Health Summary Plan Description

Open Enrollment

When you become qualified for coverage, your Open Enrollment Period begins. You will receive an Open Enrollment packet and an enrollment form with your qualified dependents listed. It will include information about the Plan for which you qualify, your Benefit Period, the premium amount and billing statement, and how to enroll and disenroll eligible dependents. You may make changes to your covered dependents for any reason during the Open Enrollment Period. Make these changes by visiting the Plan's website at www.sagph.org or by completing the dependent enrollment form and returning it to the Plan Office. Changes to your covered dependents may affect your premium rate.

After Open Enrollment you may not make changes to your covered dependents except in certain circumstances. Please see pages 11 and 12 under "Special Enrollment Opportunities".

Once your premium is processed, your Notice of Eligibility (NOE) will be sent to you within 7 to 10 business days. The NOE will contain your Health Plan ID cards, information regarding your benefit coverage and a list of your enrolled dependents. You may also print temporary ID cards by visiting the Plan's website at www.sagph.org. The ID cards only show your name but they are also valid for your dependents.

Your Open Enrollment Period is based on your type of eligibility and your Benefit Period:

Benefit Period Start Date Approximate Open Enrollment Period
Jan 1 Dec 1 through Jan 15
Apr 1 Mar 1 through Apr 15
Jul 1 Jun 1 through Jul 15
Oct 1 Sep 1 through Oct 15

Senior Performers and dependents covered under the Extended Spousal benefit are included in the January 1st Benefit Period and corresponding Open Enrollment Period.

If you think you have met the requirements for Earned Eligibility but do not receive an Open Enrollment packet, contact the Plan Office by email at email us or by phone. Earnings are sometimes reported late by production or payroll companies and this delays the Plan Office in notifying you of your Earned Eligibility. The Plan Office will help you determine if your earnings have been appropriately reported. If the Plan Office verifies that your earnings have not been reported, you will need to provide copies of your pay stubs and/or contracts for review. Once the Plan Office reviews your proof of earnings and verifies with the employer that the earnings are reportable, you will receive written notification.

You may also verify that your earnings have been reported to the Plan by checking our interactive website, www.sagph.org. Information on registering for a user name and password to access your personal information may be found on page 74. Please keep in mind that the website will not reflect total earnings for any particular quarter until 60 days after the quarter ends.

If you change your address at any time you must notify the Plan Office in addition to the SAG-AFTRA Union Office.

Important: If you are also eligible for coverage with another entertainment industry health plan and you select Participant Only coverage, your non-covered dependent(s) may be affected by the Entertainment Industry Coordination of Benefits (EICOB) rules outlined on pages 77 and 78. If you have any questions, please call the Plan Office. You might also want to call the other plan to discuss your individual situation.

Special Enrollment Opportunities

The special enrollment opportunities described below allow you to enroll or make changes to your dependent elections outside of the Open Enrollment Period. Please note that traveling is not considered a special exception.

Loss of Other Health Plan Coverage

If you do not pay the premium because you have other group health coverage, you may be allowed to participate in this Health Plan when your other coverage ends because of a reduction in employment, legal separation, divorce or death. If the other coverage is under a COBRA provision and you exhaust your COBRA coverage, you may also be allowed to participate in this Health Plan. You must submit a written request for coverage under this Plan within 30 days after your other coverage ends, along with the certificate of coverage from your other coverage issued in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

If your Health Plan coverage is available under the Extended Spousal benefit, the only special enrollment opportunity available to you is when your other coverage ends because of a reduction in employment.

CHIP/Medicaid

Special enrollment opportunities are available to:

  • Participants and their dependents who lose coverage under Medicaid or CHIP; and
  • Participants and their dependents who become eligible for a state's Medicaid or CHIP premium assistance program.

The CHIP/Medicaid enrollment events require you to submit a written request to the Plan within 60 days of their occurrence.

CHIP is a federal/state program designed to provide health care coverage for uninsured children and some adults although benefits under this program are only provided by certain states. If you think you or any of your dependents might be eligible for Medicaid or CHIP, you can call (877) KIDSNOW or visit www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the Health Plan's premium.

Enrolling New Dependents

If you acquire a new dependent after the start of your Benefit Period you can request coverage under the Plan within 30 days of the date of marriage, establishment of a same-sex civil union or domestic partnership, birth, adoption or placement for adoption. This opportunity also allows you to enroll yourself in the Plan if you had previously opted not to pay the premium during Open Enrollment. You will need to complete a New Dependent Form and submit the appropriate documentation outlined in the chart on page 7.

Senior Performers also have the opportunity to make changes to their covered dependents in the event their spouse or same-sex domestic partner turns age 65. In the case of Extended Spousal coverage, the eligible dependents have the opportunity to re-enroll in the Plan when the spouse or partner turns age 65.

Note: If you are covered under the Extended Spousal benefit and you remarry or enter into a new same-sex civil union or domestic partnership, your Plan coverage will terminate.

Disenrolling Dependents

If you are disenrolling a dependent due to divorce, dissolution of a civil union or domestic partnership, or death, you are required to submit a copy of the final judgment of divorce, certificate of dissolution of domestic partnership or civil union, or recorded death certificate. In the event of divorce or same-sex civil union or partnership dissolution, you must notify the Plan in writing within 60 days of the date your divorce or dissolution is final in order for the dependent to receive individual self-pay rights. Medical expenses incurred by your spouse, same-sex domestic partner or stepchild on or after the date of divorce or domestic partnership dissolution are not covered by the Plan. You will be billed for expenses paid by the Plan from the date of divorce or dissolution.

Note: Enrolling and disenrolling dependents can affect the amount of your premium. Premium changes will be effective the 1st of the month in which the event occurred if enrolling a new dependent(s) and the 1st of the following month if you are disenrolling a dependent(s).

You may also want to update your beneficiaries in the event of death, divorce or dissolution. A Designation of Beneficiary Form can be obtained on the Plan's website, www.sagph.org, or by contacting the Plan Office.