We work in an industry that answers “what if” questions. What if an opportunist wanted to open a theme park featuring real-life dinosaurs? What if a hobbit was tasked with destroying an evil ring?
What if you suddenly needed to visit the doctor's office? Yikes! Thinking about how you'll pay for that visit isn't as fun as imagining characters and worlds, but it's just as important. In this post, we'll discuss how to determine eligibility for the SAG-AFTRA Health Plan.
This post isn’t intended to be a comprehensive review. We aim to provide an aerial view of the basics. If you are interested in doing a deep dive, the Important Resources section at the end of this article provides links to (much) more information, including the bible of the SAG-AFTRA Health Plan: the Summary Plan Description.
Who Should Read This Post?
You're a SAG-AFTRA represented on-camera principal and/or professional background actor, but you're unfamiliar with the SAG-AFTRA Health Plan. Perhaps you’re earning more lately, and now you're wondering: do I qualify? Or, you're just preparing for times ahead. In which case, good for you!
What Will Not Be Discussed In This Post:
- SAG-Producers Pension Plan
- AFTRA Retirement Fund
- Covered Roster Artists: you qualify under separate rules
- Dental and Vision Plans: supplements provided when needed
- Coordination of Benefits with Medicare: applies to actors 65+
The Important Resources section has links to more information on the subjects listed above.
Agreements, Covered Earnings, And Available Plans
Agreements that DO Apply to the SAG-AFTRA Health Plan:
- Codified Basic (Theatrical) Agreement
- Television Programming Agreement
- Television Commercials Agreement
- Infomercials Agreement
- New Media Agreement
- Interactive Media Agreement
- Corporate/Educational Agreement
- Music Videos Agreement
- Television Network Code
- New Media Network Code
Agreements that DO NOT apply to the Health Plan:
- Sound Recordings Code
- Audiobooks Agreement
- Commercial Radio Broadcasting Agreement
- Radio Commercials Agreement, Regional of Local AFTRA (or SAG-AFTRA) code for Television or Radio Broadcasting
Covered Earnings vs. Non-Covered Earnings
Covered Earnings: the above agreements require employers to make contributions to the SAG-AFTRA Health Plan, or other designated health plans. When you - the actor - are paid by that employer, those are Covered Earnings through Covered Employment. You're covered. However, you must meet a certain amount of covered earnings to be eligible, as outlined below.
Non-Covered Earnings: meal penalties, payments for rest period violations, traveling, lodging, living expenses, late fees, reimbursements for special hair, dress, personal automobile and equipment, payments for wardrobe damage, and more! All of these are NOT covered earnings. Also, producing, directing, and writing work is not covered. Actors only.
Plan I and Plan II
SAG-AFTRA has two plans with some differences in the benefits offered. Depending on how much you earn, you'll qualify for one, or the other, first. With Everyset you can track your hours to determine your eligibility for either Plan I or Plan II.
Qualifying for Plan 1
You must earn at least $33,000 in Covered Earnings in your Base Earnings Period to receive Earned Eligibility for Plan I health coverage. A Base Earning Period is four calendar quarters. The SAG-AFTRA Health Plan uses January 1, April 1, July 1, and October 1 to kick off each Base Earning Period.
Qualifying for Plan II
You may qualify for Plan II health coverage by earning at least $17,000 in your Base Earnings Period, or by qualifying under one of the Alternate Eligibility Rules.
Once you achieve Earned Eligibility, the SAG-AFTRA Health Plan will let you know you're eligible, typically via snail mail. If you decide to go for it, first you'll work with the Health Plan team to pay your monthly premium (the monthly base cost for health coverage).
Once your premium is paid, your Benefit Period begins on the next calendar quarter and includes 12 months of coverage. Just remember to keep paying your monthly premiums to retain coverage.
Alternative Days Eligibility
To qualify under the Alternative Days Eligibility Rule, you must have at least 78 eligible “Alternative Days” during your Base Earnings Period. Eligibility Days are determined by dividing your total applicable Sessional Covered Earnings by the minimum daily rate, which is based on the type of production.
A full summary of Sessional Covered Earnings can be found in the Summary Plan Description link below.
Age And Service Eligibility
Lastly, if you don't qualify for any of the options above, you may qualify for Plan II coverage under the Age and Service Eligibility Rule. To qualify, you must be at least 40, have at least 10 Age and Service Credits, and earn at least $11,600 in Covered Earnings during your Base Earnings Period.
How do you earn Age and Service Credits? For each year prior to January 1, 2017 that you achieved Earned Eligibility you earn one credit, whether you opted into the SAG Health Plan or not. To continue earning credits, you must make $17,000 in your Base Earnings Period.
We as actors use our bodies and minds to help create “what if” stories through character. Our physical, mental, and emotional health are essential to do this consistently. Therefore, we must stay proactive and prepared. If you find that you do not qualify for the SAG-AFTRA Health Plan right now, please research your other options for health coverage. Happy acting!
Important Resources:
Summary Plan Description (SPD)
Artists Health Insurance Resource Center
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