• This page contains information for the SAG-Producers Health Plan.

    Visit the SAG-AFTRA Health Plan website at www.sagaftraplans.org.

     
  • Summary of Benefits and Coverage

     
  • HOSPITAL (including Mental Health and Substance Abuse Treatment)

      Network Provider
    Non-Network Provider
    Calendar Year Deductible The Industry Health Network:
    $150/person
    $300/family

    BlueCard PPO / Beacon Health Options (formerly ValueOptions):
    $250/person;
    $500/family
    Not covered
    Inpatient (Room/Board/Ancillary Svcs.) 90% Not covered*
    Outpatient Surgery 90% Not covered
    Emergency Room 90% after $100 copay; copay is waived if immediately confined Not covered*
    Coinsurance Out-of-Pocket Limit $1,750/person;
    $3,500/family
    Not covered
    *Emergency treatment within 72 hours after an accident or within 24 hours of a sudden and serious illness will be covered at the Network Level of Benefits.
     
  • MEDICAL

      Network Provider Non-Network Provider
    Calendar Year Deductible The Industry Health Network:
    None

    BlueCard PPO / Beacon Health Options (formerly ValueOptions):
    $250/person;
    $500/family
    $500/person;
    $1,000/family
    Office Visit (including X-Ray and Lab) 90% after $15 copay 70% after $15 copay
    Surgeon - Inpatient 90% after $100 copay 70% after $100 copay
    - Outpatient Hospital, Surgical Center, Surgical Suite

    90% after $100 copay

    70% after $100 copay*
    - Doctor's Office 90% after $15 copay 70% after $15 copay
    Maternity Care - Prenatal Visits No deductible; 100% 70%
    Maternity Care - Delivery 90% after $100 copay 70% after $100 copay
    Routine Physical Exam No deductible; 100% No deductible;
    70% after $15 copay
    Routine Child Exam No deductible; 100% No deductible;
    70% after $15 copay
    Mammogram/Pap No deductible; 100% No deductible; 70%
    Coinsurance Out-of-Pocket Limit $1,000/person; $2,000/family $2,500/person; $5,000/family
    Hospital/Medical Out-of-Pocket Maximum (includes Deductibles, Copays, Coinsurance) $6,850/person; $13,700/family None
    Other Benefits The following benefits are also available subject to specific rules:

    Therapy, Outpatient Nursing, Case Management.

    *If the surgery takes place in a non-network surgical suite or ambulatory surgical center, the Plan will allow up to $1,000 for use of the facility's operating and recovery rooms and all central supplies when medically necessary for the procedure performed. The Plan will also allow up to $1,000 for the use of a non-network birthing center. Coverage for network surgical suites and surgical centers and for network birthing centers is provided under the hospital benefits.

     
  • PRESCRIPTION DRUGS

    Participating Pharmacies Express Scripts Participating Retail Pharmacy Express Scripts Home Delivery (includes Specialty)
    Specialty medications must be obtained through by mail through the specialty pharmacy, Accredo.
    Calendar Year Deductible $150/person; $300/family
    Supply Up to a 30 day supply/prescription or refill Up to a 90 day supply/prescription or refill
    Copay The greater of: The greater of:
    Generic - $10 or 10% Generic - $20 or 10%;
    max copay is $50 / prescription
    Preferred Brand - $25 or 25% Preferred Brand - $50 or 25%;
    max copay is $125 / prescription
    Non-Preferred Brand - $40 or 40% Non-Preferred Brand - $100 or 40%;
    max copay is $300 / prescription

    In addition, if you receive a brand name drug when a generic exists, you will pay the difference in cost between the generic and brand name medication.

    Generic prescription contraceptives are covered at 100% with no deductible or copay.

    In addition, if you receive a brand name drug when a generic exists, you will pay the difference in cost between the generic and brand name medication subject to the maximum copays listed above.

    Generic prescription contraceptives are covered at 100% with no deductible or copay.

     
  • MENTAL HEALTH AND SUBSTANCE ABUSE

      Beacon Health Options (formerly ValueOptions) Provider Non-Network Provider
    Hospital and Alternative Levels of Care Covered under the Hospital Benefit Not covered
    Medical Covered under the Medical Benefit Covered under the Medical Benefit
     
  • DENTAL

      Delta Dental PPO Provider Delta Premier and Non-Network Providers
    Calendar Year Deductible $75/person; $200/family;
    waived for diagnostic and preventive
    $75/person; $200/family
    Diagnostic and Preventive Benefits 100% 75%
    Basic Benefits 75% 75%
    Major Benefits 50% 50%
    Calendar Year Maximum* $2,500 $2,500
    * There is no dental maximum for individuals under age 19.
     
  • VISION - EXAM PLUS PLAN

      Vision Service Plan Provider Non-Network Provider
    Eye Exams 100% after $10 copay;
    one exam/calendar year
    80% up to maximum payment of $50;
    one exam/calendar year
    Glasses 20% discount No benefit
    Professional Services for Contact Lenses 15% discount No benefit