Forms & Documents

Benefit options and costs

• Telepictures

• WAG

• Unscripted Television

• TV Affiliates

Benefits enrollment

• Benefits Enrollment Form

• Benefits Change Form

• Domestic Partner Affidavit

• Consent for Electronic Delivery of Benefit Communications

Benefits eligibility

• Summary Plan Description / Summary of Material Modifications (9/2020) /Summary of Material Modifications (9/13/21)

• List of Participating Employers

Medical

• Aetna HMO Deductible Plan (HMO) (CA only)

  • Summary of Benefits & Coverage (SBC) / Benefit Summary

  • Evidence of Coverage / Schedule of Benefits

• Aetna Open Access Managed Choice POS Plan (POS)

  • Summary of Benefits & Coverage (SBC) / Benefit Summary / Travel & Lodging Rider effective 10/1/22

  • Booklet-Certificate

  • Schedule of Benefits

• Aetna Open Access Managed Choice POS HDHP Plan (Basic PPO)

  • Summary of Benefits & Coverage (SBC) / Benefit Summary / Travel & Lodging Rider effective 10/1/22

  • Booklet-Certificate

  • Schedule of Benefits

• Aetna Medical POS / Basic PPO Claim Form

• Provider Search

• Essential Health Benefits Comparison Notice for IL employees

• New Mexico Indemnity Medical Plan (8/1/22-7/31/23) New Mexico Indemnity Medical Plan (3/1/22-2/28/23)

• IL Essential Health Benefits Comparison Notice (8/1/22-7/31/23)

Aetna Pharmacy

• Mail Order Form

• Out-of-Network Claim Form

• 2021 Online Formulary

Dental

• Aetna Dental Maintenance Organization Plan (DMO)

  • Summary of Benefits & Coverage (SBC) / Benefit Summary

  • Schedule of Benefits

  • Booklet-Certificate

• Provider Search

• Aetna Dental Preferred Provider Organization Plan (PPO)

  • Summary of Benefits & Coverage (SBC) / Benefit Summary

  • Schedule of Benefits

  • Booklet-Certificate

• Aetna Dental PPO Claim Form

• Provider Search

Vision

• VSP Benefits Summary

• VSP Out-of-Network Claim Form

• VSP Evidence of Coverage & Disclosure

• VSP Schedule of Benefits

Supplemental medical

• Transamerica Accident Enrollment Form

• Transamerica Critical Illness Enrollment Form

• Electronic Funds Transfer Authorization Form

Basic life and AD&D

MetLife (effective 8/1/22)

• Life Insurance & AD&D Benefit Summary / Certificate of Coverage (to follow)

• Life Insurance & AD&D Benefit Summary / Certificate of Coverage (to follow) / Waiver / Imputed Income (for grandfathered employees)

• Life Insurance Beneficiary Form (requires action on your part)

• Life Conversion Brochure

Voluntary group whole life

• Transamerica Group Whole Life Enrollment Form

• Electronic Funds Transfer Authorization Form

Flexible Spending Accounts (FSAs) Available to non-union, full-time Telepictures (tier 1) employees

• FSA Enrollment Form

• FSA Benefit Summary

• FSA Summary Plan Description (SPD) / Summary of Material Modifications (9/2020) / Summary of Material Modifications (9/13/21)

• Reimbursement Form

• Direct Deposit Authorization Form

401(k) Plan Closed Effective December 31, 2023

• Summary Plan Description Plan - As a result of the spin-off of Warner Media from AT&T Inc.

• 401k Loan Policy

Actions

• Plan Document (4/8/22) - Transition to WMD (will be posted soon)

• Second Amendment (4/8/22)

• Summary of Material Modifications (12/31/21) - Investment options

• First Amendment (12/14/21)

• Summary of Material Modifications (12/1/21) - AT&T U.S. Stock Fund & Total Return Bond Fund

• Qualified Default Investment Alternative (11/1/21)

• Summary of Material Modifications (1/1/21) - Transition to AT&T

• Plan Document (1/1/21) - Restatement

• Implemented CARES Act Loan Payment Deferrals (3/26/20)

• Fidelity Freedom Fund 2065 (10/2019)

• Hardship Withdrawal Changes (1/1/19)

• Fidelity Index fund(s) share class conversions (11/1/18)

• Funds Eliminated (9/17/18) - Fidelity Leveraged Company Stock Fund & Hennessey Cornerstone Mid Cap 30 Fund)

• Disability Changes (4/1/18)

• Share Class Changes (4/2/18)

• Fund Merger (1/19/18) - Rainier & Hennessy)

  • Hennessey Institutional Class

  • Hennessey Investor Class

• Summary of Material Modifications (7/27/17) - Removes River Tower Productions, Inc. & Cedarhurst Enterprises, Inc.)

• Summary Of Material Modifications (12/1/16) - Horizon eligibility, MBLC Productions Inc. & FUDD Ink

• Fund Changes (2/16/16) - RS Partners Fund Class A eliminated

• Other Changes (2/16/16) - Plan Administrator, language clarification

• Fund Changes (8/3/15) - RS Partners Fund Class A frozen & JPMorgan US Small Company Fund added

• Fund Changes (3/11/15) - Fidelity Stock Selector Small Cap Fund frozen & Fidelity Investment Grade Bond Fund un-frozen

• Fund Changes (7/25/14) - Fidelity Freedom® 2000 Fund combines with Fidelity Freedom® Income Fund

• Funds Eliminated (3/3/14 - Fidelity Equity Dividend Income Fund & Eaton Vance Large Cap Value Fund

• Summary of Material Modifications (5/1/13) - Eligibility

• Summary of Material Modifications (4/1/12) - Eligibility

• Summary of Material Modifications (7/11) - HEART

• Fund Un-Frozen (8/1/10) - Fidelity Blue Chip Growth Fund

• Fund Eliminated (6/1/09) - Ariel Appreciation Fund

• Funds Frozen (6/1/09) - Fidelity Investment Grade Bond Fund & Fidelity Equity Income II Fund

• Fund Frozen (5/1/08) - Ariel Appreciation Fund

• Fund Frozen (10/1/07) - Fidelity Blue Chip Growth Fund

• Summary of Material Modifications (1/1/07) - Eligibility

• Fund Eliminated (10/16/06) - Fidelity Aggressive Growth Fund

• Fund Frozen (1/1/05) - Fidelity Aggressive Growth Fund