Alyssa Lane
The SAG-AFTRA Health Insurance Plan offers a wide range of services, including medical, surgical, and mental health, life and AD&D insurance, maternity care, hearing aids, therapy, and dental and vision services. To qualify for this insurance plan, one must meet the eligibility criteria for Earned Eligibility. This includes meeting a minimum income threshold, which is currently set at $25,950 in any 12-month period, or working a certain number of days under specified contracts. The eligibility criteria vary depending on one's occupation, and there are also special rules for retirees. The cost of the plan to the member can vary between $125 and $250 per month, or up to $2501 following unemployment.
| Characteristics | Values |
|---|---|
| Name of Insurance | SAG-AFTRA Health Insurance |
| Cost | $125 - $250 per month, or up to $2501 following unemployment |
| Eligibility Criteria | $26,470 in covered earnings and 102 days working per calendar year |
| Services Covered | Medical, surgical, mental health, life and AD&D insurance, maternity care, hearing aids, therapy, dental and vision services |
| Medicare Part A Coverage | Inpatient care in hospitals and skilled nursing facilities |
| Medicare Part B Coverage | Medically necessary doctor's services and outpatient care |
| Medicare Part B Exception | Dental services in rare cases |
| Medicare Part A Exception | Dental services in hospitals |
| Medicare Part A and B | Required when Medicare is primary coverage and SAG-AFTRA Health Plan is secondary |
| Medicare Annual Enrollment Period | October 1 to December 15 |
| Qualifying Period | October 1 to September 30 |
| Alternative Days Eligibility Rule | 106 Eligibility Days during the Base Earnings Period |
| Eligibility Days Calculation | Total applicable sessional Covered Earnings divided by the SAG-AFTRA minimum daily rate |
| Minimum Earnings Requirement | $25,950 in any 12-month period |
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What You'll Learn
Minimum income threshold
To qualify for SAG-AFTRA Health Insurance, you must meet the eligibility requirements for "Earned Eligibility". This means earning above a certain threshold, which is currently set at $25,950 in any 12-month period. This threshold is known as the 'Eligibility Threshold' or 'minimum earnings requirement'. This amount must be earned from SAG work (session fees, residuals, etc) and is subject to adjustment by the Trustees.
The SAG-AFTRA Health Insurance Plan covers a wide range of services, including medical, surgical, mental health, life and AD&D insurance, maternity care, hearing aids, therapy, and dental and vision services. It costs between $125 and $250 per month, or up to $2501 following unemployment.
The eligibility criteria also include a minimum number of working days per calendar year, which is stated as 102 days by one source and 106 days by another. This is known as the 'Eligibility Days' requirement and is determined by dividing total applicable sessional Covered Earnings by the SAG-AFTRA minimum daily rate, which varies depending on the type of production.
It is important to note that the SAG-AFTRA Health Plan is secondary to Medicare, which must be enrolled in and used as the primary coverage. This means that Medicare will pay primary benefits, while the SAG-AFTRA Plan pays secondary benefits.
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Contracts and earnings
To qualify for SAG-AFTRA Health Insurance, you must meet the eligibility requirements for Earned Eligibility. This means meeting a minimum income threshold, which is currently set at $25,950 to $26,470 in any 12-month period, or working a minimum number of days on set, which is currently 102 to 106 days. This is determined by dividing total applicable sessional Covered Earnings by the SAG-AFTRA minimum daily rate, which varies depending on the type of production.
Covered Earnings include session fees, residuals, and earnings from employment under the Sound Recordings Code, the Audiobooks Agreement, the Commercial Radio Broadcasting Agreement, and the Radio Commercials Agreement. Payments for things like travel expenses, wardrobe damage, and services not covered by a SAG-AFTRA Collective Bargaining Agreement (such as producing, directing, and writing work) are considered non-Covered Earnings and do not count toward eligibility.
If you are a retiree, the plan will evaluate your earnings from October 1 to September 30 to determine your eligibility for the following calendar year. If you are not a retiree, both sessional and residual earnings are considered in the evaluation.
Once you have met the eligibility requirements and enrolled in coverage, you must pay the plan premium, which is due quarterly for most participants with Earned Eligibility. The cost to the member monthly varies between $125 and $250, or up to $2501 following unemployment.
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$13.48 $24.95
Base earnings period
To qualify for the SAG-AFTRA Health Insurance Plan, you must meet the eligibility requirements, also known as "Earned Eligibility". This is based on either the performance of work under specific contracts or earnings through a contributing employer during a set period. The minimum requirements for Earned Eligibility are outlined below.
The Base Earnings Period is the 12-month period that starts on the calendar quarter following your coverage start date. If your coverage start date is the first day of a calendar quarter, your benefit period will be the 12-month period beginning on that date.
To qualify for the Active Plan coverage, you must meet the Eligibility Threshold in Covered Earnings during your 12-month Base Earnings Period. Both sessional and residual earnings are included toward the Eligibility Threshold, which is currently $26,470. You must also meet the Eligibility Threshold for Eligibility Days (currently 102 days) worked under specified contracts during your Base Earnings Period.
To qualify under the Alternative Days eligibility rule, you must have at least 106 Eligibility Days during your Base Earnings Period. Eligibility Days are determined by dividing your total applicable sessional Covered Earnings by the SAG-AFTRA minimum daily rate, which is based on the type of production.
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Eligibility days
To qualify for the SAG-AFTRA Health Insurance Plan, you must meet the eligibility requirements, which are based on your earnings and the number of days worked. This is known as "Earned Eligibility". The eligibility criteria vary depending on your occupation, with specific contracts or earnings requirements through a contributing employer during a set base earnings period.
For retirees, the eligibility threshold is currently set at $25,950 in covered earnings during their base earnings period. This means that retirees must earn at least $25,950 from SAG work (session fees, residuals, etc.) in a year to qualify for health insurance. The SAG-AFTRA Health Insurance Plan then becomes their secondary coverage, with Medicare paying their primary benefits.
In addition to the earnings requirement, there is also an Eligibility Days criterion. This rule states that you must have a minimum of 106 Eligibility Days during your base earnings period. These days are determined by dividing your total applicable sessional covered earnings by the SAG-AFTRA minimum daily rate, which varies depending on the type of production.
It's important to note that not all work contributes to the Eligibility Days requirement. For example, earnings from employment under certain agreements, such as the Sound Recordings Code, the Audiobooks Agreement, and the Commercial Radio Broadcasting Agreement, do not count towards the Eligibility Days requirement for Alternative Days eligibility.
The SAG-AFTRA Health Insurance Plan offers comprehensive health care benefits, including medical, surgical, mental health, dental, vision, and life insurance. It also covers items such as hearing aids, therapy, and maternity care. However, it is known for its complex eligibility criteria, and the cost may be prohibitive for those earning less than $50,000 annually.
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Plan premiums
Quarterly Payments
For most participants with Earned Eligibility, including network and station staff and covered Roster Artists, premiums are typically due on a quarterly basis. The premium payment is due on the first day of each calendar quarter, and there is a 30-day grace period for these quarterly payments. However, this grace period is intended for unforeseen circumstances, and coverage will not be granted until the premium is processed.
Senior Performers and Surviving Dependents
Senior Performers enrolling eligible family members or those with Surviving Dependent coverage typically make premium payments on a monthly basis, with the premium due on the first day of each month. There is a 15-day grace period for these monthly payments.
Eligibility Threshold
To qualify for Earned Eligibility, participants must meet an Eligibility Threshold, which is currently set at $26,470 in Covered Earnings during their 12-month Base Earnings Period. This threshold includes both sessional and residual earnings. Additionally, participants must work a minimum number of Eligibility Days, which is currently 102 days, under specified contracts during their Base Earnings Period.
COBRA Coverage
The SAG-AFTRA Health Plan also offers COBRA coverage, which provides an alternative for those who have lost their Active Plan coverage. The Extended Career COBRA benefit requires earnings of $21,230 during the base earnings period from October 1, 2023, to September 30, 2024, and this requirement is scheduled to increase by 2% annually. Those who qualify for this benefit and elect COBRA coverage will pay a reduced premium of 20% of the standard COBRA premium.
Cost Range
The cost to members of the SAG-AFTRA Health Insurance plan varies, with monthly costs ranging from $125 to $250, or up to $2501 following unemployment. The higher costs are typically for those with spouses who are not Medicare-eligible, as the costs for these spouses are significantly higher.
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Frequently asked questions
You need to earn a minimum of \$25,950 from SAG work in a 12-month period to qualify for health insurance. This amount is subject to change over time.
Eligibility is determined by dividing total applicable sessional Covered Earnings by the SAG-AFTRA minimum daily rate, which is based on the type of production.
Retirees must meet the Eligibility Threshold for Eligibility Days (102 days) worked under specified contracts during their Base Earnings Period.
The cost to the member monthly varies between $125 and $250, or up to $2501 following unemployment.
The SAG-AFTRA Health insurance plan covers a wide range of services, including medical, surgical, mental health, life and AD&D insurance, maternity care, hearing aids, therapy, and dental and vision services.
