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There’s much to learn! Here’s what’s happening for our actively working participants, who aren’t receiving a SAG or AFTRA pension.
Changes to the Plan’s earnings requirements
Premium cost changes, based on the number of family members you enroll
New rules for covering your spouse — with attestation required
Additional benefit enhancements and cost-sharing changes
What if you don’t qualify for coverage?
Your to-do list — take action!
The SAG-AFTRA Health Plan is not your only health insurance option! See several alternatives that may be available to you. And don’t forget, you can receive personalized help from Via Benefits as you consider what’s best for you.
Changes to the Plan’s earnings requirements
When you meet certain thresholds during a base earnings period, you become eligible for SAG-AFTRA Health Plan benefits. These criteria are effective for base earnings periods ending on September 30, 2020, and after.
+ For participants under age 65
You need to meet one of the requirements below to establish eligibility for the SAG-AFTRA Health Plan:
| Covered earnings threshold | $25,950 during your 12-month base earnings period; includes both sessional and residual earnings |
| Alternative days threshold | 100 days worked during your base earnings period |
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+ For participants age 65 or over and not receiving a pension
You need to meet one of the requirements below to establish eligibility for the SAG-AFTRA Health Plan:
| Covered earnings threshold | $25,950 during your 12-month base earnings period You must have at least some sessional earnings; if so, both sessional and residual earnings are included |
| Alternative days threshold | 100 days worked during your base earnings period under specified contracts |
+ Age & Service eligibility discontinued
We’re discontinuing the Age & Service criteria to establish eligibility. We’re introducing a new safety net benefit called Extended Career COBRA.
+ Effective date for your transition into the new single SAG-AFTRA Health Plan
If you meet the SAG-AFTRA Health Plan eligibility criteria, you can enroll at the start of your next benefit period (January 1, 2021; April 1, 2021; July 1, 2021; or October 1, 2021).
Here’s how the timing works:
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Unsure of your 12-month benefit period?
Check by logging in to the SAG-AFTRA Health Plan Benefits Manager
Combining Plan I and Plan II
The SAG-AFTRA Health Plan provides comprehensive coverage for your healthcare needs. We cover your day-to-day care, including doctor’s visits and prescription drugs. And we cover more complicated needs, like caring for a chronic condition, surgery, or a difficult diagnosis.
Our commitment to your health and well-being will continue, as we will combine our current Plan I and Plan II benefits into one high-quality plan in 2021.
Here are highlights of key Plan features |
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| In-network | Out-of-network | |
| - Annual deductible | ||
| UNDER HOSPITAL: | ||
The Industry Health Network:$150 / person; $300 / family BlueCard PPO/Beacon Health Options:$500 / person; $1,000 / family combined with medical |
Not covered |
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| UNDER MEDICAL: | ||
The Industry Health Network:None BlueCard PPO/Beacon Health Options:$500 / person; $1,000 / family combined with medical |
$500 / person; $1,000 / family |
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| - Coinsurance out-of-pocket maximum (for medical and hospital care) | ||
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$2,750 individual / $5,500 family |
None |
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| - Overall out-of-pocket maximum (includes deductible, copays, and coinsurance for medical, hospital, and prescription drugs) | ||
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$8,550 individual / $17,100 family |
None |
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| - Medical office visits (including telehealth) | ||
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You pay $25 copay |
Plan pays 60% of allowed amount after deductible |
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| - Emergency room | ||
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You pay $100 copay plus 10% of contract rate after you meet the deductible |
Not Covered except 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. |
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| - Inpatient hospital | ||
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You pay $100 copay plus 10% of contract rate after you meet the deductible |
Not covered |
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| - Outpatient surgery | ||
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You pay $100 copay plus 10% of contract rate after you meet the deductible |
Not covered |
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New Extended Career COBRA
When you’re not able to maintain eligibility for your next benefit period, you can choose to continue SAG-AFTRA Health Plan coverage through COBRA. And, if you qualify for our new Extended Career COBRA benefit you will pay a significantly reduced COBRA premium. Note: Retirees receiving a SAG or AFTRA pension, Roster Artists, Station Staff, and employees of SAG-AFTRA, the SAG-AFTRA Foundation, the SAG-Producers Pension Plan and the AFTRA Retirement Fund are not eligible for Extended Career COBRA.
Here’s how it works.
The new benefit is designed for performers working continuously in the industry — but who may work and earn less than anticipated during a given year.
If you qualify for our new Extended Career COBRA benefit – and you elect timely – you will pay a reduced premium of 20% of the COBRA rate.
To qualify, you need to meet the following thresholds:
+ Covered earnings during your base earnings period
$20,000
AND
+ Extended Career Credits*
- With at least 12 Extended Career Credits, you will pay a reduced premium of 20% of the COBRA rate for up to 12 months
- If you have 20 or more Extended Career Credits, you will pay a reduced premium of 20% of the COBRA rate for up to 18 months
* You receive an Extended Career Credit each time you meet the Plan’s earnings requirements and qualify for 12 months of coverage. Your current Age & Service credits will be converted to Extended Career Credits.
You’ll receive a notice of qualification for SAG-AFTRA Health Plan coverage or COBRA about 45 days before your next benefit period. For reference, check out the current COBRA premiums; 2021 premiums will be published in late October.
Premium costs will increase on January 1, 2021. Your quarterly cost will be based on the number of family members you cover. |
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| Participant only | $375 per quarter |
| Participant plus one dependent | $531 per quarter |
| Participant plus two or more dependents | $747 per quarter |
The new premiums apply to all active participants as of January 1, 2021.
New rules for covering your spouse — with attestation required
If you cover your spouse, be sure to understand our new working spouse rule. Get more details.
Additional benefit enhancements and cost-sharing changes
Beginning January 1, 2021, you’ll notice several changes to your coverage and cost-sharing between you and the Plan. Get more details.
What if you don’t qualify for coverage?
Be sure to contact Via Benefits to explore your options. A personal benefits advisor can help you compare all your options — whether through the Via Benefits marketplace, your state’s health insurance marketplace, Medicare, COBRA, and more.
If you don’t qualify for your current coverage, you’ll receive an offer to extend your current coverage through COBRA. You may also be eligible for our new Extended Career COBRA benefit and several additional alternatives.
You’ll receive a COBRA offer about 45 days before you lose eligibility for coverage.
Learn more about Temporary COBRA Relief
If you’ll lose your current active Plan coverage as of October 1, 2020, January 1, 2021, or April 1, 2021, be sure to learn more about our Temporary COBRA Relief Program, which will reduce the COBRA premium for qualified participants.
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, during September, October, and November.
+ Pay close attention if your benefit period runs from January 1 – December 31!
- Watch for personalized Plan information in November. You’ll need to enroll in the SAG-AFTRA Health Plan and pay your first premium by January 1, 2021.
- Enrolling your spouse? You’ll need to return your spouse coverage attestation to the plan by January 1, 2021. You’ll receive instructions for completing the process in November. Watch your mail for details.
- Losing your current coverage? Decide if you want to enroll in COBRA (or contact Via Benefits to discuss your options). Your COBRA offer will note any deadlines.
+ If your current benefit period runs out in 2021 (March 31, June 30, or September 30):
- You’ll receive information about your next benefit period about 45 days before your coverage ends. Watch for your mail for details.
+ How to contact Via Benefits
| Medicare-eligible participants | Participants under age 65 |
|---|---|
| Phone: (833) 981-1280 Web: my.viabenefits.com/sagaftrahp | Phone: (833) 963-1230 Web: marketplace.viabenefits.com/sagaftrahp |