SAG-AFTRA and the AFL-CIO have teamed up to provide two new affordable health plan options to all Medicare-eligible SAG-AFTRA members and their spouses, many of whom might have lost, or are in danger of losing, their union health coverage due to recent changes in the guild’s Health Plan eligibility rules. The Motion Picture & Television Fund and the Actors Fund are administering the application process.
SAG-AFTRA president Gabrielle Carteris and AFL-CIO president Richard Trumka said in a joint statement that the new options, which will become available in early July, are being offered through Anthem Blue Cross and Blue Shield, which are group Medicare Advantage plans that include prescription drug coverage.
More from Deadline
There are two tiers available for this benefit: the Medicare Advantage Premier PPO is available for a monthly premium of $198.90 with no annual deductible and full pharmacy gap coverage, and the Medicare Advantage Value PPO, which is available for a monthly premium of $99.30 with an annual deductible of $250 and generic pharmacy gap coverage.
Members who qualify for Senior Performer benefits under the SAG-AFTRA Health Plan’s Health Reimbursement Account (HRA) Plan will also qualify for HRA allocations if they enroll in one of these new Medicare Advantage plans. Those HRA accounts were established last December to help cover qualified out-of-pocket costs.
Carteris and Trumka cited several other benefits contained in the new options for Medicare-eligible members, including:
Nationwide access to providers and care, with the same benefits in or out of network without penalty.
As group plans, there are enhanced benefits compared to individual Medicare plans.
No copay for some medical services, such as routine annual physicals and preventive care.
Brand-name prescription drug benefits and “donut hole” gap coverage.
Broader pharmacy formulary list for needed prescriptions.
A simplified enrollment experience and purposefully designed programs for older adults.
Additional value-added programs and services that include telehealth, SilverSneakers health club memberships, and hearing and vision benefits.
For information on signing up for one of these plans in early July, Medicare-eligible SAG-AFTRA members are asked to contact Entertainment Health Insurance Solutions or Artists Health Insurance Resource Center.
Health coverage for senior performers has become a hot-button political issue at SAG-AFTRA ever since the SAG-AFTRA Health Plan announced that changes to eligibility requirements would be going into effect on Jan. 1, 2021. Facing staggering deficits, the Plan has said that without restructuring, it was looking at a $141 million deficit last year, another $83 million this year, and that it would have run out of reserves by 2024.
The Plan’s trustees projected that some 3,500 performers and 2,800 of their dependents would lose benefits under the restructuring, though the vast majority of them are eligible for coverage under Medicare or Obamacare.
A lawsuit filed in U.S. District Court in Los Angeles in December claims that the benefit changes “illegally discriminate based on age and violate the Age Discrimination and Employment Act of 1967,” and are a breach of fiduciary duty under the Employee Retirement Income Security Act. The 10 named plaintiffs in the suit include former SAG president Ed Asner and David Jolliffe, currently a vice president of the union’s Los Angeles Local – both of whom are leaders of the union’s dissident Membership First faction that spearheaded the lawsuit.
Membership First says that “8,200 seniors lost their union health insurance” as a result of the new eligibility requirements; that “members over 65 taking their pensions will not have their residuals count as earnings to qualify for the SAG-AFTRA Health Plan,” and that “it is unlikely that any commercial performer over 65, earning scale, will qualify for SAG-AFTRA health insurance again” because “90% of all commercial earnings come from residuals.”
SAG-AFTRA, however, has said that members are being “misled” by Membership First. “Here are five facts you need to know about changes to the SAG-AFTRA Health Plan,” the union said in December:
1. “Without significant changes, the SAG-AFTRA Health Plan’s reserves would have vanished for ALL participants by 2024. Ask yourself this: Why would the Health Plan want to reduce coverage for members if there was any other option?
2. “Senior Performers are not losing their healthcare coverage; they will continue to have Medicare as their primary insurance, as they do today. Plus, they will receive a stipend under the new Health Reimbursement Account Plan to use for supplemental coverage of their choosing through Via Benefits. For many Senior Performers, this will mean comparable coverage at a comparable price.
3. “Spouses aren’t getting ‘kicked off’ the plan. If you meet eligibility requirements and your spouse does not have access to their own employer-sponsored health plan, your spouse can still be covered by the SAG-AFTRA Health Plan. If they are covered by their own employer-sponsored health plan, they will also be eligible for secondary coverage under the SAG-AFTRA Health Plan.
4. “There’s a new reduced cost COBRA safety net available specifically designed to help ease the transition for many participants. Those who qualify will be eligible to maintain their SAG-AFTRA Health Plan coverage with significantly reduced COBRA premiums — at only 20% of the regular COBRA premium — for 12-18 months after their current eligibility expires. For detailed information, please visit sagaftraplans.org/health.
5. “The idea that premium increases or higher employer contributions alone could have fixed the Health Plan is simply wrong. The root of the problem is the exorbitant cost of healthcare — a problem made worse by our industry’s production shutdown due to the pandemic crisis. The cost of healthcare remains a top issue for Americans, and the SAG-AFTRA Health Plan is not immune from this and other economic forces. Structural changes were required to put the Plan on a secure footing now and into the future.”