SAG-AFTRA Health SPD

Retiree and Senior Performers Coverage

As a Retiree, if you meet certain requirements, you may also be considered a Senior Performer (see page 9 for a definition of Senior Performer). As noted in Section II:

  • Retirees who meet the Plan’s Earned Eligibility requirements applicable to Retirees and Senior Performers may enroll in the Plan, with the Plan  paying primary benefits and Medicare (if you are enrolled) paying secondary. 
  • Retirees who do not meet the Earned Eligibility requirements will have access to the SAG-AFTRA Health Plan / Via Benefits program, with options to enhance and supplement Medicare coverage. In addition, Retirees who meet the requirements to be a Senior Performer are eligible for the SAG-AFTRA Health Plan Senior Performers Health Reimbursement Account (HRA) Plan if they are not eligible for coverage under this Plan. 

If you meet the Earned Eligibility requirements and decide to enroll in coverage under this Plan, your medical, prescription drug, dental, life insurance and vision benefits for Senior Performers are the same as those offered to Active Participants.

It is important to note that benefits for Senior Performers (including access to the SAG-AFTRA Health Plan / Via Benefits Program and the SAG-AFTRA Senior Performers HRA) are offered under the SAG-AFTRA Health Fund and are not part of the benefits provided by the AFTRA Retirement Plan or the SAG-Producers Pension Plan. 

Like all benefits under the SAG-AFTRA Health Plan, Retiree and Senior Performers benefits are not guaranteed and may be amended, modified or terminated at any time for those who are or may become covered by these benefits.

Regaining Earned Eligibility

Each year, the Plan will evaluate covered earnings during the Base Earnings Period from October 1 to September 30, to determine the coverage offered for the next calendar year. See page 9 for additional information as to what earnings are considered in determining eligibility for coverage.

You may meet the requirements for Earned Eligibility if:

  • You meet the minimum Covered Earnings threshold for Earned Eligibility.
  • You meet the Alternative Days requirement.
  • You become a Covered Roster Artist.
  • You become a Network / Station Staff.
  • You become a Staff Employee.

If you meet one of the requirements, you may enroll in Active Plan coverage, and Medicare will become secondary to the Plan. Refer to Section II for more details on Plan eligibility.

Senior Performer Surviving Dependent Eligibility Following the Death of a Senior Performer

The Senior Performer Surviving Dependent benefit provides health benefits upon the death of a Senior Performer (or a Participant or former Participant who meets certain requirements described below) to their Eligible Dependents, provided the deceased individual meets certain requirements at the time of their death. An Eligible Dependent includes the deceased individual’s Dependent children and surviving legal spouse, provided the deceased individual and their spouse were married for at least 12 months immediately preceding the individual’s death.

The Senior Performer Surviving Dependent benefit is provided to the deceased individual’s Eligible Dependents if at least one of the following applies:

  • The Senior Performer was at least age 65 at death and had at least 20 Retiree Health Credits;
  • The Senior Performer was at least age 65 at death, had at least 15 qualifying years under the AFTRA Health Plan or at least 15 pension credits under the SAG-Producers Pension Plan as of December 31, 2016, and was age 55 or older on December 31, 2016; or
  • The Participant or former Participant was at least age 50 at death, had at least 20 Retiree Health Credits, and their age plus Retiree Health Credits was at least 75. Coverage for their Dependents will begin on the date the deceased individual would have turned 65.
  • Coverage for the surviving spouse will continue until the spouse remarries or dies, provided the Plan premium is paid. Coverage for the Senior Performer’s surviving spouse is subject to termination under the Working Spouse rule. Coverage for the Senior Performer’s surviving spouse will also end once the spouse becomes Medicare-eligible, at which point they will have access to the SAG-AFTRA Health Plan / Via Benefits program. 

Coverage for Dependent children will continue until they no longer meet the Plan’s definition of a Dependent, provided the Plan premium is paid.

The Plan requests verification of the marital status of all surviving spouses covered under this benefit annually during the Open Enrollment Period. Eligibility for this coverage will not be extended unless the Plan receives a completed questionnaire.

In some cases, Dependents may be able to continue coverage under COBRA after their eligibility for Senior Performer Surviving Dependent benefits ends. The Dependents will be notified by the Plan if this additional coverage is available.

Senior Performer Surviving Dependent eligibility may be replaced with Earned Eligibility if the Participant met one of the requirements outlined on the previous page under “Regaining Earned Eligibility” (i.e. if sessional earnings are attributed to the deceased Participant). 

Note: Senior Performer Surviving Dependent benefits are not guaranteed and may be amended, modified or terminated at any time.

 

Special Grandfathering Rule for Those With AFTRA or SAG Retiree Health Coverage

If, as of December 31, 2016, you are eligible for or are receiving health coverage under either the AFTRA Health Plan’s Senior Citizen Health Program or the SAG-Producers Health Plan’s Senior Performers benefit, including occupational disability pensioners receiving Senior Performers coverage under the SAG-Producers Health Plan, you will be eligible for Senior Performers coverage under Plan I of the SAG-AFTRA Health Plan beginning January 1, 2017.