Establishing eligibility: You may move into our new SAG-AFTRA Health Plan / Via Benefits program or qualify for active SAG-AFTRA Health Plan coverage

We’re making several changes to the criteria we use to establish eligibility for active SAG-AFTRA Health Plan coverage:

1. The covered earnings and alternative days thresholds that establish plan eligibility will change.
2. The types of earnings included in your eligibility evaluation will change.
3. We’re transitioning Retirees to a calendar-year benefit period.

Here's how it works:

Changes to eligibility thresholds for Retirees

We’ll determine your eligibility for Via Benefits or the active Plan by evaluating your covered earnings or alternative days worked from October 1, 2019, through September 30, 2020.

Only sessional earnings will be included in your earnings evaluation.

This new rule phases in for Retirees as follows:

Alignment of Retirees to a calendar-year benefit period

In addition to changing the eligibility thresholds, we’re transitioning our Retirees into calendar-year benefit periods. This will allow us to align our plan with Medicare’s annual calendar, making it easier for you to work with Medicare. The Medicare Annual Enrollment Period is October 1 to December 15. 
Here’s how the timing for the transition works, based on your current status as a SAG-AFTRA Health Plan participant and your current benefit period. 
 

New benefit: The Plan’s partnership with Via Benefits

We’re partnering with Via Benefits to provide more choices and personalized support and service to our Retirees. You can shop around and customize your benefits coverage to meet your personal health needs and use of healthcare services. For example:

• You can select a Medicare Advantage plan, which supplements your Medicare Part A and Part B hospital, doctor / outpatient care, and prescription drug coverage, and may offer extras like SilverSneakers®. 
• You can shop for a stand-alone Medigap plan, a Medicare Part D prescription drug plan, dental insurance, and vision insurance. 

Learn more about Via Benefits, and begin your shopping and enrollment process online at my.viabenefits.com/sagaftrahp, or call (833) 981-1280.

New benefit for Senior Performers: Health Reimbursement Account to help pay for healthcare expenses

This is a new benefit for Senior Performers. When you enroll in a Via Benefits medical plan, you’re eligible for the SAG-AFTRA Health Plan Senior Performers Health Reimbursement Account (HRA). 

The SAG-AFTRA Health Fund credits money to your Senior Performers HRA. The amount is based on your Retiree Health Credits and whether you enroll yourself only, or yourself and your Medicare-eligible spouse. 

OR

Using your Senior Performers HRA

Your Senior Performers HRA helps to cover the cost of eligible healthcare expenses for you and your enrolled Medicare-eligible spouse. You can use it to pay your Via Benefits medical plan premiums, Medicare premiums, copayments, deductibles, coinsurance, and other eligible healthcare expenses as long as you have money in your account.  

The federal government does not allow you to contribute to an HRA. However, any unused HRA funds roll over from year to year.

New benefit for Senior Performers: Help with paying catastrophic prescription drug expenses

This is a new benefit for Senior Performers. When you enroll in a plan that includes prescription drug benefits with Via Benefits, your plan will cover 95% of prescription drug expenses after you reach the Medicare catastrophic expense amount — and you pay 5%. 

For Senior Performers facing very high prescription drug expenses, their share can be difficult to pay. That’s why the SAG-AFTRA Health Fund will offer a catastrophic prescription drug HRA. Through this arrangement, you (and your enrolled Medicare-eligible spouse) may be reimbursed for your share of catastrophic expenses.

You’ll learn more about this program in a mailing from Via Benefits.

Covering family members

You and your Medicare-eligible spouse are eligible for the new SAG-AFTRA Health Plan / Via Benefits program — and Senior Performers are eligible for the new Health Reimbursement Account. 

Also, Retirees who enroll themselves through a Via Benefits medical plan can cover eligible dependents under age 65 through the SAG-AFTRA Health Plan. If you do, be sure to take note of a few new rules for 2021.

2021 premium costs

If you’re moving into the new SAG-AFTRA Health Plan / Via Benefits program

When shopping for a plan through Via Benefits, you may find low-cost premium options — with $0 premium plans available to many participants. 

Your premium cost will be based on the plan and coverage you choose and whether you cover your Medicare-eligible spouse. You pay your premium directly to the plan you choose.

The cost for Senior Performers to enroll dependents under age 65 in the SAG-AFTRA Health Plan is $250 per month. The premium covers all eligible dependents (one or more), and it’s paid directly to the SAG-AFTRA Health Plan. The new premium is effective January 1, 2021.

Note: Premiums can no longer be deducted from your pension benefit.

If you qualify for and enroll in the active SAG-AFTRA Health Plan or you’re running out your current coverage later in 2021

The new SAG-AFTRA Health Plan premiums will apply.

Your cost is based on the number of family members you enroll, and you’ll start paying the new premium as of January 1, 2021.

Additional benefit enhancements and cost-sharing changes

If you enroll or remain in the active SAG-AFTRA Health Plan, beginning January 1, 2021, you’ll see a few benefit enhancements and changes to coverage and cost-sharing between you and the plan. Get more details.

Your to-do list — take action!

Our Plan changes will affect different participants at different times. You’ll receive personalized information, including a confirmation of your benefits and any actions required, starting in August.