Health Plan Eligibility FAQs

  1. How will I know when I have met the eligibility requirement?

    Once you have met the earnings or days worked requirement for eligibility, the Plan Office will send you a Notice of Qualification. You will receive ID cards after the Plan receives your initial premium. The Notice outlines your eligibility period, type of eligibility and benefit coverage. If you believe you have met the eligibility requirement but do not receive a Notice of Qualification, you should call the Plan Office.
  2. What is the reason for the three-month waiting period between the earnings and the benefit periods?

    The three-month waiting period is needed for employers to submit reports of earnings and for the Plan to process these reports so that we can be sure that we have all of your earnings.
  3. How does the Alternative Eligibility Program work and how are days of employment calculated?

    The Health Plan has an Alternative Eligibility Program in the event you do not meet the minimum covered earnings requirement. You qualify for Earned Plan II coverage if you work the required number of days in covered employment (See here) and pay the required premium. Eligibility is calculated by dividing the total sessions earned by the daily rate, which is based on the type of production. If you have any questions about your alternative days calculation, please contact the Participant Eligibility Department at the Plan Office, extension 6232.
  4. Can I combine my earnings with those of my spouse so that we can qualify for benefits?

    No. Contributions to the Plan and eligibility for benefits are made on an individual basis.
  5. Can I pay the difference of what I need to qualify for benefits? For example, if I'm $40 short of meeting the earnings requirement, can I pay $40 to the Plan?

    No. The earnings or days of employment requirement is based solely on your earnings or days of employment covered by the collective bargaining agreement. You cannot pay for any shortfall. The premium you pay for Earned or Earned Inactive coverage does not count as earnings for eligibility.
  6. Are my Health Plan benefits guaranteed?

    No. The benefits and coverage provided under the Health Plan, whether Earned, Retiree or Self-Pay, are not contractual benefits. The benefits may be reduced, modified or discontinued by action of the Trustees at any time. Health Plan benefits will never vest.
  7. Do I have to accept or use this insurance?

    No. You are not required to use the insurance coverage. If you meet the requirements for Earned eligibility but do not want to use the insurance, you can simply not pay the premium and your coverage will be terminated.

    If your coverage in this Plan is terminated because you did not pay your premium and this coverage would have been primary to another entertainment plan, coverage for you and/or your dependents under the other plan may be reduced or eliminated. You should contact your other plan for further information about how your coverage may be affected should you choose to let your coverage under this Plan lapse or choose not to enroll your dependents.
  8. What happens if I lose Earned eligibility because I do not meet the minimum earnings requirement?

    If you do not meet the minimum earnings or days requirement for continued Earned eligibility, you will receive a notice from the Plan Office advising you of your options, including the Health Plan's Self-Pay program and conversion options. If you are totally disabled, you may be entitled to an extension of coverage. You can also seek private insurance coverage.
  9. Can you recommend any other health insurance companies?

    The Plan cannot make recommendations regarding specific companies. However, we urge participants who lose Earned eligibility to look at all of their options. The Plan's Web site has phone numbers and/or web links to companies offering private insurance policies as well as to government sponsored programs.
  10. Will the Plan cover my dependents automatically or must I pay for that coverage?

    Beginning July 1, 2011, the Health Plan transitioned to a new premium structure for participants with Earned Eligibility. The new structure requires different payments depending on whether or not you cover your dependents under the Plan.
  11. How do I add a dependent?

    You must complete a New Dependent Form and file it with the Plan Office. Depending on the type of dependent, the form will ask you to provide specific supporting documentation.
  12. Does the Plan cover step, adopted or foster children?

    Yes, provided you supply the proper legal documentation.
  13. Can the Trustees change the eligibility requirements?

    Yes. Under Federal law, Trustees have the authority to change the eligibility requirements and benefits provided under the Plan.
  14. Can I cover my parents?

  15. Can I get printed directories of network doctors?

    All of the managed care networks have toll free telephone numbers and internet web sites from which you can get a list of providers in your area.
  16. What is the Notice of Qualification packet and who will be receiving these?

    The Notice of Qualification packet will be sent to participants who have met the earnings requirement and qualify for benefits. This packet contains the dependent enrollment form and billing statement.
  17. When will my Notice of Eligibility packet be sent?

    Notice Of Eligibility (NOE) packets are mailed once your premium payment is received.
  18. Can I print out an NOE from the web once payment is made?

    Yes, please allow 48 hours for payment to post before printing your NOE.
  19. How long will it take to process my dis-enrollment form?

    Please allow 5-7 business days to process your dis-enrollment. You will receive a confirmation letter in the mail once your form has been processed. For faster service, log onto our secure website to make changes to your dependents and submit your premium payment.
  20. If I want to dis-enroll my dependents, what do I need to do?

    Simply use our secure website to make the change. No other paperwork or explanations are necessary. If necessary, you may return your dis-enrollment/enrollment form to the Plan Office and check the dis-enrollment check box.