SAG-AFTRA Health Plan Expands Open Enrollment Outreach Efforts As Benefit Changes Loom

David Robb
·4 min read

With new eligibility requirements set to take effect on January 1, the SAG-AFTRA Health Plan said today that it has expanded its open enrollment outreach efforts. The goal is to connect participants who may be losing their coverage to other available benefits and services.

Facing staggering deficits, the Plan has said that without restructuring, it was looking at a $141 million deficit this year and $83 million in 2021, and that it would have run out of reserves by 2024.

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“We take seriously our role in providing all participants with the information they need to access care and get the facts about their benefits,” said SAG-AFTRA Health Plan CEO Michael Estrada. “We know some participants have questions about changes to the Health Plan. We are committed to clearing up any confusion and helping Participants get the information they need to make their healthcare decisions.”

The Plan’s trustees have projected that some 3,500 performers and 2,800 of their dependents will lose benefits under the restructuring, although the vast majority of them are eligible for coverage under Medicare or Obamacare.

Upcoming changes to the Plan include increased eligibility thresholds for many and higher premiums for all participants in order to put it back in the black by 2022. The Plan’s actuaries estimate that under the changes, the Plan will run a surplus of $26 million in 2022 and a $53 million surplus in 2023. That money will be used to refill the Plans’ depleted reserves, which have plummeted 20% – or about $100 million – from a high of $500 million three years ago.

The Plan said today that in order to avoid an interruption in coverage, all participants should enroll by December 31, 2020. The final deadline to enroll, however, is January 15, 2021, for active participants and the end of February 2021 for retirees and senior performers.

The Plan, which has also launched new educational social media content, along with direct email and phone outreach, noted that, “The majority of participants have already signed up for their 2021 coverage due to the Health Plan’s comprehensive outreach efforts over the past several weeks.”

Here’s an overview of the upcoming benefit changes:

“Years of skyrocketing U.S. healthcare costs, made more urgent by the production shutdown due to the Covid-19 pandemic, threatened the Health Plan’s finances and long-term viability,” the Plan said in a statement. “As a result, the Health Plan was projected to have significant annual deficits and would exhaust its reserve funds by 2024 if further changes were not made. In August, SAG-AFTRA Health Plan announced necessary and proactive changes to protect its long-term sustainability and financial health. Changes centered around cost-saving measures that preserved high-quality healthcare benefits for participants.”

The Plan also advised participants that:
• Senior performers and retirees will continue to receive their primary health coverage through Medicare, as a vast majority now do and have for years. They can also sign up for secondary or supplemental health insurance coverage through a Medicare plan in the Via Benefits exchange. They will have access to a newly created Health Reimbursement Account to help cover qualified out-of-pocket costs. Because of the wide range of more than 100 Medicare supplemental and Medicare Advantage plans that will be made available to these participants through Via Benefits, many will have the opportunity to secure additional benefits at lower cost than they currently have.

• Spouses of eligible Health Plan pwill continue to receive primary coverage under the SAG-AFTRA Health Plan if they do not have access to their own employer-sponsored health plan. If spouses are covered by their own employer-sponsored health plan, they will also be eligible for secondary coverage under the SAG-AFTRA Health Plan.

• The SAG-AFTRA Health Plan added a new, reduced premium COBRA safety net, which allows qualifying participants with extended careers to retain their SAG-AFTRA Health Plan coverage at only 20% of the regular COBRA premium for up to 12-18 months after their current eligibility expires. On top of this, the Plan introduced a temporary reduced cost COBRA premium due to Covid-19 that will give transitional relief to certain participants who have lost coverage.

The Plan said that it continues to offer “a high-quality benefits package to tens of thousands of eligible media professionals and their dependents around the globe that exceeds most other employer-sponsored health plans.”

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