We are pleased to provide you with this 2021 SAG-AFTRA Health Plan Summary Plan Description (SPD), which describes in detail the benefits available to covered Participants and their Eligible Dependents under the SAG-AFTRA Health Plan (Plan) as of January 1, 2021. This SPD constitutes the Plan’s governing document.
Please review the SPD carefully to get the most out of your Plan benefits. Understanding health benefits can sometimes be daunting, and we have made every effort to present the information as clearly and simply as possible. However, sometimes we must use words and phrases that are legal in nature. We’ve included a glossary to help clarify those terms, and terms from the glossary are capitalized throughout the SPD.
Whenever the benefits in this SPD materially change, you will be notified of the modifications of your benefits. Keep your SPD and notices together so you have ready access to the most current information about the Plan. You can also find the SPD and any updates online at www.sagaftraplans.org/health. This SPD, which is effective January 1, 2021, provides current summary information about the Plan and supersedes the prior Plan SPD and all benefits updates and newsletters. In 2020, the Board of Trustees adopted several changes to the Plan’s benefits.
This SPD reflects those changes, as well as other changes made to the Plan since it was first established on January 1, 2017. For coverage applicable to services rendered before January 2021, please refer to the Plan’s 2017 Summary Plan Descriptions and related notices of modifications.
It’s important to know that the Plan is a self-funded ERISA plan and, therefore, not subject to state-mandated insurance laws. In addition, Trustees may (with or without prior notice) reduce, modify or discontinue benefits or the qualification rules for benefits at any time, with respect to any individual who is covered, or who may become covered, under the Plan. Rights to future benefits, including without limitation, Retiree and Senior Performers benefits, are not promised, vested or guaranteed. The Trustees have the sole and exclusive power and responsibility to make all decisions regarding the Plan and what it covers. The Trustees’ decisions regarding the Plan are binding upon SAG-AFTRA, employers, Participants, Dependents and beneficiaries. Plan employees cannot alter benefits and eligibility or other rules, and Plan employees’ opinions or interpretations cannot amend what is set forth in this document and are not binding upon the Trustees.
You need to keep current with your premium payments to ensure coverage when you receive health care services. We encourage you to sign up for automatic premium payments, both for your convenience and to eliminate the possibility of late or missed payments. You can do this by registering for a personal account in your Benefits Manager at www.sagaftraplans.org/health, where you can also view your earnings, sign up for Plan emails and more. Finally, please inform the Plan if you change your address or marital status, or if you wish to add or drop Dependents.
If you have questions, please call the Plan Office at (800) 777-4013, or use the Benefits Manager secure message center at www.sagaftraplans.org/health. We look forward to providing you and your family with high-quality benefits for years to come.
Sincerely, SAG-AFTRA Health Plan Board of Trustees
Chief Executive Officer
Cohen, Weiss and Simon LLP
Proskauer Rose LLP
Are You Ready for the SAG-AFTRA Health Plan? Here’s a Checklist:
- If you haven’t already done so, submit a completed Participant Information Form, and familiarize yourself with this SPD.
- Find out if you qualify for coverage.
- Review Plan benefits.
- Make sure you and your Eligible Dependents are enrolled in coverage.
- Register to manage your benefits through your personal Benefits Manager at www.sagaftraplans.org/health.
- Update / confirm your contact information (see “About the Participant Information Form” to the right).
- File your Claims for benefits no later than
- 15 months after the date services are incurred (18 months for Hospital charges).
- Visit www.sagaftraplans.org/health for additional information.
About the SAG-AFTRA Health Plan
The Plan is jointly-administered by a Board of Trustees with representation from both SAG-AFTRA and contributing industry employers. The Trustees are responsible for setting the benefits, rules and regulations of the Plan and generally overseeing Plan operations. The Plan’s staff, headed by the chief executive officer, is responsible for day‑to‑day operations of the Plan. The Plan’s Trustees and staff are assisted by professional consultants, including legal counsel, investment advisors and managers, health benefit consultants, actuaries and certified public accountants.
The Plan is a separate legal entity from SAG-AFTRA, the union. Please remember that all communications (correspondence, forms, payments, documentation, etc.) regarding your health benefits should be sent directly to the Plan and not to SAG-AFTRA. The Plan is not a subsidiary, department or agent of SAGAFTRA. No portion of SAG-AFTRA’s union dues is used to pay for Plan benefits or operational expenses, except for contributions that SAG-AFTRA makes to the Plan to provide benefits to its own employees.
The benefits provided by the Plan for individuals who have already earned eligibility, including those for Senior Performers and their Dependents, are not vested or guaranteed. The Plan’s benefits and eligibility provisions may be modified, reduced or canceled at any time by the Board of Trustees.
About the Participant Information Form
If you perform Covered Employment, you will need to complete a Participant Information Form (PIF) and submit it to the Plan as directed. You may also obtain a PIF by calling the Plan at (800) 777-4013. The PIF is a confidential legal document containing the Participant’s signature. It provides basic demographic information which allows us to notify you if you qualify for coverage and to provide you with benefits if you enroll in the Plan. It is also required in order to create an online account to manage your benefits through the Benefits Manager.
You do not need to complete a PIF every time you perform Covered Employment. After you file your initial form you should only file a new PIF if your information changes.
Annual Summary of Earnings Statements
Summary of Earnings statements are mailed to all Participants annually. Your statement will list all SAGAFTRA Covered Earnings for the previous calendar year that were reported to the Health Plan on your behalf by Contributing Employers.
Since reported earnings can affect your qualification for benefits, it is very important that you review your statement carefully as soon as you receive it. You should confirm that your statement reflects all of the SAG-AFTRA Covered Employment you performed during the previous calendar year. If you believe that it does not, or if you did not receive a Summary of Earnings statement but think you had Covered Employment during the year, notify the Plan immediately to request an earnings review.
What Other Forms Are Required?
In addition to the Participant Information Form, you may need to complete other Plan forms to ensure that your benefits are not interrupted. Three commonly required forms are described below.
- An Authorization for Release of Health Information Form may be required for the Plan to release any information about a Participant or Dependent to another party (see here and here).
- A New Dependent Form must be submitted with the required documentation to add new Dependents to your coverage.
- A Designation of Beneficiaries Form informs the Plan of who you want to receive any benefits that may be payable from the Plan upon your death.
Your Benefits Manager
Once the Plan has your PIF on file, you may register for your Benefits Manager account. Through the Benefits Manager you can:
Make changes to your address.
Enroll qualified Dependents or update/add new Dependent information. A qualified Dependent is a Dependent for whom the Plan has verified the required documentation.
- Make premium payments.
- View your earnings history and eligibility for benefits.
- View Claims documents and check the status of a Claim.
- Print health care ID cards.
- Email us using our secure message center.
- Subscribe to Plan emails – by doing so you can receive the following materials via email:
To register visit the Benefits Manager, click “Register” and follow the prompts. When your registration is complete, you will be assigned a user name. Your password will be emailed to you – but only if the email address you provided during registration matches the email address on file at the Plan. If the email addresses do not match, your password will be mailed to you at the address on record with the Plan. You should receive your password in a few days.
Receiving Plan information online is completely voluntary. If you do not choose to register, you do not need to do anything, and the site’s non-secured content will still be available to you. If you do not choose to receive Plan information by email, you will continue to receive required notices and Plan updates via U.S. mail.
As a Participant, it is your responsibility to notify the Plan of any life events such as marriage, divorce, death of a spouse or the birth or adoption of a child, or other changes that could affect your health coverage or that of your Dependents. Generally, you have 60 days to notify us of life events (depending on the event), or you may miss certain opportunities available to you. To learn more about life events, refer to the life events section.
Remember: Notify the Plan of changes to your address separately from any notifications to other organizations.
The SAG-AFTRA Health Plan is separate from SAG-AFTRA (the union) and from the SAG-Producers Pension Plan and the AFTRA Retirement Plan. Notification of changes of address or other information provided to SAG-AFTRA, the SAG-Producers Pension Plan or the AFTRA Retirement Plan does not automatically update your information with the SAG-AFTRA Health Plan – you must contact us separately. Please notify the Health Plan promptly of any changes to your address or contact information and by the required deadline for qualifying life events.
Beneficiary Designation Forms
Please remember that you are responsible for filing a new Designation of Beneficiaries Form with the Plan if you have a life event, such as a marriage, a divorce or the death of your beneficiary. The Plan will use the last beneficiary on file in determining who should receive any benefits that may be payable, even if you have divorced or married since filing the form with the Plan. Therefore, it is important to file a new Designation of Beneficiaries Form with the Plan immediately if you wish to change your beneficiary.
Your Rights: Nondiscrimination
The Plan complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. The Plan does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. The Plan:
- Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters; and
- Written information in other formats (large print, audio, accessible electronic formats, other formats);
- Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters; and
- Information written in other languages.
If you need these services, contact the Plan’s Compliance Department. If you believe that the Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with:
Attention: Compliance Department
SAG-AFTRA Health Plan
P.O. Box 7830, Burbank, CA 91510-7830
Email: [email protected]
You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, the Compliance Department is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Room 509F, HHH Building, Washington, D.C. 20201, (800) 368–1019, (800) 537–7697 (TDD).
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1 (800) 777-4013
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