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When you lose eligibility in the Health Plan, you will receive a notice from the Plan Office outlining all the available benefits and options for continued coverage. In the event of your death, your dependents will receive this information.
All notices from the Plan will be mailed to the address on file at the Plan Office. This is one reason why it is so important to keep the Plan Office informed of your current address or if you change business managers. If you move, you must complete a new Performer Information Form or a Change of Address Card and file it with the Plan Office. The Performer Information Form is discussed on page 65. These forms are available on the Plan’s Web site: www.sagph.org.
Loss of Earned Eligibility
Participants
Failure to Satisfy Minimum Requirements
You will lose Earned Eligibility at the end of the one year Benefit Period if you have not satisfied the Covered Earnings or Days of Employment requirement in your established Base Earnings Period. Health Plan coverage may also be terminated by reason of a Plan amendment which revises the eligibility requirements.
If you lose your Earned Eligibility because you do not meet the minimum requirement, you may be able to continue your coverage under one of the following programs:
Self-Pay Program: page 14
Total Disability Extension: page 22
Conversion Options: page 24
Failure to Pay Premium
Your coverage will also be terminated if the Plan does not receive your quarterly premium by the end of the 15-day grace period. With the exceptions noted below, you will not be entitled to any coverage under the Health Plan until you qualify for your next Benefit Period. Nor will you be entitled to self-pay for coverage under the Health Plan, or enrollment in the conversion options.
For example: If your Benefit Period is April 1, 2007 through March 31, 2008 and you fail to pay your first quarterly premium by April 15, 2007, your coverage will terminate effective April 1, 2007. You will not be entitled to any Health Plan coverage until April 1, 2008, provided you requalify by meeting the minimum Covered Earnings or Days of Employment requirement.
Special Exceptions
The general rule is that if you fail to pay the premium by the due date, you will not be eligible to participate in the Health Plan until your next Benefit Period. However, there are two exceptions to this general rule. New Dependents - If you do not pay the premium and subsequently acquire a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be eligible to participate in this Health Plan prior to your next Benefit Period. You must submit a written
request for coverage under this Plan within 30 days of the date of marriage, birth, adoption or placement for adoption.
Other Coverage - If you do not pay the premium because you have other health coverage, you may be allowed to participate in this Health Plan when your other coverage ends because of a reduction in employment, separation, divorce or death. This does not apply if your other coverage ends because you fail to pay the other plan’s premium. You may also be allowed to participate in this Health Plan if your other coverage is under a COBRA provision and you exhaust your COBRAcoverage. You must submit a written request for coverage under this Plan within 30 days after your other coverage ends.
Special Note: If your coverage in this Plan is terminated because you do not pay your premium, your coverage under other plans may be reduced or eliminated. You should contact your other plan for further information.
Dependents
In general, coverage for your dependents ends when your coverage terminates – or sooner, if they no longer qualify as dependents. However, they may be eligible for coverage under one of the programs listed on page 11.
If your death occurs during your Earned Eligibility Benefit Period, coverage for your eligible dependents may continue until the end of the Earned Eligibility period accrued as a result of your reported income or employment, provided your dependents pay the Health Plan premium as outlined on page 4.
Thereafter, coverage may be extended to your eligible dependents. Please refer to “Extended Spousal Benefit” on the following page.
Loss of Senior Performers Eligibility
If you die while you are covered under the Senior Performers Health Plan, coverage for your eligible dependents will continue until the later of:
- The end of the calendar year in which your death occurs; or
- Six months following your death.
Thereafter, coverage may be extended to your eligible dependents. Please refer to “Extended Spousal Benefit” on the following page.
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