Welfare Plan SPD
Welfare Plan Documents
Eligibility and Enrollment
Retiree Medical Coverage
Self-Pay Premiums
COBRA
Disability Crediting & Waivers
Member Assistance Program
(Actor's Fund)
Eligibility and Enrollment

Participant Eligibility

The “Plan Year” for Welfare benefits starts July 1 and ends June 30. To be eligible for Welfare benefits during a Plan Year, you must have “Covered Earnings” (earnings on which an employer pays contributions to the Welfare Fund) during the prior calendar year.

The minimum covered earnings requirements for calendar year 2017 for coverage beginning July 1, 2018 will be as follows:

          Tier I Benefits:  $37,500 - $55,000
          Tier II Benefits: $55,001 - $80,000
          Tier III Benefits: $80,001 or more

The minimum covered earnings requirements for calendar year 2016 for coverage beginning July 1, 2017 will be as follows:

          Tier I Benefits:  $37,500 - $55,000
          Tier II Benefits: $55,001 - $80,000
          Tier III Benefits: $80,001 or more

(See the Benefit Comparison Chart for a quick summary of the differences among Tiers I, II, or III benefits.)

Dependent Eligibility
If you qualify and elect coverage for yourself, you may also elect coverage for your eligible dependents. Eligible dependents include:

  1. your spouse to whom you are legally married or your same-sex partner if your relationship is legally recognized as a marriage or civil union in the state or jurisdiction where the marriage or civil union was performed.

    Effective January 1, 2015, same-sex civil union coverage for partners who live in a state or jurisdiction that permits same-sex marriage will be eliminated. Thus, all Plan participants in a civil union who are currently covering a same-sex partner under the Plan that lives in a state that allows same-sex marriage will need to be married by December 31, 2014 in order to continue coverage of the same-sex partner. A copy of the certified marriage certificate must be provided to the Plan within 60 days of the date of marriage. If no marriage certificate is received by the Plan, the same-sex partner’s coverage will be terminated effective December 31, 2014. When coverage is terminated, COBRA continuation coverage will not be offered,

  2. unmarried dependent children (until the end of the calendar year in which they turn age 26),
  3. unmarried dependent children age 26-29 have the ability to purchase our insurance at a cost equal to 100% of the full premium rate for individual coverage, if they have no other insurance, and
  4. unmarried mentally or physically incapacitated children over the age of 26 who are incapable of self-sustained employment and dependent on you for support. (Please note that proof of incapacity MUST be provided no later than 60 days after the child turns age 26.)

Coverage for dependents is subject to various documentation requirements. Please see the Summary Plan Description or call the Fund Office for details.

Open Enrollment
Once each year, usually in June, the Fund has an Open Enrollment Period for the upcoming Plan Year. At this time you are able to enroll for the first time, make changes to your election type (Participant, Participant +1, or Family coverage), and elect to buy-up to Tier III coverage. The Fund Office will send you enrollment materials if you qualify for coverage based on your “Covered Earnings” as shown above. For the self-pay premium rates for the three benefit Tiers and the election options, see the Self-Pay Premium Chart.

Mid-Year Coverage Changes
Generally speaking, you may only make coverage elections or changes during the Open Enrollment period. This is very important because if you lose your coverage because you fail to pay your self-pay premium on time, you will not be able to elect coverage again until the next open enrollment. It also means that if you elect to buy up to Tier III coverage and later find that you can’t afford the higher self-pay premium, you do not have the option of changing your election back to the lower (and less expensive) Tier for which you were originally eligible.

However, there are some exceptions.

  1. If you decline coverage for yourself or any of your dependents because you have other insurance coverage, and you then lose that coverage (for reasons other than cause or failure to pay premiums), you may be eligible to enroll mid-year. However, you MUST request enrollment within 60 days of the other coverage ending.
  2. You may be able to do a mid-year enrollment in cases of marriage, birth and adoption. Again, you MUST request enrollment within 60 days of the marriage, birth or adoption.

In both cases, please call the Fund Office as soon as possible to check your eligibility and get the process started.

It’s also possible that your election type could change mid-year in cases of death, divorce, and children becoming ineligible for coverage. Please note that if you become divorced, your spouse’s coverage will terminate as of the end of the month in which your divorce is final. You are responsible for contacting the Fund Office if you and your spouse become divorced.

Dependent Coverage after the Death of the Participant
If you are NOT eligible to receive a pension and were covered under the Welfare Plan at the time of your death, your enrolled dependents will continue to be covered for the balance of the Plan year, and the subsequent year if you had met the earnings requirements for that year – provided that the self-pay premiums are paid on time.

If you were eligible to receive a pension and were covered under the Welfare Plan at the time of your death, your enrolled dependents will continue to be covered for 60 months with no self-pay premium required.

News, Notes and Links

  • ER Alternatives: What are your options?
  • Visit aetna.com for health insurance coverage information.
  • Visit express-scripts.com for pharmacy benefit information.
  • For a full description of the Plan rules regarding eligibility and enrollment, please see the Summary Plan Description and any applicable Plan Amendments and Clarifications.
  • Please note that nothing on this website is intended to interpret, extend or change in any way the provisions expressed in the Summary Plan Description and any other Plan documents. If you have any questions regarding your particular situation, please contact the Fund Office for more information.
 

Terms of Service l Privacy Policy l Site Map

Copyright 2009 Welfare, Pension and Annuity Funds of Local No. One, IATSE
Designed and Developed by Interactive Media Associates