THE PERFORMER INFORMATION FORM

The Performer Information Form is one of the most important documents you will complete for the Plan. It is the Plan’s record of your current mailing address and your current dependents. The Plan also requires documentation for your dependents as outlined on page 9. In addition, the beneficiary designation section of the Performer Information Form tells the Plan who you want to receive any benefits that may be payable from the Health Plan upon your death.

You must file a Performer Information Form with the Plan Office before any Health Plan claims for benefits can be processed.

The Performer Information Form is a confidential legal document containing the participant’s signature. The Plan Office cannot release any information about a participant unless a release form is signed by the participant or the Plan receives a proper legal subpoena.

It is the participant’s responsibility to promptly notify the Plan Office of any changes in the information contained on the Performer Information Form, including change of address, addition of dependent children, marriage, divorce, name change, death of a dependent or change of beneficiary. You should also notify the Plan Office if you change your business manager. The Plan requires documentation as outlined on page 9 if you add or drop a dependent from the Performer Information Form for any reason.

The Health Plan Office and the Screen Actors Guild are two separate offices. You must notify both offices of any change of address.