• Open Enrollment Periods
Your open enrollment period is based upon your benefit period. Please refer to the chart below and your enrollment materials to determine which period applies to you. You can verify your benefit period through your Benefits Manager account.
|Benefit Period||Open Enrollment Period|
|January 1st||December 1 - January 15|
|April 1st||March 1 - April 15|
|July 1st||June 1 - July 15|
|October 1st||September 1 - October 15|
• Notice of Qualification
If you meet the Active Plan’s eligibility requirements, you will receive a Notice of Qualification from the Active Plan. Your notice includes your benefit period dates, Active Plan premiums, and a list of your eligible dependents.
• Three steps for completing Active Plan enrollment
To complete your enrollment, follow these steps:
1. Enroll online with Benefits Manager. This is your portal to enroll in the Active SAG-AFTRA Health Plan, track your reported earnings, check your eligibility, view plan coverage, update your dependents, and more.
- Go to my.sagaftraplans.org/health.
- To log in, enter your phone number or email address and your password.
- Select Enrollment. There you can review, add or delete eligible dependents and view benefit plan highlights.
2. Complete your dependent coverage verification. You’ll need to confirm whether your eligible dependents (spouse and children) are enrolled with another health plan. (See below for more information)
3. Pay your premium by the deadline. Coverage does not begin until your premium is paid. Be sure to pay before your benefit period start date. See the current Plan premiums.
• Working spouse rule and enrolling eligible dependents
Effective January 1, 2021, the Active Plan implemented a working spouse rule. This rule is in line with common practices across entertainment health plans, other union health plans, and private and public-sector employer plans. If your spouse and dependents are eligible for the Active SAG-AFTRA Heath Plan coverage, here are the requirements you should know.
Covering working and non-working spouses under age 65
If your spouse’s employer offers a health plan...
If your spouse is under age 65 and has access to an employer’s health plan they need to enroll in that plan. Once enrolled with their employer, you can choose to cover them under the Active SAG-AFTRA Health Plan as well. Their employer’s plan will pay benefits first, in the primary position. Our Active Plan will consider secondary payment of eligible expenses, and cost-sharing may apply.
If your spouse is not working, or their employer does not offer a health plan…
If your spouse is not working, or their employer does not offer a health plan, you can enroll your spouse with the Active SAG-AFTRA Health Plan. Our Plan will consider primary payment of eligible expenses.
Covering dependent children
Your eligible dependent children are not required to enroll in your spouse's employer plan or any other health plan. However, if your dependent children are enrolled in another health plan, they are subject to coordination benefits with the Active SAG-AFTRA Health Plan.
Surviving spouses under age 65
If you are a surviving spouse under age 65, you are eligible to enroll in the Active SAG-AFTRA Health Plan unless you remarry. To maintain your coverage, you’ll need to complete an annual questionnaire regarding your marital status. Watch for it in the mail, and be sure to respond promptly.
Important note: If you are covered under the surviving dependent benefit and you remarry, your Active Plan coverage will terminate as of the date of remarriage.
Adding new dependents
During open enrollment, you can add new dependents by completing a New Dependent Form and submitting all required documents that verify your dependent(s) as qualified. Coverage will be extended to your dependents following processing of your legal documents, verification of their other health plan coverage (if any), and receipt of your premium payment.
• Verification of other health plan coverage
The Active Plan has partnered with Cotiviti (formerly HMS), to verify with the additional health plans that your spouse under age 65 and your eligible dependent children are enrolled in. Cotiviti specializes in securely and efficiently collecting health plan information and works with some of the largest employers in the United States.
Cotiviti will contact you by mail after you confirm your enrollment with the Active Plan, and they will ask you to respond to questionnaires about your family members’ other health plan coverage (if any). You can complete the process online sagaftrahp.coverageupdatecenter.com, and all information you provide to Cotiviti is strictly confidential and secure. Be sure to respond promptly to avoid disruption in coverage.
Contact Cotiviti (877) 795-4611 if you have questions when using their website or completing forms you receive in the mail.
• Coordination of benefits (COB) with other health plans
COB refers to the set of rules that determines responsibility for payment among all health plans that cover you, your spouse, and your dependent children. You must keep the Active Plan informed about all other health coverage that you have or are eligible to receive, so that the plans can properly coordinate your benefits.
As you review the information the Plan provides you when we pay claims and benefits, you may see the following terms:
- Pending COB Verification – This means the Active Plan is waiting for you to complete your verification of other health plan coverage with our partner Cotiviti (formerly HMS). Your spouse is not eligible to receive Active Plan benefits until you complete this process.
- Primary Coverage – This means the Active Plan pays benefits first when coordinating benefits with other health plans.
- Secondary Coverage – This means another health plan will pay benefits before our Active Plan pays; then, our Active Plan’s cost-sharing may apply for remaining eligible expenses.
- Not Enrolled – This means you qualified for Active Plan coverage, but you did not choose to enroll. The Active Plan will not pay benefits for you or your dependents.
- Enrollment Declined – This means the Active Plan determined your spouse and/or your dependents are not eligible for Active Plan coverage (for example, because your spouse has access to their employer’s health plan and did not enroll in that plan).
- Did Not Qualify – This means you did not meet the requirements for Active Plan coverage (through covered earnings or alternative days’ eligibility). The Active Plan will re-evaluate your eligibility prior to your next benefit period.
• After you complete the enrollment process
Once you complete the enrollment process – including Active Plan enrollment through Benefits Manager, verification of other health plan coverage, and paying your premium – the Active Plan will mail you a Notice of Coverage, which includes your healthcare ID cards. Your Notice of Coverage will be sent to you within 7 to 10 business days. In most cases, you cannot make changes until your next open enrollment period. However, certain life events qualify you for a special enrollment opportunity.
• Special enrollment periods
Special enrollment opportunities allow you to make changes to your dependent elections outside of the open enrollment period. Traveling is not considered a special exception.
Adding New Dependents
If you gain a new dependent as a result of marriage, or the birth, adoption, placement for adoption or legal guardianship of a child, you may enroll the dependent in your coverage provided you notify the Plan within 60 days of the life event and you submit the required documentation. See Life Events for instructions for adding a new dependent.
A new dependent will not be enrolled in the Active Plan until we receive all the necessary documents needed to verify your relationship to the dependent. Once the Active Plan processes the new dependent documentation, they are eligible for coverage if you are enrolled and you pay the appropriate premiums.
Senior Performers also have an opportunity to make changes to their covered dependents when their spouse turns 65. In the case of surviving dependent coverage, eligible dependents will have an opportunity to reenroll in the Plan when the spouse turns 65.
If your Plan coverage is available under the surviving dependent provision, you may only reenroll outside of the open enrollment period if you have other health coverage and your other coverage ends because of a reduction in employment, or if you are eligible for a Children's Health Insurance Program (CHIP) or Medicaid event. This is described below.
If you are canceling enrollment of a current dependent due to divorce or death, you are required to submit a copy of the final judgment of divorce, or recorded death certificate to the Active Plan. In the event of divorce, you must notify the Active Plan within 60 days of the date your divorce in order to preserve individual COBRA rights for the dependent, if they qualify.
Expenses incurred by your spouse or stepchildren on or after the date of divorce are not covered by the Plan. You will be billed for expenses paid by the Active Plan from the date of divorce. It is your responsibility, as the participant, to notify the Active Plan of any change to your qualified dependents.
Enrolling and canceling enrollment of current dependents can affect the amount of your premium. Premium changes will be effective the 1st of the month in which the event occurred if enrolling a new dependent(s) and the 1st of the following month if you are canceling enrollment of a current dependent(s).
You may also wish to consider changing your beneficiaries when life events occur by submitting a new Designation of Beneficiaries form.
Other group health coverage
If you do not enroll in the Active Plan because you have other group health coverage, you may be allowed to participate in the Active SAG-AFTRA Health Plan when your other coverage ends due because of a termination of employment or reduction in hours, legal separation, loss of dependent status under the plan, divorce, or death.
If the other coverage is under a COBRA provision and you exhaust your COBRA coverage, you may also be allowed to participate in the SAG-AFTRA Health Plan.
You must submit a written request for coverage under the Plan within 60 days after your other coverage ends.
Special enrollment opportunities are also available to:
- Participants and their dependents who lose coverage under Medicaid or CHIP;
- Participants and their dependents who become eligible for a state Medicaid or CHIP premium assistance program.
The CHIP/Medicaid enrollment events require you to submit a written request to the Plan within 60 days of their occurrence.
CHIP is a federal/state program designed to provide health care coverage for uninsured children and some adults although benefits under this program are only provided by certain states. If you think you or any of your dependents might be eligible for Medicare or CHIP, you can call 1-877-KIDS-NOW (1-877-543-7669) or visit www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask your state if it has a program that might help you pay the SAG-AFTRA Health Plan premiums.
If you have any questions about the Active Plan rules for premium payments, please call the Plan at (800) 777-4013 or log in to your Benefits Manager and use the secure message center.