will once again be processed and paid in the normal manner. In the event of substantial evidence of fraudulent activity, benefits may be suspended prior to the conclusion of the audit in order to prevent additional losses to the Plan.