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| Now Showing: Health Benefits Summary |
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General Description
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| Starting January 1, 2003, Earned eligibility is based on:
1. the amount you earn from producers who are signatory to collective bargaining agreements with Screen Actors Guild - called covered earnings, AND
2. the timely payment of your premium.
The Health Plan also has an Alternative Eligibility Program in the event you do not meet the minimum covered earnings requirement. You will have Alternative Earned eligibility if you work the required number of days in covered employment and pay the required premium.
Your covered earnings and days of employment for the previous consecutive four quarters are totaled at the end of each calendar quarter until you earn eligibility. The four-quarter period in which you first meet the earnings or days requirement establishes your "base earnings period". Once your base earnings period is established, the same period will be used each year to determine your eligibility for the next period.
Once you meet the eligibility requirement you are eligible for 12 months of Health Plan coverage provided you pay the required premium. Your coverage - "benefit period" - starts three months after the end of your base earnings period as shown on the following chart:
| Base Earnings Period |
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Benefit Eligibility Period |
| Jan 1 - Dec 31 | |
April 1 - March 31 |
| April 1 - March 31 | |
July 1 - June 30 |
| July 1 - June 30 | |
Oct 1 - Sept 30 |
| Oct 1 - Sept 30 | |
Jan 1 - Dec 31 |
Note that there is a 3-month period between the end of the base earnings period and the beginning of the benefit eligibility period. All periods begin and end on calendar quarters.
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| Earned Eligibility and Alternative Eligibility |
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Minimum Health Plan Eligibility Requirements
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Eligibility Commencing
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Plan
1
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Plan
II
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January 1, April 1, July 1, or October 1, 2008
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$28,120
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$13,790; or 74 days of employment; or $10,000 if you are at least 40 years of age with 10 years of Earned Eligibility
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January 1, April 1, July 1, or October 1, 2009 |
$28,680 |
$14,070; or 74 days of employment; or $10,200 if you are at least 40 years of age with 10 years of Earned Eligibility |
January 1, April 1, July 1, or October 1, 2010 |
$29,250 |
$14,350; or 74 days of employment; or $10,400 if you are at least 40 years of age with 10 years of Earned Eligibility |
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These minimum requirements may increase each year. The Trustees have set a target increase of 3% per year, however they will determine the actual size of the increase based on an annual review of the Health Plan’s financial condition.
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| Premium | Starting January 1, 2003, participants with Earned, Earned Inactive or Alternative eligibility are required to pay a quarterly premium. The amount of premium depends on the Plan for which you qualify as follows:
Plan I $150.00 per quarter
Plan II $195.00 per quarter
Participants who have met the earnings or days of employment requirement will receive quarterly billing statements from the Plan Office. Premiums are due by the first day of each calendar quarter. Failure to pay the premium on time will result in the termination of coverage.
The premium does not apply to participants who have Senior Performers coverage, participants who regain Earned coverage while on Senior Performers coverage or participants who, on or after 10/1/04, meet the age and service requirements for Senior Performers coverage, but do not apply for a pension. |
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| Spouses, Dependents
Domestic Partners | Your legal spouse and dependent children are covered along with you. You may be required to provide a copy of certain documents for verification.
Your same-sex domestic partner may be covered as long as you meet the rules and complete the enrollment package.
It is your responsibility to notify the Plan Office when there is a change in your dependents. | | |
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| Loss of Coverage
| You (the participant) lose coverage if:
1. You do not continue to meet the Earned, Earned Inactive or Alternative eligibility requirements during your designated base earnings period, or
2. You do not pay your premium.
In general, your dependent children, spouse, or domestic partner lose coverage when you lose coverage or when they cease to be a dependent child, legal spouse, etc. as defined by the Plan.
When you lose coverage, the Plan Office will send you a notice outlining your available options. If you lose coverage due to failure to pay your premium, you will not be entitled to Health Plan coverage for the remainder of your current eligibility period.
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| Extended Coverage | Self pay coverage is available to participants (and their dependents) who lose coverage as outlined above. It is not available if the loss of coverage is due to failure to pay the Earned premium.
Basic Plan I Self-Pay is for participants covered by Plan I Earned Eligibility. It provides the same coverage as Plan I Earned coverage except for life insurance and AD&D benefits. Dental is automatically included.
Basic Plan II Self-Pay is for participants covered by Plan II Earned or Alternative Eligibility. It provides the same as Plan II Earned coverage. Dental is automatically included for participants who had dental coverage under their Earned coverage.
Lower Cost Self-Pay is available as an option to participants covered by either Plan I or Plan II. It does not include dependent coverage or coverage for mental health and chemical dependency benefits. It also has higher out-of-pocket costs.
Additional Extensions to Eligibility
Extended Spousal Benefit
Extended Self-Pay Coverage for Military Service
Total Disability Extension
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| Senior Performers Eligibility | You are eligible for Senior Performers coverage if you are receiving a pension from the SAG-Producers Pension Plan based on at least 20 Pension Credits. If you have at least 15 but less than 20 Pension Credits, you can obtain Senior Performers coverage by paying a premium equal to 25% of the actual cost of the coverage.
Exception: Participants who have at least 10 Pension Credits as of December 31, 2001 and are at least age 55 as of December 31, 2002, are eligible for Senior Performers coverage when they reach age 65 and are receiving a pension.
Important: Pension Credits earned under the Alternative Eligibility Program do not count towards eligibility for Senior Performers coverage.
The benefits provided under Senior Performers coverage are the same as those provided under Plan I Earned Eligibility except that the life insurance amount is $5,000 and there are no accidental death and dismemberment benefits. The Health Plan does not reimburse the Medicare Part B premium.
Senior Performers Health Plan benefits are not vested benefits. They may be amended or discontinued at any time by action of the Board of Trustees. | | |
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| Eligibility Rules Sheet | | |
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