Health Plan Earned Premium FAQs

  1. What are the Earned premium rates?

    Please see the chart below for Earned premium rates.

    For Coverage Commencing Jan. 1, 2015 - Mar. 31, 2016 Plan I Plan II Plan II Age and Service*
    Participant only $273
    Participant plus 1 dependent $315
    Participant plus 2+ dependents $342
    For Coverage Commencing Apr. 1, 2016 - Dec. 31, 2016: Plan I Plan II Plan II Age and Service*
    Participant only $300
    Participant plus 1 dependent $348
    Participant plus 2+ dependents $375
  2. How did the Trustees determine the premium amounts?

    The Plan's actuary provided the Trustees with the projected savings that would be realized for various premium amounts. These, together with the estimated savings for other benefit changes, had to correct the projected deficit. It was the Trustees' intent to provide a meaningful benefit program to the greatest number of participants with the lowest premium possible.
  3. Why is the premium higher in Plan II even though the benefits are lower?

    Plan II participants must pay a higher premium because virtually 100% of the cost of their coverage is subsidized - that is, the contribution received by the Plan based on their earnings does not cover the cost of the benefits. In Plan I, while some participants' coverage is subsidized, others fully cover their costs and some pay a portion of the cost for Plan II participants.

  4. Are the premiums going to change every year?

    Like all of the Plan rules, the amount of the premium is subject to review by the Trustees on an ongoing basis. However, unlike self-pay premiums, which are required under federal law to be adjusted every year, the amount of premium for the Earned and Earned Inactive coverage is determined solely by the Trustees, based on the financial condition of the Plan.
  5. How do I submit my premium payment?

    You will receive a billing statement and payment coupon, along with a payment envelope, from the Plan Office each quarter, in advance. You can pay online with a credit card or e-check or over the phone with a credit card. See here for procedures.

    You can also have the quarterly premium automatically deducted from a checking or savings account (in which case you will not receive payment coupons in the mail) by enrolling in the Auto Debit Plan. See here for information and application.

    If you wish to pay by check or money order, you should complete the payment coupon and mail it along with your check in the envelope provided. Please note that we do not accept cash payments. Payment must be sent to the payment center address shown on the coupon. Do not send your payment to the Plan Office or the SAG-AFTRA Union Office.

  6. Can I pay for the whole year in advance?

    Yes. The minimum payment is for one quarter (3 months). You can pay in advance for up to four quarters of your current eligibility period.
  7. When is my Earned premium due?

    Your premium is due on the first day of each calendar quarter. For example, the payment for the first quarter of the calendar year (January through March) is due on January 1. The due date applies even when traveling.There is a 15-day grace period and is for unforeseen circumstances only.

  8. What happens if I am late with my premium payment?

    If your payment is not received by the Plan Office on or before the due date, your Earned coverage will be terminated and you will not be eligible for coverage until your next benefit period, provided you re-qualify and meet the minimum earnings requirement. You cannot enroll in the Self-Pay Program and you will not be eligible for conversion options.

    If your coverage is terminated because your payment was not received by the due date you can reinstate your coverage by using a late payment waiver. The Plan allows one late payment waiver per Benefit Period with a maximum of two late payment waivers per lifetime for Earned Eligibility. Senior Performers and dependents covered under the Extended Spousal benefit are eligible for one late payment waiver per Benefit Period. Participants may use a late payment waiver up to the last day of the quarter for which a payment is due.

    To use one of your late payment waivers, simply make your payment using our website or submit your premium payment with your billing coupon to the Payment Center. When your payment is received after the grace period, the Plan will automatically apply one of your late payment waivers (if available) and your coverage will automatically be reinstated retroactively.

  9. What happens if I cannot afford to pay the premium?

    We maintain a list of Assistance Organizations that may be of help to you!

  10. What if I don't receive payment information in the mail?

    If you are eligible and do not receive payment information in the mail by the 15th of the month before the start of the calendar quarter (for example, by December 15, 2012 for the first calendar quarter in 2013), you should call the Plan Office or pay your premium online. You will not receive quarterly payment coupons if you are enrolled in the Auto Debit Plan.

    To ensure that you receive all quarterly billing statements and other important Plan information, be sure to keep the Plan Office informed of any change in your mailing address. If you use your business manager or agent's address, you should advise them of the new rules.

  11. Does the quarterly premium apply to participants with Senior Performers coverage?

    All participants are required to pay a premium. Please see the Eligibility and Premium Rules.

  12. How can I change my tier rate?

    Your tier rate is based on the number of dependents covered under the Plan. You may enroll/dis-enroll your dependents online during your Open Enrollment Period or by submitting your completed Open Enrollment Form to the Plan Office.
  13. Can I dis-enroll as a participant but elect coverage for a dependent?

    In some cases, your dependents may be entitled to enroll in the program even if you do not elect coverage. Contact the Plan Office for more information.

  14. Once I make the election for dependent coverage and submit the premium, can I make any changes?

    You can make multiple changes during your Open Enrollment Period regardless of whether the payment is made or not. The only restriction is that once payment is made you can no longer make changes through the website. Additional changes must be made via a paper form.
  15. What are enrolled and dis-enrolled dependents?

    Enrolled dependent(s) are qualified family members the participant has chosen to cover for a specific eligibility period. Once the premium is received the participant and their dependent(s) will have health coverage. Dis-enrolled dependent(s) are individuals the participant chose not to cover for a specific eligibility period. Dis-enrolled dependents are not eligible for health coverage or Self-Pay. Dependents may only be enrolled or dis-enrolled when the participant re-qualifies or a life event occurs.

  16. How can I add a new dependent during Open Enrollment?

    You must submit a New Dependent Form and all required documents to consider your dependent(s) as qualified. Examples are a recorded marriage certificate for a spouse or a recorded birth certificate for your dependent child. Please indicate on the form if you would like the dependent(s) enrolled in the Health Plan and submit your documents via fax, email or mail. If adding the dependent changes your tier rate, we will send you a new billing statement for the difference in the new premiums. Please see the Premium Payment Rules sheet for more information.

  17. Can I add dependent(s) outside of my Open Enrollment Period?

    You may make dependent enrollment changes outside of the Open Enrollment Period if you experience a life event that results in a change in family status. A change in family status is defined as an increase or decrease in the number of your dependents, which may result from birth, adoption, marriage, establishment of a same-sex domestic partnership, divorce, dissolution of a qualified same-sex domestic partnership, death or loss of dependent "child" status as defined by the Plan, or if your dependent obtains or loses insurance coverage on their own.

    If one of these events should occur, you will be permitted to change your dependent's enrollment status and change your premium tier (if applicable) based on the addition or loss of that dependent. A written request must be submitted to the Plan Office within 30 days from the date on which the life event occurred. No verbal requests will be accepted.

  18. Can I dis-enroll my dependent(s) outside of my Open Enrollment Period?

    If you are dis-enrolling a dependent due to divorce, dissolution of a qualified same-sex domestic partnership or death, you are required to submit a copy of the final judgment of divorce, termination of domestic partnership form or recorded death certificate to the Plan Office. In the event of divorce or same-sex partnership dissolution, you must notify the Health Plan within 60 days of the date of your divorce or dissolution of your domestic partnership in order for the dependent to receive individual self-pay rights.
  19. If I dis-enroll my dependents while on Earned coverage, what will happen if I qualify for the Senior Performer plan?

    You will have the opportunity to make changes to your enrolled dependents if and when you qualify for the Senior Performer plan.
  20. If I have coverage with another entertainment industry plan, will the special coordination of benefits rules still apply?

    Yes. The current entertainment industry coordination of benefits rules apply to all tier levels. If you qualify for coverage in the SAG-Producers Health Plan and another entertainment industry plan, you should contact the Plan Office and your other carrier for their coordination of benefits rules. For more information on the special coordination of benefits rules, click here.

    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.