Is SAG Health Insurance Good? 2023 Eligibility, Premiums, and Coverage
You're not alone if you have read the SAG-AFTRA health insurance eligibility and feel confused. SAG has over 170,000 members and only 12.7% qualify for the union’s health plan. If you are not qualified or find SAG health insurance unaffordable, an alternative like Mira could make a good fit at $45/month.
Is SAG-AFTRA Health Insurance Good? Takeaways:
The SAG-AFTRA Health insurance plan covers 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. The drawbacks of the insurance relate to its complex eligibility criteria, and the cost could be prohibitive for those earning less than $50,000 annually
SAG-AFTRA Health receives a 1.7-star rating on Google from members and a 3-star rating on Glassdoor from employees. The reviews for the SAG-AFTRA health plan on Reddit are mixed. Negative comments include reports of problems with their phone system leading to customers being transferred to the wrong numbers, lack of professionalism, and denial of benefits. On the other hand, some customers found the staff to be great, helpful, and professional. However, these positive reviews are outnumbered by the negative ones.
Cost to the member monthly varies between $125 - $250, or up to $2501 following unemployment. To qualify for SAG-AFTRA Health Insurance, the plan's eligibility requirements — "Earned Eligibility" — must be met. Eligibility varies depending on the occupation, with criteria relating to the performance of work under specific contracts or earnings through a contributing employer during a set period.
What are the eligibility requirements for SAG health insurance?
To qualify for the SAG-AFTRA Health Plan, you must meet the plan's eligibility requirements, also known as "Earned Eligibility". Typically, this involves meeting a certain threshold in covered earnings during a specified period or working a certain number of days under specific contracts.
| Occupation | Eligibility Criteria |
|---|---|
| Covered Network/Station Staff | • Must be a full-time employee of a radio or TV station or a network that is a contributing employer and who have covered earnings in that capacity. • Must have completed 30 days of full-time employment if their scheduled annual covered earnings meet either of the earnings thresholds. |
| Covered Roster Artists | • Must be signed to an exclusive recording agreement with a signatory record label that is party to the Covered Roster Artists side letter agreement to the current SAG-AFTRA National Code of Fair Practice for Sound Recordings. • Must have earned at least $10,000 in covered sessional earnings in the previous year. |
| Retirees | • Must be a retired SAG-AFTRA member who is at least 65 years old. • Must have earned at least $25,950 in covered earnings during their base earnings period. |
| Other Participants | • Must be a SAG-AFTRA member who has met the eligibility requirements for Earned Eligibility. • Must have earned at least $26,470 in covered earnings during their base earnings period. • Must have worked at least 102 days under specified contracts during their base earnings period. |
Covered earnings refer to the earnings paid to you by an employer who contributes to the plan on your behalf. These earnings are for work performed under a Collective Bargaining Agreement, which means the work requires the employer to make contributions to the plan on your behalf. On the other hand, non-covered earnings don't count towards your eligibility for the SAG-AFTRA Health Plan. These earnings include payments for various penalties and allowances, payments for services not covered by a SAG-AFTRA Collective Bargaining Agreement, such as producing, directing, and writing work. Essentially, non-covered earnings are earnings that do not require the employer to make contributions to the plan.
What type of job qualify for SAG insurance?
Different rules apply to different types of participants. For example, Covered Network/Station Staff and Roster Artists, staff of SAG-AFTRA, the SAG-AFTRA Foundation, the SAG-Producers Pension Plan, and the AFTRA Retirement Fund qualify under separate rules.
Full-time employees of a radio or TV station or a network that is a contributing employer and who have covered earnings in that capacity also have different qualification rules. They qualify for coverage on the first day of the month after they complete 30 days of full-time employment if their scheduled annual covered earnings meet either of the earnings thresholds.
Certain roster artists signed to an exclusive recording agreement with a signatory record label that is party to the Covered Roster Artists side letter agreement to the current SAG-AFTRA National Code of Fair Practice for Sound Recordings have a special qualification rule.
Finally, retirees must also meet the eligibility threshold currently set at $25,950 in covered earnings during their base earnings period, or alternatively, qualify by working a certain number of days (currently 102 days) under specified contracts during their base earnings period.
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How much does SAG health insurance cost?
Though your employer contributes toward the total premiums, to get health insurance through SAG-AFTRA, you must contribute anywhere between $125-$250 a month if eligible, or $1005-$2501 a month for the total plan after being laid off. You are responsible for paying insurance premiums quarterly by the 1st day of January, April, July, and October.
How much does my employer contribute to my insurance monthly? Employers contribute about 7.5% of members’ earnings toward union health insurance. For example, if you are making $60K annually, your employer is contributing $4,500. But even then, that isn't enough to cover the real total premiums annually.
How much is each SAG-AFTRA health insurance plan worth? According to Michael Estrada, the Plan's CEO, the cost for one year of coverage for a family of two is $11,530. “In order for us to receive $11,530 in contributions, an individual would have to earn about $153,000 in covered earnings reported to the Plan.” ($153,000 x 7.5% = $11,475.)
| 2023 SAG-AFTRA Coverage | Monthly Premium | Yearly Premium |
|---|---|---|
| Participant Only | $125 | $1,500 |
| Participant Plus 1 Dependent | $177 | $2,124 |
| Participant and 2+ Dependents | $249 | $2,988 |
| Eligible Dependents of Senior Performers (HRA Plan) | $250 | $3,000 |
| COBRA Premiums 2023 | Monthly Premium | Yearly Premium |
|---|---|---|
| Individual Only | $1,005 | $12,060 |
| Individual Plus 1 Dependent | $1,784 | $21,408 |
| Participant and 2+ Dependents | $2,501 | $30,012 |
What is Covered Under SAG Health Insurance?
The SAG-AFTRA Health Insurance plan offers a comprehensive package of health care benefits to its eligible participants and their dependents. This includes coverage for medical, surgical, and mental health care, among others. In addition, the plan offers life and AD&D insurance, adding an extra layer of protection for its members. These benefits make the plan a compelling option for those who are eligible.
| Benefit Category | In-Network Provider | Out-of-Network Provider |
|---|---|---|
| Deductible (you pay before plan starts paying) | $500/person; $1,000/family | Not covered |
| Hospital Services | ||
| Inpatient Services | 90% of contract rate after $100 copay | Not covered |
| Outpatient Surgery | 90% of contract rate after $100 copay | Not covered |
| Emergency Room | 90% of contract rate after $100 copay | Not covered |
| Medical Services | ||
| Office Visit | 100% covered after $25 copay | 60% of Plan's allowance |
| Surgeon | 90% of contract rate after $100 copay | 60% of Plan's allowance |
| X-ray and Lab | 90% of contract rate after $100 copay | 60% of Plan's allowance |
| Therapy | 90% of contract rate after $100 copay | 60% of Plan's allowance |
| Maternity Care - Prenatal Visits | 100% covered | 60% of Plan's allowance |
| Maternity Care - Delivery | 90% of contract rate | 60% of Plan's allowance |
| Routine Exams (Physical, Child, Mammogram/Pap) | 100% covered | 60% of Plan's allowance |
| Hearing Aids | 90% covered up to $1,500/device | 60% covered up to $1,500/device |
| Prescription Drugs (CVS CAREMARK) | ||
| Deductible | $75/person; $150/family | $75/person; $150/family |
| Generic (Tier 1) | $10 or 10% copay | $20 or 10% copay; max $50/prescription |
| Preferred Brand (Tier 2) | $25 or 25% copay | $50 or 25% copay; max $125/prescription |
| Non-Preferred Brand (Tier 3) | $40 or 40% copay | $100 or 40% copay; max $300/prescription |
| Dental Services | ||
| Deductible | $75/person; $200/family | $75/person; $200/family |
| Diagnostic and Preventive | 100% covered | 75% of Plan's allowance |
| Basic Benefits | 75% of contract rate | 75% of Plan's allowance |
| Major Benefits | 50% of contract rate | 50% of Plan's allowance |
| Vision Services | ||
| Eye exams | 100% after $10 copay; (one per year) | 80% or $50; (1 per year) |
| Glasses | 20% discount | Not covered |
| Professional Services for Contact Lenses | 15% discount | Not covered |
Drawbacks of SAG-AFTRA Health Insurance
One of the potential drawbacks of the SAG-AFTRA Health Plan is its eligibility criteria. The plan is only available to members of the Screen Actors Guild - American Federation of Television and Radio Artists (SAG-AFTRA), and qualifying for coverage can be complex. The requirements for covered earnings and alternative days worked can be challenging to meet, particularly for those in intermittent or lower-paid work. This may limit the plan's accessibility.
Furthermore, the cost of each plan could be unaffordable for those making less than $50,000 per year.
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Which provider can I see with SAG plan?
For hospital and medical benefits, the network is managed by BlueCard PPO – Nationwide, including California providers and non-California providers. California providers can submit claims through the Anthem portal or Sydney Health app or by mail to Blue Cross of California. Non-California providers need to reach out to their local Blue Cross Blue Shield Plan.
Prescription drug benefits are managed by CVS Caremark. Claims can be submitted to the CVS Caremark Claims Department in Phoenix, AZ. CVS Caremark also offers a mobile app for convenience.
The mental health and substance use disorder benefits are handled by Carelon Behavioral Health. Claims can be sent to their office in Hicksville, NY.
For dental benefits, Delta Dental USA is the network provider. Claims can be sent to Delta Dental of California in Sacramento, CA. Delta Dental provides separate customer service lines for claims and for finding a network provider.
The vision benefits are taken care of by the Vision Service Plan. For an Exam Plus eye exam received through a VSP Provider, the provider will file the claim for the individual. If a non-VSP Provider is used, the individual should request a copy of the bill and send it to VSP Vision in Birmingham, AL.
Will I lose health benefits by going on strike?
If a SAG-AFTRA member participates in a strike authorized by the union, they would generally continue to receive health and pension benefits. However, the specifics could depend on the length of the strike, the member's standing with the union, the terms of their specific plan, and other factors.
In terms of earning eligibility for future benefits, it's important to remember that these are often based on a member's earnings and/or work hours. Therefore, a prolonged strike could potentially impact future eligibility if it significantly reduces a member's earnings or work hours for the year.
Frequently Asked Questions
Is mental health covered under SAG-AFTRA health insurance? Yes, the SAG-AFTRA Health Plan provides coverage for mental health care. These benefits are managed by Carelon Behavioral Health.
Can I add my spouse or children to my SAG-AFTRA health plan? Yes, you can add your dependents to your SAG-AFTRA health plan. The cost of the plan will vary depending on the number of dependents you add. There is a 'Participant Plus 1 Dependent' plan and a 'Participant and 2+ Dependents' plan.
What happens to my SAG-AFTRA health insurance if I stop working or my earnings decrease significantly? Eligibility for SAG-AFTRA Health Plan is based on earnings and/or days worked. If you stop working or your earnings decrease significantly, you may lose your eligibility. However, there may be an option to continue your health coverage under COBRA for a certain period, but the premiums are higher.
Does the SAG-AFTRA health plan cover prescription drugs? Yes, prescription drug benefits are part of the SAG-AFTRA health plan. These benefits are managed by CVS Caremark.
Do I have to see a doctor in a specific network with SAG-AFTRA health insurance? Yes, the SAG-AFTRA health plan has network providers. For hospital and medical services, the network is managed by BlueCard PPO, and for prescription drugs, it's managed by CVS Caremark. For dental benefits, the network provider is Delta Dental USA, and for vision benefits, the plan is handled by Vision Service Plan.
Are dental and vision services included in the SAG-AFTRA health plan? Yes, dental and vision services are included in the SAG-AFTRA health plan. The dental benefits are managed by Delta Dental USA, and vision benefits are taken care of by the Vision Service Plan.
Can I keep my SAG-AFTRA health insurance if I retire? Yes, you can keep your SAG-AFTRA health insurance if you retire, as long as you meet the eligibility criteria. You must be a retired SAG-AFTRA member who is at least 65 years old and have earned at least $25,950 in covered earnings during their base earnings period.
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