SAG-AFTRA Health SPD

Qualifying for SAG-AFTRA Health Plan Coverage

The Plan provides an extensive package of health care benefits to eligible Participants and their qualified Dependents. To receive coverage, you must meet the Plan’s eligibility requirements and pay the required premiums.

This section describes the Plan’s requirements for Earned Eligibility. The sections that follow describe the Plan’s premiums and payment rules, and the options that may be available to you if you lose Earned Eligibility.

The Plan does not cover charges for treatment after a Participant’s eligibility for coverage has ended, even if the medical condition developed during a period of coverage.

If, as of December 31, 2016, you were enrolled under the AFTRA Health Fund or the Screen Actors Guild–Producers Health Plan and your Benefit Period extended past January 1, 2017, you will continue coverage under the SAG-AFTRA Health Plan for the remainder of your Benefit Period, as long as you pay your premium in full by the due date. You should have received a letter from the Plan outlining your benefits and coverage duration prior to January 1, 2017. If you did not receive a letter, please contact the Plan at (800) 777-4013.

Understanding Covered Earnings

Before reviewing the different ways you can become eligible for coverage, it is important to understand Covered Earnings under the Plan.

Covered Earnings are earnings paid to you and reported to the Plan on your behalf by a Contributing Employer for Covered Employment. Covered Employment is work performed under a Collective Bargaining Agreement that requires the employer to make contributions to the Plan on your behalf with respect to those earnings.

Special Rule for Work Performed Under the Non-Broadcast/Industrial Code

If you are employed by a company in which you or a family member has an ownership or controlling interest, or which you fund directly or indirectly, earnings from that company will not qualify as Covered Earnings for purposes of this Plan unless the project for which the earnings are reported was produced for one or more clients who are third parties (entities not owned, funded or controlled, directly or indirectly, by you, your spouse, parent or child, or by a trust for your benefit or your spouse, parent or child).

Earnings Not Considered for Eligibility (Non-Covered Earnings)

Contributions to the Plan are not required to be made for non-Covered Earnings. As such, non-Covered Earnings do not count toward eligibility for benefits. Examples of non-Covered Earnings include but are not limited to:

  • Payments for various penalties and allowances such as meal penalties, payments for rest period violations, traveling, lodging or living expenses, interest or liquidated damages (late fees), reimbursements for special hair or dress, payments for wardrobe damage or reimbursements for the use of a personal automobile or other equipment.
  • Payment for services not covered by a SAG-AFTRA Collective Bargaining Agreement, such as producing, directing and writing work.

Additional examples of non-Covered Earnings may be obtained by calling the Plan at (800) 777-4013 or online.

Earned Eligibility Requirements

There are different rules for qualifying for Earned Eligibility depending on what type of Participant you are. Most Participants will qualify based on Covered Earnings, although Covered Roster Artists will qualify under separate rules. Eligibility rules for staff of SAG-AFTRA (the union), the SAGAFTRA Foundation, the SAG-Producers Pension Plan, the AFTRA Retirement Fund and the Industry Advancement and Cooperative Fund are provided in a supplement to this SPD which is distributed to these employees separately but is considered part of the SPD and Plan document as if fully set forth herein.

Qualifying Based on Covered Earnings

There are two levels of coverage – Plan I and Plan II – with some differences in the benefits available under each. The level for which you qualify is determined by which earnings threshold you meet first.

The minimum requirements for Earned Eligibility beginning on or after the first day of any Calendar Quarter in 2017 are outlined below. Calendar Quarters begin on January 1, April 1, July 1 and October 1. These minimum earnings requirements are scheduled to increase 2% each year.

In addition to satisfying one of these requirements, you must pay the Plan premium. See Premiums as of January 1, 2017 and payment rules.

Plan I Earnings Threshold

You must earn at least $33,000 in Covered Earnings in your Base Earnings Period to receive Earned Eligibility for Plan I health coverage.

Plan II Earnings Threshold

If you do not meet the earnings threshold for Plan I, you may qualify for Plan II health coverage by earning at least $17,000 in Covered Earnings in your Base Earnings Period, or by qualifying under one of the alternate eligibility rules described below.

If you are at least age 65 and meet the earnings requirement solely through residuals, Medicare will be your primary coverage and your Plan coverage will be secondary. 

Alternative Days Eligibility

If you do not satisfy the Covered Earnings requirements by meeting the earnings thresholds, as set forth above, you may qualify for Plan II coverage under the Alternative Days eligibility rule.

To qualify under the Alternative Days eligibility rule, you must have at least 78 Eligibility Days during your Base Earnings Period. Eligibility Days are determined by dividing your total applicable sessional Covered Earnings by the SAG-AFTRA minimum daily rate, which is based on the type of production.

Sessional Covered Earnings from employment under the Codified Basic (Theatrical) Agreement, Television Programming Agreement, Television Commercials Agreement, Infomercials Agreement, New Media Agreement, Interactive Media Agreement, Corporate/Educational Agreement, Music Videos Agreement, Television Network Code and New Media Network Code (as set forth in the table below) may be used to satisfy the Eligibility Days requirement for Alternative Days eligibility.

Sessional Covered Earnings from employment under the Sound Recordings Code, the Audiobooks Agreement, the Commercial Radio Broadcasting Agreement, the Radio Commercials Agreement, any Regional or Local AFTRA (or SAG-AFTRA) code for Television or Radio Broadcasting or any other AFTRA or SAG-AFTRA Collective Bargaining Agreement side letter or other agreement requiring contributions to be made to the AFTRA Health Plan or to this Plan (with the exception of those identified as counting toward Alternative Days eligibility in the table below) may NOT be used to satisfy the Eligibility Days requirement for Alternative Days eligibility.

Alternative Days eligibility is not available to employees of a radio or television station or network.

Age and Service Eligibility

If you do not satisfy the Covered Earnings requirements by meeting the earnings thresholds set forth above or the Alternative Days eligibility requirements, set forth above, you may qualify for Plan II coverage under the Age and Service eligibility rule.

To qualify under the Age and Service eligibility rule, you must meet each of the following criteria:

  • Be at least age 40 on the first day of your Benefit Period;
  • Have at least 10 Age and Service Credits; and
  • Earn at least $11,600 in Covered Earnings during your Base Earnings Period (as defined in “Earnings Considered for Age and Service Eligibility”). For eligibility beginning on or after January 1, 2018, you must earn at least $13,000 in Covered Earnings during your Base Earnings Period.

Earned Eligibility based on the Age and Service eligibility rule is not available to employees of a radio or television station or network.

Age and Service Credits

Each year prior to January 1, 2017 for which you qualified for SAG Health Plan Earned Eligibility, including those years for which you chose not to enroll in coverage, will be counted as an Age and Service Credit.

No years of eligibility under the AFTRA Health Fund earned prior to January 1, 2017 will be counted as an Age and Service Credit.

For eligibility beginning on or after January 1, 2017, in order to earn an Age and Service Credit, you must have $17,000 in Covered Earnings during your Base Earnings Period from employment as described below or qualify for Alternative Days eligibility during your Base Earnings Period, even if you opt not to enroll in coverage.

Earnings Considered for Age and Service Eligibility

Covered Earnings from employment under the Codified Basic (Theatrical) Agreement, Television Programming Agreement, Television Commercials Agreement, Infomercials Agreement, New Media Agreement, Interactive Media Agreement, Corporate/Educational Agreement, Music Videos Agreement, Television Network Code and New Media Network Code (as set forth in the table on the following page) may be used to satisfy the Age and Service Covered Earnings requirement and to earn an Age and Service Credit on or after January 1, 2017.

Covered Earnings from employment under the Sound Recording Code, the Audiobooks Agreement, the Commercial Radio Broadcasting Agreement, the Radio Commercials Agreement, any Regional or Local AFTRA (or SAG-AFTRA) code for Television or Radio Broadcasting or any other AFTRA or SAG-AFTRA Collective Bargaining Agreement side letter or other agreement requiring contributions to be made to the AFTRA Health Plan or to this Plan (with the exception of those identified as counting toward Age and Service eligibility in the table below) may NOT be used to satisfy the Age and Service Covered Earnings requirement or to earn an Age and Service Credit.
 

SAG-AFTRA Agreements

Codified Basic (Theatrical)

Yes

Yes

Television Programming (Network, Cable, Public, Made for Video, Animation, Exhibit A)

Yes

Yes

Television Commercials

Yes

Yes

Infomercials

Yes

Yes

New Media

Yes

Yes

Interactive Media

Yes

Yes

Corporate/Educational

Yes

Yes

Music Videos

Yes

Yes

Television Network Code (Front-of-the-book)

Yes

Yes

New Media Network Code (Front-of-the-book)

Yes

Yes

Sound Recordings Code

No

No

Audiobooks

No

No

Commercial Radio Broadcasting

No

No

Radio Commercials

No

No

Regional or Local Code for Television or Radio Broadcasting

No

No

Network/Station Staff

No

No

How You First Qualify for Earned Eligibility

Base Earnings Period

Your Base Earnings Period is the first four consecutive Calendar Quarter period during which you qualify for Earned Eligibility as described in this section. Going forward, your Covered Earnings during this same four-quarter period will determine if you continue to qualify for Plan benefits in future years.

You become eligible for 12 months of health coverage once the Plan reviews your Covered Earnings and Eligibility Days. Generally this determination occurs approximately six weeks after the end of your Base Earnings Period. This six-week period is needed for employers to submit reports of your earnings and for the Plan to process these reports.

You cannot qualify for Plan I and Plan II simultaneously. You will be eligible for the Plan for which you first meet the requirements. Subsequent Covered Earnings or Eligibility Days are not considered until your next Base Earnings Period, which will then be used to determine your continuing eligibility status.

Benefit Period

Once you qualify for Earned Eligibility, you are eligible for 12 months of coverage, provided that you pay the required Plan premium. This 12-month period of coverage is referred to as your Benefit Period. The Benefit Period begins on the first day of the Calendar Quarter after the Plan determines you are eligible for coverage, as outlined below.

 

Base Earnings Period/Benefit Period

January 1 – December 31

February 15

April 1 – March 31

April 1 – March 31

May 15

July 1 – June 30

July 1 – June 30

August 15

October 1 – September 30

October 1 – September 30

November 15

January 1 – December 31

Example: Qualifying for Plan II

September 30 $0
December 31 $0
March 31 $7,000
June 30 $10,000
Total Covered Earnings $17,000

In This Example:

  • The Participant begins Covered Employment in January.
  • By the end of the second Calendar Quarter (June 30), the Covered Earnings meet the Plan II earnings threshold.
  • To determine eligibility, the Plan looks back over the four-quarter period ending June 30, which is established as the Base Earnings Period in this example. This is the case even though the Participant did not actually start working until January.
  • The Participant’s Benefit Period begins October 1.

 

Example: Qualifying for Plan I

December 31 $0
March 31 $4,000
June 30 $10,000
September 30 $19,000
Total Covered Earnings $33,000

In This Example:

  • The Participant begins Covered Employment in January.
  • By the end of the third Calendar Quarter (September 30), the Participant satisfies the Plan I requirement.
  • To determine eligibility, the Plan looks back at the four-quarter period ending September 30 (since that is when the earnings requirement was met). As such, the Participant’s Base Earnings Period becomes October 1 through September 30.
  • The Participant’s Benefit Period begins January 1.

Network / Station Staff Eligibility

The qualification rules for Plan coverage are different if you are a full-time employee of a radio or TV station or a network that is a Contributing Employer and you have Covered Earnings in that capacity.

You will qualify to enroll for coverage on the first day of the month after you complete 30 days of full-time employment with a Contributing Employer if your scheduled annual Covered Earnings meet either of the earnings thresholds described earlier in this section.

In addition, if you are a network or station staff employee transferring into the Plan as part of a group from a Contributing Employer’s group health plan, you will qualify for coverage immediately (with no 30-day waiting period) upon termination of that employer’s coverage if:

  • Your scheduled annual Covered Earnings meet either of the earnings thresholds and you were enrolled in the employer’s plan for at least 30 days immediately preceding the transfer; and
  • The transfer was made according to the terms of a Collective Bargaining Agreement with SAG-AFTRA.

Benefit Period

If your coverage starts at the beginning of a Calendar Quarter, your Benefit Period will be the 12-month period beginning on the date your coverage starts. If your coverage start date is not on the first day of a Calendar Quarter, your Benefit Period will be the 12-month period that starts on the Calendar Quarter which follows your coverage start date. The one or two months prior to the start of your initial Benefit Period is called interim eligibility.

Network/Station Staff Eligibility

February 1, March 1 or April 1 April 1 – March 31
May 1, June 1 or July 1 July 1 – June 30
August 1, September 1 or October 1 October 1 – September 30
November 1, December 1 or January 1 January 1 – December 31

Covered Roster Artist Eligibility

A special qualification rule applies to certain roster artists, including newly signed roster artists, signed to an exclusive recording agreement with a signatory record label that is party to the Covered Roster Artists side letter agreement to the current SAG-AFTRA National Code of Fair Practice for Sound Recordings (Sound Code). The Sound Code requires the signatory record label to make an annual special payment to the Plan on the roster artist’s behalf to provide one year of coverage under Plan II.

Under this alternate eligibility rule, if your royalty earnings from the label over the current and immediately preceding six-month reporting period are insufficient for you to meet the Plan’s earnings requirements, you will be eligible to enroll in Plan II coverage for one year provided that you pay the premium and the label makes the annual special payment required under the Sound Code. You may also enroll in one year of Plan II coverage if you are a new artist who recently signed a royalty agreement with a signatory label and you do not yet have sufficient earnings to qualify under the earnings requirements, provided that you pay the premium and the label makes the required annual special payment to the Plan.

Note that the record label is required to make the special payment on your behalf only if you enroll in the Plan and pay the required premium in full by the due date.

Benefit Period

The special employer payment will provide one year of coverage beginning as described below.

Covered Roster Artist Eligibility

January – June 30

October 1

October 1 – September 30

July 1 – December 31

April 1

April 1 – March 31