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

• 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

• Aetna 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)

• 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

• Fourth Amendment - adopted December 18, 2023, and effective as of the dates provided therein to bring the Plan into compliance with all changes in law through the Plan’s termination date, including applicable changes in law made by the Setting Every Community Up for Retirement Enhancement Act of 2019 and the SECURE 2.0 Act of 2022

• Third Amendment - adopted December 20, 2023 and effective December 31, 2023 (except as otherwise provided) to effectuate the Plan’s termination

• Second Amendment- adopted December 18, 2023 and effective January 1, 2021 to retroactively conform the Plan’s terms to its operation, in compliance with the Employee Plans Compliance Resolution Program (IRS Rev. Proc. 2021-30)

• First Amendment - adopted December 21, 2022 and effective January 1, 2023, to reflect certain administrative changes and to delegate certain settlor authority to Warner Bros. Discovery, Inc.;

• Plan Document (4/8/22) - Transition to WMD

• 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