This section describes the premium payment rules for Earned Eligibility, Senior Performers coverage and the Surviving Dependent benefit. The premium payment rules for COBRA Continuation Coverage.
All Participants must pay a premium for Plan coverage. The amount of your premium depends on the type of coverage or plan option for which you qualify, as well as how many Dependents you enroll.
Premium Changes and Dependent Coverage
As a Participant, it is your responsibility to notify the Plan when you acquire new Dependents, marry or divorce. A new Dependent cannot be added to your coverage until we receive a Dependent Enrollment Form and the required documentation. For additional information about notification requirements and deadlines related to enrolling or disenrolling Dependents, refer to the “Life Events and Dependent Coverage.”
Premium changes related to a change in your covered Dependents are effective as follows:
- If you are enrolling a new Dependent outside the Open Enrollment Period, the premium change will be effective back to the 1st day of the month in which the life event occurred.
- If you are disenrolling a Dependent outside the Open Enrollment Period, the premium change is effective on the 1st day of the month following the month in which the event occurred.
Earned Eligibility Premium
For most Participants with Earned Eligibility, the premium is due quarterly. This premium also applies to those covered under the Plan’s Total Disability Extension. Your quarterly premium costs will be based on the number of family members you cover. The premiums below are effective as of January 1, 2021 and are subject to adjustment at the Trustees’ sole discretion. Refer to www.sagaftraplans.org/health for the current premiums.
Earned Eligibility Premiums
|Coverage Elections||Premium Costs for 2021|
|Participant Only||$375 per quarter|
|Participant Plus One Dependent||$531 per quarter|
|Participant Plus Two or More Dependents||$747 per quarter|
Retirees and Senior Performers who do not meet the Earned Eligibility requirements may enroll in plan(s) through the SAG-AFTRA Health Plan / Via Benefits program.
Senior Performers who enroll in a Via Benefits Medicare plan, or who enroll in a Medicare plan through AHIRC and EHIS (in connection with the Actors Fund and the MPTF) may choose to enroll their Eligible Dependents with the Plan as Senior Performer Dependents. These may include your legal spouse under age 65 and your eligible children under age 26. The premium cost for Dependents of such Senior Performers is $250 per month, which covers all your eligible family members (one or more). The Working Spouse rule applies to spouses of Senior Performers who are eligible for coverage under this Plan.
The premium cost may vary for Senior Performer Surviving Dependents. Contact the Plan, or log in to Benefits Manager to see the applicable premium.
Premium Payroll Deduction Available to Some Network/Station Staff
If you are a Network/Station Staff Participant, the station or network that employs you may deduct Plan premiums from your paycheck. If this is the case, you are not required to make separate quarterly premium payments, though it is your responsibility to ensure that the payments are being made on your behalf. To learn if this option is available to you, contact your employer’s Human Resources department.
Important Note: If your Plan coverage is terminated because you do not pay your premium, your coverage under other entertainment industry health plans may be reduced or eliminated under those plans’ coordination of benefits rules. Please contact your other health plan for more information.
You may pay the premium in advance, regardless of your method of payment (except for automatic payments, which are described below). However, you may not pay the premium for any period beyond your current Benefit Period.
Automatic payment – The automatic payment option deducts your quarterly Earned Eligibility premium or monthly Senior Performers/Surviving Dependent premium from your U.S. checking or savings account. Payments are deducted on approximately the 25th of the month prior to the due date. The Plan will continue to deduct the premium as long as you remain continuously eligible for coverage, even if there is a change in the premium because you experience a change in your eligibility type or benefit plan, or if the Trustees make a change to the premium. Sign up for the automatic premium payment option.
Pay online – You may pay your premium online by check or with a credit/debit card. Simply enter your U.S. checking or savings account number or your credit/debit card information. You will receive electronic confirmation that your payment has been received.
For your protection, online payments and phone payments are non-recurring. This means the Plan will not automatically charge your credit card or debit your account everytime a payment is due. For recurring payments that you do not have to initiate, choose the automatic payment option.
Pay by phone – You may pay your premium by telephone 24/7 with a credit/debit card by calling the Plan at (800) 777-4013 and following the prompts. You will receive a confirmation number indicating that your payment has been received. For your security, this is an automated system; Plan staff will not be able to take your credit card information.
Pay by mail – A quarterly premium billing statement will be sent to you a few weeks before the due date. Make your check, money order or cashier’s check from a U.S. bank payable to the SAG-AFTRA Health Plan and send it with your coupon in the envelope provided to the address below.
SAG-AFTRA Health Plan Payment Center
P. O. Box 30110
Los Angeles, CA 90030-0110
To help ensure that your premium payment is processed correctly, please write your SAG-AFTRA Health Plan health care ID number (found on your premium billing statement) on your check. Your payment must be received no later than the due date to be on time.
Do not send your payment to the Plan’s regular mailing address or to the SAG-AFTRA union office.
Any check or debit returned to the Plan for any reason will be assessed a fee. You may replace the premium payment and pay the fee using any of the payment options outlined above.
Deduction from monthly pension – If you are eligible for Senior Performers coverage, you may choose to have the monthly premium automatically deducted from your monthly AFTRA Retirement Plan or SAGProducers Pension Plan pension benefit. This option provides convenience and helps ensure that your health coverage will continue uninterrupted so long as you remain eligible.
Premium Due Dates
Your premium is due on the first day of each Calendar Quarter for Earned Eligibility coverage. For those with Senior Performers or Surviving Dependent coverage, the premium is due on the first day of each month unless you are paying by mail. In this case your premium is due on the first day of each Calendar Quarter. For example, the quarterly payment for the first quarter of a calendar year (January through March) is due on January 1. While there is a 15-day grace period, this should only be used for unforeseen circumstances. Coverage will not be granted until your premium is processed.
If the Plan does not receive your premium by the due date, you are not entitled to coverage until your next Benefit Period. If your coverage is terminated due to your non-payment, you will not be offered COBRA Continuation Coverage, nor will you be offered any other Plan coverage options.
For example, if your Benefit Period is January 1 through December 31 and you fail to pay your first quarterly premium by the end of the grace period on January 15, you will not be entitled to Plan coverage until the following January 1, provided you re-qualify for coverage at that time by meeting the eligibility requirements.
Late Payment Waivers
If your payment is not received by the due date, including the grace period, you may reinstate your coverage by using a late payment waiver. The Plan allows one late payment waiver per Benefit Period, with a maximum of two late payment waivers per lifetime for Earned Eligibility. Individuals with Senior Performers or Surviving Dependent coverage are eligible for one late payment waiver per Benefit Period. Participants may use a late payment waiver up to the last day of the quarter for which the payment is due.
To use a late payment waiver, simply make your payment:
- By phone at (800) 777-4013; or
- By submitting your payment with your billing coupon.
When your payment is received after the grace period, the Plan will apply one of your late payment waivers (if available), and your coverage will be reinstated retroactively.
SAG-AFTRA Foundation Grant Program
The SAG-AFTRA Foundation is a separate legal entity from the SAG-AFTRA Health Plan that provides charitable, educational and humanitarian services for SAG-AFTRA members. The Foundation, established in 1985, also offers services to SAG-AFTRA members as well as opportunities to those interested and able to assist those who need help. Based on rules determined solely by the Foundation, individuals who have a catastrophic illness or injury and who, due to financial need, cannot afford the Plan’s premium may be offered financial grants to help pay the premium.
Grant Qualification Requirements
To qualify for a SAG-AFTRA Foundation grant the individual must be a Participant or Dependent under the Plan. The applicant must qualify for Earned Eligibility, Senior Performers benefits, Surviving Dependent benefits or COBRA Continuation Coverage and must meet the following requirements:
- The applicant has a catastrophic illness or injury, which means an illness or injury which prevents you from performing the material and substantial duties of your regular occupation, and the effects of which are likely to be of long or indefinite duration. With respect to a minor Participant or Dependent, catastrophic illness or injury means an illness or injury which prevents you from engaging in most of the normal activities of a person of like age and gender in good health, and the effects of which are likely to be of long or indefinite duration.
- The applicant must be suffering from a financial hardship that prevents the individual from being able to afford the premium payments.
If the Foundation approves a grant for Earned Eligibility, Senior Performers benefits or Surviving Dependent benefits, grant funds will automatically be applied to the cost of the premium of the Plan for which you qualified – either Plan I or Plan II.
If a grant is approved for COBRA Continuation Coverage, the grant funds will be applied to the cost of the COBRA premium for the medical portion of Plan II. The applicant is responsible for paying the dental portion of the COBRA premium. If additional COBRA Continuation Coverage is desired, such as choosing to enroll in Plan I, the additional premium amount must be paid by the applicant.
Coverage will terminate on the earlier of:
- The date the applicant no longer qualifies for Plan coverage;
- The date on which the grant funds have been exhausted; or
- The date the applicant stops paying his or her portion of the premium (if applicable).
Contact the Plan for an application or more information about the SAG-AFTRA Foundation and other assistance organizations.