• Intro

    This summary describes your rights and responsibilities for enrollment and participation in the Self-Pay Program. You (and your dependents) may enroll in the Program even if you (or your dependents) are covered by another health plan, including Medicare, on the date Earned Eligibility is lost. In some cases your dependents may be entitled to enroll in the Program even if you do not elect Self-Pay coverage. For a more detailed explanation of the Self-Pay Program, refer to your Health Plan Summary Plan Description booklet or visit www.sagph.org.

     
  • Enrollment Opportunities:

    At the time Earned Eligibility is lost you have 60 days to enroll in the Self-Pay Program using our website or by returning your enrollment form to the Plan Office. This is also the time during which you can choose the dependents you would like to cover and select your premium rate. You can enroll dependents who were not enrolled under your Earned coverage although these dependents are not entitled to self-pay for coverage on an individual basis. You will receive an enrollment form with your qualified dependent(s) listed.

    Your enrollment in the Self-Pay Program must be received by the Plan Office within 60 days of the later of:

    1. the date your coverage terminated or,
    2. the date on your Self-Pay enrollment offer.

    New dependents can only be added by completing a New Dependent form and submitting all required documents to consider your dependent(s) as qualified. Examples are a recorded marriage certificate for a spouse or a recorded birth certificate for your dependent child. Once we have your legal documents and your enrollment has been processed, coverage can be extended to your dependent(s) following receipt of your premium. A new dependent is not entitled to self-pay for coverage on an individual basis unless he or she is a newborn or newly adopted child.

    You will have additional opportunities to change your dependent enrollment during the annual open enrollment period or if you experience a life event. Please refer to the following rules:

    Annual Open Enrollment – You will have an opportunity to change your dependent enrollment every year for the duration of your Self-Pay period. Changes to your enrollment must be completed using our website or by returning your enrollment form to the Plan Office by December 31st to be effective January 1st of the following year. Open enrollment materials will be mailed in November.

    Life Event Enrollment Changes – You may make dependent enrollment changes outside of the open enrollment period if you have a change in family status. A change in family status is defined as an increase or decrease in the number of your dependents which results from birth, adoption, marriage, establishment of a same-sex domestic partnership, divorce, dissolution of a qualified same-sex domestic partnership, death or loss of dependent "child" status as defined by the Plan, or your dependent obtains or loses insurance coverage on their own.

    If one of these events should occur you will be permitted to change your dependent's enrollment status and change your premium tier (if applicable) based on the addition or loss of that dependent. A request must be made to the Plan Office in writing within 60 days of the change in family status. No verbal requests will be accepted.

     
  • Coverage Options:

    Self-Pay coverage is identical to the coverage provided to the Earned Eligible participants of each respective Plan, except that Self-Pay participants are not entitled to life insurance or accidental death and dismemberment benefits.

    The chart below illustrates the Self-Pay coverage options. Your Self-Pay enrollment offer includes the specific rates and options available to you. Participants losing coverage under Plan I may choose to enroll in either Plan I or Plan II with dental. Please refer to the Benefit Summary included with your packet for a comparison of the benefits under each plan.

    Options

    Plan I

    Plan II
    (with 3 or more
    Health Years)

    Plan II
    (with less than 3
    Health Years)

    Benefits

    Hospital, Medical,
    Prescriptions, Dental, Vision,
    Mental Health/Substance Abuse

    Hospital, Medical, Prescriptions*, Dental

    Hospital, Medical, Prescriptions*

    Individual only

    $585/monthly

    $468/monthly

    $437/monthly

    Individual plus 1 dependent

    $1,146/monthly

    $916/monthly

    $856/monthly

    Individual plus
    2 or more dependents

    $1,601/monthly

    $1,281/monthly

    $1,197/monthly

    *Does not include prescription drugs for mental health and substance abuse treatment.

    NOTE: If your Earned Eligibility changes from Plan I to Plan II, you may choose to enroll and pay for Plan I Self-Pay coverage. However, the Health Plan does not coordinate benefits between your Plan I Self-Pay and your Plan II Earned coverage. Instead, you receive Plan I benefits. The Benefit Summary outlines the benefit differences between the Plans.

     
  • Length of Coverage:

    The maximum length of Self-Pay coverage is as follows:

    18 months – for participants (and their qualified dependents) with less than 17 years of Earned Eligibility in the Health Plan who lose eligibility due to a reduction in earnings. Participants who are entitled to Medicare prior to the date they lose Earned Eligibility should call the Plan Office for information concerning their maximum Self-Pay period.

    36 months – for participants (and their qualified dependents) with at least 17 years of Earned Eligibility in the Health Plan who lose eligibility due to a reduction in earnings.

    36 months – for qualified dependents who lose their dependent status due to the death of a participant, divorce from a participant, dissolution of a domestic partner relationship with a participant, or loss of "child" status as defined by the Plan.

    29 months – for participants or dependents who are determined by Social Security to be totally disabled on the date Earned Eligibility ends or within 60 days thereafter. Non-disabled dependents of a disabled participant are also entitled to 29 months of Self-Pay coverage. For more information on these provisions, please contact the Plan Office.

    Early Retirement and Disability Pensioners – participants and their qualified dependents receiving an Early Retirement or Disability Pension are eligible to self-pay until age 65 provided:

    • they have at least 15 Pension Credits; or
    • they had at least 10 Pension Credits as of December 31, 2001 and were at least age 55 as of December 31, 2002.
    Pension Credits earned under the Alternative Eligibility Program do not count toward this Self-Pay eligibility.
     
  • Time Limits for First Payment:

    Your first payment is due on the first day of the month immediately following the date on which your Earned Eligibility terminates. You must pay your first premium within 45 days of the end of your enrollment period. Coverage will not be verified for any health provider prior to the receipt of your premium payment and claims cannot be considered.

    Your first payment must include all of the premiums to keep your coverage continuous from the date your Earned Eligibility terminated. For example, if your Earned Eligibility ended on December 31st, and you make your first premium payment in February, you must pay both January and February.

     
  • Monthly Billing Procedure and Payment Options:

    After the Plan Office receives your enrollment, monthly payment coupons will be mailed. Please include a coupon for each monthly payment. If you do not receive your payment coupons within 30 days after enrollment, notify the Plan Office immediately. Payment is due the first of each calendar month, although there is a 30-day grace period as mandated by federal law. Claims will not be considered for payment until your premium is received. If you do not pay your monthly premium on time, you will forfeit your rights to coverage under this program. The Health Plan provides several easy and convenient methods for submitting your premium:

    Auto Debit – The Auto Debit Plan deducts your monthly premium automatically on a recurring basis each month from a checking or savings account. Payments are deducted around the 25th of the month prior to the due date. The Health Plan will continue to deduct your monthly premium as long as you remain continuously eligible for Self-Pay coverage, even if there is a change in the premium rate. You can sign up online or download an enrollment form to mail to the Plan office.

    Pay by Web – Pay your monthly premium online. After Auto Debit, this is the fastest, easiest way to pay your premium. Simply click here for payment options. You will receive instant confirmation that your payment has been received.

    Pay by Phone - Pay your monthly premium over the telephone 24/7 with a credit card. Simply call the Plan Office to access the Interactive Voice Response (IVR) and follow the prompts. The phone numbers are (818) 954-9400 or (800) 777-4013. If you choose to pay by phone, call the IVR before the due date and provide the necessary information. You will receive instant confirmation your payment has been received. 'For your security, this is an automated system. A Participant Service Representative will not be able to take your credit card information over the phone.

    For your protection, pay by web and pay by phone payments are non-recurring, which means that the Plan will not store your credit card information and will not automatically charge your credit card or use e-Check information every time a payment is due.

    Pay by Mail –Checks, money orders or cashier's checks from a U.S. bank should be made payable to: Screen Actors Guild – Producers Health Plan and sent to the Plan Office. Be sure to include the account number from the billing coupon on your check to ensure proper crediting. Your payment must be received by the Plan Office no later than the due date to be considered timely.

     
  • SAG Foundation Grant Program For Catastrophic Illnesses and Injuries:

    The SAG Foundation offers financial grants to participants or qualified legal dependents of participants who have a catastrophic illness or injury and who, due to financial need, cannot afford the Health Plan's Self-Pay Program. Contact the Plan Office for more details.

     
  • Coordination of Benefits (COB):

    The Health Plan will coordinate benefits with other plans. Contact the Plan Office when coordinating benefits with your (or your spouse's) other insurance. If you have Medicare, Medicare is primary and the Health Plan's self-pay coverage is secondary.

     
  • Termination of Self-Pay Coverage:

    Your Self-Pay coverage will terminate on the earlier of:

    • The first of the month for which you do not pay your premium by the due date.
    • The first of the month after the month in which Social Security determines you are no longer totally disabled if your Self-Pay coverage is based on your being totally disabled.
    • The first of the month following the expiration of the maximum Self-Pay coverage period for which you qualify (see Length of Coverage section).
    • The first of the month for which you qualify for Earned Eligibility, unless you are paying for Plan I Self-Pay and your Earned Eligibility is for Plan II.
    • If the Health Plan no longer provides health coverage.
     
  • Other Coverage Options:

    Other Group Health Coverage – You may qualify for a special enrollment opportunity for another group health plan for which you are eligible, such as a spouse's plan, even if the plan generally does not accept late enrollees. You must request enrollment within 30 days after your Earned Eligibility terminates.

    Health Insurance Marketplace – As key parts of the health law take effect, you will be able to buy coverage through the Health Insurance Marketplace at www.healthcare.gov. In the Marketplace, you may be eligible for a new kind of tax credit that lowers your monthly premiums right away, and you can see what your premium, deductibles, and out-of-pocket costs will be before you make a decision to enroll. Being eligible for the Self-Pay Program does not limit your eligibility for coverage with a tax credit through the Marketplace.

    Life Insurance Conversion – Life insurance conversion policies are available only to the participant (not dependents) immediately following the termination of Plan I Earned Eligibility due to loss of earnings. You must submit an application and payment to Metropolitan Life Insurance Company within 31 days of the date you lose life insurance coverage. For applications, call Metlife at (800) MET-LIFE or (800) 638-5433. The benefit is $10,000, and the Group Policy number is 1113312.

    Additionally, you may qualify for a waiver of the life insurance premium if you are totally disabled. Please contact the Plan Office at (818) 954-9400 or (800) 777-4013 for more information.

    Resources – The Health Plan has prepared these three resource guides to help you when your earned and self-pay coverage ends. If you need to locate private health insurance or pharmacy discount programs, these guides provide a good starting point to help you find an insurance program suitable for your circumstances. Please be aware that the Health Plan does not monitor the Web sites contained in these guides and, therefore, cannot be held responsible for any information which may be contained in or omitted from them. In addition, by listing these sites, the Health Plan is in no way endorsing, recommending or otherwise promoting the benefit programs of these companies.

    Rx Resource Guide - This pharmacy resource guide offers links and phone numbers for a variety of governmental, non-profit and for-profit programs which can help you with drug costs by means of subsidies or discounts.

    Nationwide Health Insurance Guide - This guide gives links, phone numbers and information on industry assistance programs, Federal/State health insurance programs and private sources for individual health insurance.

    State by State Guide to Additional Insurance Resources - Find government health insurance resources in your state.