Ah, the mysteries of being an actor. Among the greatest of them all — along with how to get an agent, how to get into the union, and just what the heck is a pre-read — are the ever-changing labyrinths that are our various health insurance options. They vary from union to union, from year to year, sometimes even from state to state, and then there are the options that kick in when your insurance runs out. It's so potentially confusing, it's enough to keep you healthy.
Making sense of these plans is a challenge, and, in the final analysis, it's best to visit the health insurance sections of the Screen Actors Guild, American Federation of Television and Radio Artists, and Actors' Equity Association websites and get individual answers to your specific questions as you need them, rather than attempting to grasp the whole topic all at once. But here are answers to some of the most frequently asked questions, broken down by union.
What are the eligibility requirements for health insurance through the actors' unions?
SAG
Performers who make the required SAG earnings within four consecutive calendar quarters — January through March, April through June, July through September, and October through December — are eligible for coverage under the union's Health Plan. There are two levels — Plan I and Plan II — based on the amount of your covered earnings.
They break down like so:
o To be covered under Plan I, you must earn at least $28,120 in SAG-covered earnings within a four-quarter period.
o Under Plan II, there are three ways to qualify for coverage. The first two are fairly simple: Earn $13,790, or work 74 days within four quarters, under union jurisdiction. The third way is to be at least age 40, have 10 years of Health Plan eligibility, and make $10,000 within four quarters. These amounts may increase every year.
Equity
Twelve weeks of covered Equity employment within a four-quarter period qualifies you for six months of insurance coverage; 20 weeks qualifies you for 12 months of coverage. Participants are evaluated for eligibility four times per year. In 13 states — including New York, New Jersey, Connecticut, Florida, Illinois, and California — participants may choose between an indemnity plan and an HMO plan. There is an open-enrollment period every May, during which participants may change plans. The website explains the pros and cons in detail.
AFTRA
To qualify under the Individual Plan, you must make a minimum of $10,000 within four consecutive quarters; to qualify for the Family Plan, you must make a minimum of $30,000.
What does "covered employment" mean?
"Covered employment" means any union job that requires employers to contribute to a union health plan.
What if I qualify for insurance through more than one union?
It's very good news. If you can accumulate enough work and/or hours to be insured by more than one union, you can pay both premiums and have even more coverage. In that instance, you'll submit claims first to your primary insurance, then, once those have been processed, to your secondary insurance. Many providers will handle the dual submission process for you.
How long does my insurance last before I need to re-qualify?
SAG
12 months.
Equity
Six or 12 months, depending on how many weeks you've worked.
AFTRA
12 months.
Once I'm eligible, do I still have to pay for insurance?
SAG
Yes. There's a quarterly premium of $150 for Plan I and $195 for Plan II.
Equity
Yes. There's a $100 quarterly premium.
AFTRA
Yes. The quarterly premium for the Individual Plan is $330. If you qualify for the Family Plan, you have the following options: $330 for yourself, $578 for you and your spouse, $578 for you and your children, or $633 for you, your spouse, and your children.
What are the yearly deductibles?
There are different deductibles for different kinds of medical services, so make sure you're aware of them before you head off on a tour of doctors. Here are the basics.
Equity
$350 per person, $700 per family.
AFTRA
Network providers: $200 per person, $400 per family. Out-of-network providers: $400 per person, $800 per family.
Once I qualify, when does the insurance kick in?
In all cases, coverage begins on the first day of a calendar quarter. Those dates are Jan. 1, April 1, July 1, and Oct. 1. But you guessed correctly. It's not quite that simple.
Equity
Eligibility is established during a 12-month period known as the accrual period. That's followed by a three-month waiting period, and then a benefit period, during which you're insured, lasting either six months or 12 months, depending on how much you worked during the accrual period.
SAG and AFTRA
Coverage begins on the first day of the second calendar quarter following the quarter in which the earnings requirements are met.
What's the annual deductible for prescriptions?
SAG
$100 per person or $200 per family.
Equity
$100 per person or $200 per family.
AFTRA
$75 per person or $150 per family.
Does my insurance cover my spouse, same-sex domestic partner, and/or kids?
SAG
Both plans cover your legal opposite-sex spouse or same-sex domestic partner and dependent children — including step-, adopted, or foster children — at no additional charge.
Equity
Yes, but there are many variables and requirements. Contact Equity-League Pension and Health on this one. www.equityleague.org.
AFTRA
Yes, your spouse, children, and/or same-sex partner are covered once you qualify for the Family Plan. Also, there's a "buy-up" option for those on the Individual Plan who want to cover dependents, which is currently $1,361 for your spouse/partner or your children. It's more to cover everyone.
Is there dental coverage?
SAG
Yes, dental coverage is provided to all Plan I participants and to Plan II participants with at least three years of Health Plan eligibility. Dental coverage has a separate deductible, which is the same whether or not your dentist is part of the network (Delta Dental).
o Plan I: $75 per person, $200 per family.
o Plan II: $100 per person, no family maximum deductible.
Equity
Yes. The dental plans have separate premiums, as follows. There are no deductibles. Equity-League also has a self-pay dental plan, but only for participants who have health coverage.
AFTRA
The Dental Plan offered through the AFTRA Health Fund provides only preventive services. These include office visits and examinations; diagnostic services, such as X-rays; cleaning; and dental sealants (subject to age limits as described in the Health Plan summary plan description).
What about vision care?
SAG
Insured SAG members are covered for one eye exam per year under Plan I. If you go to a network provider, there's a $10 co-payment. If you go to a non-network provider, you're covered for 80 percent up to a maximum payment of $50. Discounts on additional vision services are also available. See the website for details. Plan II does not cover vision.
Equity
Insured Equity members are covered under the Davis Vision Plan for an eye exam every two years, but reimbursements are limited if you go to an out-of-network provider. There is no deductible.
AFTRA
The AFTRA health plan does not cover vision.
What else is covered?
From acupuncture to X-rays, the plans vary as to which specific medical disciplines and procedures are covered. Even if you're interested in so-called alternative treatment, it's worth checking to see if your insurance plan covers it.
What if I'm currently insured, but I fail to qualify for the next year of insurance?
Under federal regulations, those whose eligibility expires can continue their insurance for 18 months by self-paying through COBRA. Those who've received a Disability Award from the Social Security Administration may remain on COBRA self-pay for 29 months. In addition, our unions offer the following:
SAG
As of July 1, 2008, Early Retirement and Disability pensioners with at least 15 pension credits are eligible to self-pay until age 65. Even if you fail to qualify under this provision, there are still several options and variables. As always, check the website or call the Health Plan office. Lower Cost Self-Pay is available as an option to participants covered by either Plan I or Plan II. It does not include dependent coverage or coverage for mental-health and chemical-dependency benefits. It also has higher out-of-pocket costs.
Equity
Members who are vested with 10 years of service under the Pension Plan may remain on self-pay status indefinitely.
AFTRA
There is a self-pay Early Retiree Coverage option available for those who are ages 55-65 when their AFTRA insurance lapses.
What are some of the lesser-known health insurance plan benefits?
Each of the programs offers additional help of which you may not be aware:
SAG
Plan I provides a $10,000 life insurance benefit and a $10,000 accidental-death-and-dismemberment benefit.
Can't afford your premiums? SAG maintains a list of assistance organizations on its website that may be able to help: www.sagph.org/html/assist_org.htm.
Equity
If you're on workers' compensation, you may be eligible for a Supplemental Workers' Compensation benefit in addition to your insurance coverage. You can get a claim form through the office of the Equity-League Pension, Health and 401(k) Trust Funds or from any Actors' Equity office.
AFTRA
1) Along with AFTRA health insurance coverage comes an automatic $30,000 life insurance policy, which remains in place as long as you remain covered.
2) Supplemental dental and vision coverage are available through AFTRA, as opposed to the AFTRA Health and Retirement Funds. A separate premium will apply.
Contact your local AFTRA office for details on the supplemental coverage and the types of benefits it offers.
Keep in mind, this article has only scratched the surface. The websites provide more detail and map out more variables, so be sure to research your specific questions. As complicated as it all is, health insurance is a necessity these days, and we're fortunate that our unions provide coverage for those of us who qualify. If you're able to sustain your eligibility and sort through the details, you'll have the security of knowing that at least part of your medical bills will be taken care of. Here's to your health!