• Eligibility Requirements



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    Eligibility for health coverage under the Screen Actors Guild – Producers Health Plan is established 1) through employment with producers who have signed Collective Bargaining Agreements with SAG – AFTRA and 2) upon receipt of the appropriate premium payment for coverage.

    Base Earnings Period

    If you meet the minimum earnings or minimum days of employment requirement within four consecutive calendar quarters, you will establish one year of coverage for yourself and your qualified dependents. Your premium payment is determined by the Plan for which you qualify and the number of dependents you choose to cover.

    The four quarter period in which you must satisfy the minimum earnings or days requirement is called your Base Earnings Period. The one year period of coverage is called your Benefit Period and starts three months after your Base Earnings Period ends. The chart below outlines the Benefit Periods that correspond to the various Base Earnings Periods.

    Base Earnings Period Benefit Period
    Oct. 1, 2014 through Sept. 30, 2015
    Jan. 1, 2016 through Dec. 31, 2016
    Jan. 1, 2015 through Dec. 31, 2015
    Apr. 1, 2016 through Mar. 31, 2017
    Apr. 1, 2015 through Mar. 31, 2016
    Jul. 1, 2016 through Jun. 30, 2017
    Jul. 1, 2015 through Jun. 30, 2016
    Oct. 1, 2016 through Sept. 30, 2017

    The Health Plan has two levels of benefits: Plan I and Plan II. The Plan for which you qualify depends on the amount of your earnings or your number of days of employment.

    Please see the chart below for the requirements for each of these Plans and their corresponding premium payments. Once you meet the minimum earnings or days of employment requirement, your eligibility continues for one full year provided you continue to pay your premium. You are automatically eligible for the first Plan for which you meet the earnings or days requirement. Subsequent earnings are used in the next Base Earnings Period to determine your continuing eligibility.

     
  • Earned Eligibility and Alternative Eligibility

    Plan I Plan II (Earnings) Plan II (Days) Plan II (Age and Service) Plan II (Combined Earnings)*
    Earnings Requirements for Benefits Commencing
    2015 (Jan. 1, Apr. 1, Jul. 1, Dec. 1) and 2016 (Jan. 1 only )
    $30,750 $15,100 76 days $10,900 with 10 Health Plan Years and age 40 or over $15,100
    Earnings Requirements for Benefits Commencing
    2016 (Apr. 1, Jul. 1 , Oct. 1)
    $32,000 $16,000 78 days $11,600 with 10 Health Plan Years and age 40 or over $16,000

    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.

    *Combined Earnings eligibility allows participants who do not otherwise qualify for coverage under the SAG-PHP or the AFTRA HP to qualify for Plan II benefits by combining their reportable SAG-PHP earnings and their reportable AFTRA HP earnings to meet the minimum earnings requirement under the SAG-PHP as reflected in the table above.

     
  • Premium

    All participants are required to pay a premium. The three-tiered premium structure allows participants to choose a rate based on the number of dependents they elect to cover under the Plan. The quarterly premium rates are outlined below. For Senior Performer rates please see below.

    Earned Premium

    For Coverage Commencing Jan. 1, 2015 - Mar. 31, 2016 Plan I Plan II Plan II Age and Service
    Participant only $273
    quarterly
    $324
    quarterly
    $414
    quarterly
    Participant plus 1 dependent $315
    quarterly
    $372
    quarterly
    $477
    quarterly
    Participant plus 2+ dependents $342
    quarterly
    $405
    quarterly
    $519
    quarterly
    For Coverage Commencing Apr. 1, 2016 - Dec. 31, 2016: Plan I Plan II Plan II Age and Service
    Participant only $300
    quarterly
    $357
    quarterly
    $456
    quarterly
    Participant plus 1 dependent $348
    quarterly
    $408
    quarterly
    $525
    quarterly
    Participant plus 2+ dependents $375
    quarterly
    $447
    quarterly
    $570
    quarterly

    Senior Performers and Extended Spousal Eligibility

    If you are at least age 65 and have earned sufficient Pension Credits under the Pension Plan, you may be eligible for Senior Performers benefits. If you are an Occupational Disability pensioner who has earned sufficient Pension Credits for Senior Performers coverage, you are eligible at any age provided your disability occurred in the course of employment covered by the Pension Plan. Additionally, in the event of your death, your dependents may be eligible to continue coverage under the Extended Spousal Benefit. A brief description of the requirements and premiums is provided below.

    Senior Performers and Extended Spousal With no spouse or with spouse age 65 and over With spouse under age 65
    For Coverage Commencing:
    2015 (Jan. 1 – Dec. 31) and 2016 (Jan. 1 – Mar. 31)
    20+ Pension Credits * $50/monthly ** $100/monthly **
    15-19 Pension Credits $155/monthly ** $155/monthly **
    For Coverage Commencing:
    2016 (Apr. 1 – Dec. 31)
    20+ Pension Credits * $60/monthly ** $120/monthly **
    15-19 Pension Credits $165/monthly ** $165/monthly **

    * Includes Senior Performers who had at least 10 Pension Credits as of 12/31/2001 and were at least age 55 as of 12/31/2002. 4

    **Includes coverage for dependent children.

    Participants with Earned Eligibility who meet the requirements for Senior Performers coverage will pay the Senior Performer premium if it is lower than the Earned premium, even if they have not actually retired.

    Important Note: Alternative Pension Credits do not count toward eligibility for Senior Performers coverage.

    The Extended Spousal benefit is provided to qualified dependents if, at the time of the participant's death, he or she was age 65 or older and had at least 15 Pension Credits. It is also available if the participant earned 10 Pension Credit s as of 12/31/2001 and was age 55 as of 12/31/2002; or if the participant was a t least age 50 and had at least 20 Pension Credits and his or her age plus years of Pension Credits was at least 75. Coverage begins when the participant would have reached age 65 had he or she lived.

     
  • Spouses and Dependents

    Your legal spouse and dependent children can be enrolled in the Health Plan. You may be required to provide a copy of certain documents for verification.

    It is your responsibility to notify the Plan Office when there is a change in your dependents.

     
  • Loss of Coverage

    You (the participant) lose coverage if:

    1. You do not continue to meet the minimum earnings or days worked 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.

     
  • Self-Pay

    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.

    Plan I Self-Pay is available to 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.

    Plan II Self-Pay is for participants covered by Plan II Earned or Alternative Eligibility. It is also available as an option to participants covered by Plan I Earned Eligibility. Plan II Self-Pay provides the same coverage as Plan II Earned coverage. Dental is automatically included for participants who had dental coverage under their Earned coverage.

    Additional Extensions to Eligibility

    Extended Spousal Benefit
    Extended Self-Pay Coverage for Military Service
    Total Disability Extension