SAG-AFTRA Forms

Participant Information Form

Update your contact information with the Plan. You can also update your information by logging in to your Benefits Manager

New Dependent Form

Add new dependents for health coverage during open enrollment or following a life event. You can also add dependents by logging in to your Benefits Manager

Designation of Beneficiaries Form

Use this form to designate the beneficiaries of your Plan benefits in the event of your death.

Authorization for Release of Health Information Form

Give us permission to disclose your health information to a specific person or organization.

HRA Enrollment Waiver

Senior Performers should use this form if they have health coverage through Medicaid, Medi-Cal, military (TRICARE, VA), another retirement plan or are ineligible for Medicare due to residency requirements. When submitting the form, please attach the required documentation.  

Working Spouse Rule Form

The Plan’s Working Spouse Rule states that if enrolling a spouse, you must confirm whether they are working for an employer that offers health plan coverage. An annual update will be required at the start of the new benefit period. For your convenience you may complete the verification process on the Benefits Manager, if needed please complete the attached form and follow the instructions on the form to submit to the Plan.

Surviving Spouse: Annual Update and Working Spouse Rule Form

An annual update will be required at the start of each new benefit period to confirm the marital status and to complete the Working Spouse Rule verification for an enrolled surviving spouse. Please complete the attached form and follow the instructions on the form to submit to the Plan.