SAG-AFTRA Health Benefits

Plan II

Download a copy of the SAG-AFTRA Health Plan 2017 Benefits Summary.

The minimum earnings requirement for Plan II eligibility is $17,000 in covered earnings in your base earnings period.

Download a copy of the 2018 Benefits Summary (effective January 1, 2018).

Benefits Summary

- Hospital

Calendar Year Deductible

The Industry Health Network ‐ $150/person; $300/family

BlueCard PPO/Beacon Health Options ‐ $500/person; $1,000/family

Not covered

Inpatient (Room and Board and Ancillary Services)

80% after $100 copay

Not covered*

Outpatient Surgery

80% after $100 copay

Not covered

Emergency Room

80% after $100 copay; emergency room

copay is waived if immediately confined

Not covered*

Coinsurance Out‐of‐Pocket Limit

$2,000/person; $4,000/family

Not covered

- Medical

Calendar Year Deductible

The Industry Health Network ‐ None

BlueCard PPO/Beacon Health Options ‐ $500/person; $1,000 family

$1,000/person; $2,000/family

Office Visit

No deductible; 100% after $25 copay

60%

Surgeon

80%

60%

X‐ray and Lab

80%

60%

Therapy (Occupational, Osteopathic, Physical, Speech, Vision)

80%

60%

Maternity Care ‐ Prenatal Visits

No deductible; 100%

60%

Maternity Care ‐ Delivery

80%

60%

Routine Physical Exam

No deductible; 100%

60%

Routine Child Exam

No deductible; 100%

60%

Routine Mammogram/Pap

No deductible; 100%

60%

Hearing Aids

80% up to a maximum payment of $1,000 per device; one device per ear per three‐year period

60% up to a maximum payment of $1,000 per device; one device per ear per three‐year period

Coinsurance Out‐of‐Pocket Limit

$1,200/person; $2,400/family

$3,000/person; $6,000/family

- Overall Out‐of‐Pocket Maximum

Hospital / Medical / Rx Out‐of‐Pocket Maximum (includes Deductibles, Copays, Coinsurance)

$7,150/person; $14,300/family

None

- Mental Health and Substance Abuse

Hospital and Alternative Levels of Care*

Covered under the Hospital Benefit

Not covered**

Medical

Covered under the Medical Benefit

Covered under the Medical Benefit

- Dental

Calendar Year Deductible

$100/person; no family maximum

$100/person; no family maximum

Diagnostic and Preventive Benefits

No deductible; 100%

60%

Basic Benefits

60%

60%

Major Benefits

50%

50%

Calendar Year Maximum***

$1,000

$1,000

- Vision

Eye Exams, Glasses, Professional Services for Contact Lenses

Not covered

Not covered

- Prescription Drugs (Express Scripts)
Specialty medications must be obtained by mail through the specialty pharmacy, Accredo, beginning with the first fill. Long-term medications must be obtained by mail through the home delivery pharmacy or any Walgreens Network pharmacy beginning with the third fill. Non-formulary drugs are not covered.
Non-formulary drugs are not covered.

Retail

Mail Order

Deductible

$175/person; $350/family (combined with Mail Order)

$175/person; $350/family (combined with Retail)

Supply

Up to 30 day supply

Up to 90 day supply

Copay

The greater of:

The greater of:

Generic

$10 or 10%

10% $20 or 10%; max copay is $50/prescription

Preferred Brand

$25 or 25%

$50 or 25%; max copay is $125/prescription

Non‐Preferred Brand

$40 or 40%

$100 or 40%; max copay is $300/prescription

In addition, if you receive a brand name drug when a generic exists, you will pay the difference in cost between the generic and brand name medication.

Generic prescription contraceptives are covered at 100% with no deductible or copay.

In addition to the maximum copays listed above, if you receive a brand name drug when a generic exists, you will pay the difference in cost between the generic and brand name medication.

Generic prescription contraceptives are covered at 100% with no deductible or copay.

*Emergency treatment within 72 hours after an accident or within 24 hours of a sudden and serious illness will be covered at the In‐Network Level of Benefits.
**Alternative levels of care include Residential Treatment Center, Partial Hospital Program and Intensive Outpatient Program.
***There is no dental maximum for individuals under age 19.