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)
Welfare Plan Documents & Forms

Summary Plan Description

The Summary Plan Description (also called the SPD), together with the AETNA booklets for Tiers I, II or III and retiree coverage (see below), describe the key features of the Welfare Fund benefits program. Please note that the SPD was last issued in May of 2016.

Plan Changes and Clarifications

05-06-2016 elimination of age 26-29 coverage

10-31-2016 change in tier III eligibility

01-01-2018 self-pay premium rates and various coverage changes

 

Benefit Descriptions:

AETNA Medical Benefits Booklet

AETNA Medicare Benefits Booklet

Tier I Summary of Benefits

Tier II Summary of Benefits

Tier III Summary of Benefits

 

Benefit Comparison Chart: This is a summary chart that shows the major differences among Tier I, II and III coverage.

Summary Annual Report: This is the most recent basic financial statement sent to participants of the Welfare Funds.

HIPAA Privacy Notice:  This notice describes how medical information about you may be used and disclosed and how to get access to this information.

Creditable Coverage Notice:  This notice has information about your current prescription drug coverage with the Welfare Fund and about your options under Medicare's prescription drug coverage.

Forms:

Spousal Coverage Confirmation:  This form only needs to be completed if you have elected medical coverage for your spouse.

AETNA Claim Form:  This form only needs to be completed if the provider is not submitting the claim on your behalf.

Change of Address Form: Please use this form for changes of address or other contact information.

Credit Card Authorization Form:  This form is for authorizing the Welfare Fund to automatically charge your card for future self-pay premiums.

 

News, Notes and Links

  • Visit aetna.com for health insurance coverage information.
  • Visit express-scripts.com for pharmacy benefit information.
  • ER Alternatives: What are your options?
  • 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