Health Summary Plan Description

Loss Of Eligibility

Loss of Earned Eligibility Notification

When you lose eligibility in the Health Plan, you will receive a notice from the Plan Office outlining all the available benefits and options for continued coverage. In the event of your death, your dependents will receive this information.

All notices from the Plan will be mailed to the address on file at the Plan Office. This is one reason why it is so important to keep the Plan Office informed of your current address. If you move, you may update your address on the Plan's secure website. Or, you may complete a Performer Information Form and file it with the Plan Office. This form is available on the Plan's website: www.sagph.org.

Loss of Earned Eligibility

Participants

You will lose Earned Eligibility at the end of the 12-month Benefit Period if you have not satisfied the Covered Earnings or Days of Employment requirement in your established Base Earnings Period. Health Plan coverage may also be terminated by reason of a Plan amendment which revises the eligibility requirements.

If you lose your Earned Eligibility because you do not meet the minimum requirement, you may be able to continue your coverage under one of the following programs:

Dependents

In general, coverage for your dependents ends when your coverage terminates – or sooner, if they no longer qualify as dependents. However, they may be eligible for coverage under one of the programs listed previously.

If your death occurs during your Earned Eligibility Benefit Period, coverage for your eligible dependents may continue until the end of the Earned Eligibility period accrued as a result of your reported income or employment, provided your dependents pay the Health Plan premium as outlined on page 13.

Thereafter, coverage may be extended to your eligible dependents. Please refer to "Extended Spousal Eligibility" on page 9.

Loss of Senior Performers Eligibility

If you die while you are covered under the Senior Performers Health Plan, coverage for your eligible dependents will continue until:

  • The end of the month in which your death occurs if your dependents are eligible for the Extended Spousal benefit; or
  • The later of (i) the end of the calendar year in which your death occurs, or (ii) six months following your death if your dependents are not eligible for the Extended Spousal benefit.

Loss of Extended Spousal Eligibility

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. Coverage for a permanently disabled dependent child age 26 or older will also terminate if:

  • The surviving spouse or same-sex domestic partner remarries or enters into a new same-sex civil union or domestic partnership; or
  • The surviving spouse or same-sex domestic partner dies.

Coverage for other dependent children will terminate when they no longer qualify as dependents.

If coverage terminates, you and/or your eligible dependent children may be eligible for coverage under the Self-Pay Program (see page 18).