Participating Dentist is a dentist that is within the DentaIGuard
Preferred provider network offered by The Guardian Life Insurance
Company.
Participating Pharmacy is a pharmacy participating in a preferred
provider network of pharmacies maintained by Medco Health Solutions.
Performer is an employee on the basis of whose services a contributing
employer is obligated to contribute to the AFTRA Health and Retirement
Funds pursuant to a collective bargaining agreement by and between the
employer and AFTRA.
Physician means a duly licensed doctor of medicine authorized to
perform medical or surgical service within the lawful scope of his or
her practice.
Prescription drugs are drugs that are obtainable only by a physician's
or dentist's written prescription, dispensed by a licensed pharmacist,
and approved for their intended use by the United States Food and Drug
Administration.
Qualifying year refers to eligibility for coverage under the Senior
Citizen or Early Retiree Program. It is a Base Year during which
an individual had covered earnings equal to the greater of:
the amount required as of the last day of such Base Year to qualify for
a year of eligibility under the AFTRA Individual Health Plan or $2,000.
Related employee is an employee (other than a temporary employee) of AFTRA or the AFTRA Health and Retirement Funds.
Scheduled allowance is the maximum dollar amount of a medical
provider’s fee for a particular service in a particular geographic
area, which will be taken into account (prior to application of any
deductible, co-insurance or maximum) in determining benefits under the
Plan. In the case of a fee billed by a Network Provider, the
scheduled allowance shall be deemed equal to the discount fee.
For Major Medical benefits, in the case of a fee billed by a
Non-Network Provider, the scheduled allowance will be based on the
highest amount charged for the specific service by 70% of medical
providers in the geographic area.
Staff Performer is a performer who is a full-time employee of a radio or television station or network.
