Health Summary Plan Description

Earned Eligibility

For the latest updates to these rules and information, please see the Fall 2015 Take 2.

Eligibility Requirements

The Health Plan has two levels of benefits: Plan I and Plan II. There are three ways to qualify for coverage: Covered Earnings, Days of Employment (Alternative Eligibility Program), or a combination of age, service and Covered Earnings (Age and Service – see page 2). The manner in which you qualify for coverage determines the level of Plan benefits you will receive.

Covered Earnings and Days of Employment

Covered Earnings are those earnings generated in connection with your work as an actor in theatrical motion pictures, television motion pictures, television commercials, corporate or educational motion pictures, public television, music videos and interactive media projects in accordance with Collective Bargaining Agreements between SAG-AFTRA and Producers in the industry. Earnings are typically credited to the quarter in which payment is made.

If you do not satisfy the Covered Earnings requirement, you may qualify under the Alternative Eligibility Program based on your Days of Employment. Days of Employment are determined by dividing your total sessional earnings by the SAG-AFTRA minimum daily rate, which is based on the type of production.

These services must be performed for Producers who have signed Collective Bargaining Agreements with SAG-AFTRA. Contributions may only be made by signatory Producers in accordance with the Health Plan Trust Agreement.

Minimum Requirements

The minimum requirements for Earned Eligibility beginning on or after the first day of any calendar quarter in 2013 are outlined below. Calendar quarters start on January 1st, April 1st, July 1st and October 1st. These minimum requirements may increase each year. The Trustees have set a target increase of 3% per year, although they will determine the actual size of the increase based on an annual review of the Health Plan's financial condition.

In addition to satisfying one of these requirements you must pay the Health Plan premium. Premium rates and payment rules are outlined on page 13.

Plan I
You must earn at least $30,750 in Covered Earnings in your Base Earnings Period (see page 3) in order to generate Earned Eligibility for Plan I.

Plan II
There are three ways to generate Earned Eligibility for Plan II:

  • Earn at least $15,100 in Covered Earnings in your Base Earnings Period; or
  • Alternative Eligibility Program – Have at least 76 Days of Employment in your Base Earnings Period; or
  • Age and Service – If you are at least age 40 on the first day of your Benefit Period (see page 4), and have at least 10 years of Earned Eligibility, you must earn at least $10,900 in Covered Earnings in your Base Earnings Period. All years during which you qualified for Earned Eligibility will count toward the 10-year requirement, even those years for which you chose not to pay the premium.

Special Note Regarding the Alternative Eligibility Program

As outlined above, the Alternative Eligibility Program allows you to earn a year of Plan II coverage based on Days of Employment. The Alternative Eligibility Program also applies to the Pension Plan; however a Pension Credit earned under this Program will not be applied toward Senior Performers Health Plan eligibility or eligibility under the Extended Spousal benefit.

Non-Covered Earnings

Non-Covered Earnings are those earnings that do not require contributions to be made to the Health Plan; consequently, they are not counted in determining eligibility for benefits under this Plan. Some examples of Non-Covered Earnings are:

  • Payments for various penalties and allowances such as meal penalties, payments for rest period violations, traveling, lodging or living expenses, interest or liquidated damages (late fees), reimbursements for special hair dress, for wardrobe damage or for the use of personal automobile or other equipment.
  • Residual payments for the following:
    • Television motion pictures produced prior to June 1, 1960.
    • Television commercials produced prior to November 16, 1960.
    • Theatrical motion pictures produced prior to January 31, 1966, and released to free television. (Theatrical motion pictures produced after that date and released to television after July 31, 1971 may be counted for eligibility.)
  • Earnings in excess of the theatrical, television and commercial contribution limits. For a schedule of the applicable "ceilings" amounts, please call the Plan Office or visit the Plan's website, www.sagph.org, and click the link for "employers", or contact the Plan Office by email at email us or by phone.
  • Payments for work performed for a non-signatory company.
  • Payment for services not covered by a SAG-AFTRA Collective Bargaining Agreement, such as producing, directing and writing services.

Base Earnings Period

Your Base Earnings Period is your qualification period. It is the first consecutive four-quarter period in which you meet the Covered Earnings, Days of Employment or Age and Service requirement for Earned Eligibility. If you have, you will be entitled to 12 months of Earned Eligibility coverage provided you pay the Health Plan premium described on page 13. This 12-month period of Earned Eligibility coverage is referred to as your Benefit Period.

Becoming eligible for coverage

You become eligible for 12 months of health coverage when the Plan reviews your Covered Earnings and Days of Employment. This occurs approximately six weeks after the end of the Base Earnings Period. This six-week period is needed for employers to submit reports of your earnings and for the Plan to process these reports. The 12-month Benefit Period begins on the first day of the calendar quarter after the date that the Plan determines that you are eligible for coverage.

You cannot qualify for Plan I and Plan II simultaneously. You will be eligible for the Plan for which you first meet the requirements. Subsequent Covered Earnings or Days of Employment are not considered until your next Base Earnings Period which will then be used to determine your continuing eligibility status.

In the example below, a participant begins working in covered employment in January. By the end of the second quarter (June 30th), the participant has enough Covered Earnings to satisfy the Plan II requirement. In determining this, the Plan looks back over the four-quarter period that ends June 30th, even though the participant did not actually start working until January. His Base Earnings Period becomes July 1st through June 30th.

Qualifying for Plan II
Quarter Earnings
Jul 1 through Sep 30 $0
Oct 1 through Dec 31 $0
Jan 1 through Mar 31 $7,000
Apr 1 through Jun 30 $9,000

In the next example, the participant starts working in January and satisfies the Plan I requirement by September 30th. The Plan looks back at the four-quarter period ending September 30th and the Base Earnings Period becomes October 1st through September 30th.

Qualifying for Plan I
Quarter Earnings
Oct 1 through Dec 31 $0
Jan 1 through Mar 31 $ 4,000
Apr 1 through Jun 30 $10,000
Jul 1 through Sep 30 $19,000

Benefit Period

Your Benefit Period is the 12-month period of Health Plan coverage that you earn by meeting the Covered Earnings, Days of Employment or Age and Service requirement. The Benefit Period begins on the first day of the calendar quarter after the date that the Plan determines that you are eligible for coverage.

The chart below illustrates the four Base Earnings Periods and the four corresponding Benefit Periods that may apply to you.

Base Earnings Period Approximate Eligibility
Determination Date
Benefit Period
Jan 1 through Dec 31 Feb 15 Apr 1 through Mar 31
Apr 1 through Mar 31 May 15 Jul 1 through Jun 30
Jul 1 through Jun 30 Aug 15 Oct 1 through Sep 30
Oct 1 through Sep 30 Nov 15 Jan 1 through Dec 31

Maintaining Earned Eligibility

In order to maintain your Earned Eligibility without interruption you must continue to meet the minimum Covered Earnings, Days of Employment, or Age and Service requirement during your established Base Earnings Period every year. You must also pay the applicable Health Plan premium. Once you have established Earned Eligibility, your Base Earnings Period and Benefit Period will not change unless you fail to meet the minimum requirement.

If you do not meet the minimum requirement in your established Base Earnings Period, you will no longer be eligible for Earned Eligibility in the Health Plan. To requalify for Earned Eligibility, you will have to meet the requirements outlined on page 2.

Extended Coverage for Military Service

In accordance with the Uniformed Services Employment and Re-Employment Rights Act of 1994 (USERRA), the Plan provides certain benefits for participants who have military service which started on or after October 13, 1994. Congress enacted USERRA to provide protection to individuals who are members of the uniformed services. Uniformed services are defined as:

  • The Armed Forces, The Army National Guard and the Air National Guard when engaged in active duty for training, inactive duty for training, or fulltime National Guard duty;
  • The Commissioned Corps of the Public Health Services; and
  • Any other category of persons designated by the President in time of war or national emergency.

You will have the choice of using your Earned Eligibility prior to enrolling in the Plan's Self-Pay Program, or immediately enrolling in the Plan's Self-Pay Program and freezing your Earned Eligibility for up to five years of uniformed service. In either case, the earned or selfpay premium will be waived for up to 24 months.

Upon your return from military service, you may use any frozen Earned Eligibility, provided you notify the Plan Office of your intent to resume coverage and that coverage is resumed within one year of your return from uniformed service. Please contact the Plan Office for additional information if you are going to serve or have served in the military.