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