| VAKONI |
about that...
ABOUT THAT...
February 15, 2015
AFTRA HR vs SAG PH: Determining the Primary Plan
So you happen to qualify for both plans!
Great, now you think you get to change plans or stay with the plan you have, right? Guess what - you kinda really can't do that. Well, of course you can just pay the premiums of the plan you want and not the other. Problem solved. Nope. The plans determine which is primary and which is secondary (or coinsurance) on their own, regardless of which you have paid premiums for, or which you would like to have as primary or secondary.
Let me explain...
The AFTRA HR and SAG PH plans think that they are somehow related, I have no idea why... but they group themselves as Entertainment Industry Plans. These plans have a very important policy of positioning themselves as PRIMARY or SECONDARY insurance.
This is a BIG deal. If you are paying premiums to a plan that isn't your PRIMARY plan, they will not give you the benefits you see outlined in the plan documents. They will only act as a coinsurance paying out only a fraction of the benefits.
To understand which plan is your primary plan according to the insurance plans themselves, please walk through this:
Great, now you think you get to change plans or stay with the plan you have, right? Guess what - you kinda really can't do that. Well, of course you can just pay the premiums of the plan you want and not the other. Problem solved. Nope. The plans determine which is primary and which is secondary (or coinsurance) on their own, regardless of which you have paid premiums for, or which you would like to have as primary or secondary.
Let me explain...
The AFTRA HR and SAG PH plans think that they are somehow related, I have no idea why... but they group themselves as Entertainment Industry Plans. These plans have a very important policy of positioning themselves as PRIMARY or SECONDARY insurance.
This is a BIG deal. If you are paying premiums to a plan that isn't your PRIMARY plan, they will not give you the benefits you see outlined in the plan documents. They will only act as a coinsurance paying out only a fraction of the benefits.
To understand which plan is your primary plan according to the insurance plans themselves, please walk through this:
1. Are you ELIGIBLE(1) for more than one Entertainment Industry Plan?
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Nope.
Your primary insurance is the singular plan
that you are eligible for. (why are you even here?) GO TO STEP 4 ► |
Yes, I am eligible for more than one plan.
CONTINUE ► |
2. Regarding the Entertainment Industry Plans that you currently are eligible for, which plan were you eligible for longest without any break in eligibility(2)?
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I was eligible for AFTRA HR for a longer period without a break in eligibility.
Your primary insurance is the AFTRA HR plan. Any other plans that you became eligible for after becoming continuously eligible for this plan are secondary. CONTINUE ► |
I was eligible for SAG PH plan for a longer period without a break in eligibility.
Your primary insurance is the SAG PH plan. Any other plans that you became eligible for after becoming continuously eligible for this plan are secondary. CONTINUE ► |
Neither plan was first, I became eligible for both plans over the same exact periods (rare).
Call your plans, make sure that this is truly the case. You get to choose which plan you want to be primary. GO TO STEP 5 ► |
4. So it looks like you have a primary plan already.
Thinking of going with the secondary plan and just not paying or using the primary?
They will pay only around 20% of the benefits they would otherwise pay if they were your primary insurance. And remember your primary plan will only pay its plan benefits if you have paid the premiums for that plan. So if you are only paying premiums for what has been determined to be your secondary plan, you may find yourself with getting only around 20% of the benefits you thought you had. It is important to understand that the PLAN determines its position most of the time, NOT you.
Even if you don't have a choice in which plan is primary, it is always possible to change that.
Just work under contracts that will only contribute to qualification for a plan that you wish to be primary. As a result you will not qualify for the other plan and it will not remain as primary because if you are only eligible for one plan, that plan will be your primary plan. Now if you become eligible for both plans again, your primary plan will be that which you had continuous eligibility for over the longest period of time.
Obviously this takes considerable time and it can be risky to turn down work for contracts that happen to earn eligibility to a plan you don't want. However, everyone's situation is different and if you can choose which contracts to work under you may want information to make that decision.
Your primary plan is likely to be the only plan premiums you pay, unless you want additional coverage from a secondary plan. Which plan is best for you as your primary insurance? Now that you understand primary and secondary positions, you should continue on to the comparison between the plans.
Thinking of going with the secondary plan and just not paying or using the primary?
They will pay only around 20% of the benefits they would otherwise pay if they were your primary insurance. And remember your primary plan will only pay its plan benefits if you have paid the premiums for that plan. So if you are only paying premiums for what has been determined to be your secondary plan, you may find yourself with getting only around 20% of the benefits you thought you had. It is important to understand that the PLAN determines its position most of the time, NOT you.
Even if you don't have a choice in which plan is primary, it is always possible to change that.
Just work under contracts that will only contribute to qualification for a plan that you wish to be primary. As a result you will not qualify for the other plan and it will not remain as primary because if you are only eligible for one plan, that plan will be your primary plan. Now if you become eligible for both plans again, your primary plan will be that which you had continuous eligibility for over the longest period of time.
Obviously this takes considerable time and it can be risky to turn down work for contracts that happen to earn eligibility to a plan you don't want. However, everyone's situation is different and if you can choose which contracts to work under you may want information to make that decision.
Your primary plan is likely to be the only plan premiums you pay, unless you want additional coverage from a secondary plan. Which plan is best for you as your primary insurance? Now that you understand primary and secondary positions, you should continue on to the comparison between the plans.
5. AFTRA HR vs SAG PH: A comparison of plan benefits.
I created a table to bring common aspects of each plan along side each other for comparison. This table is NOT exhaustive of the plans' benefits. It has been compiled from sagph.org & aftrahr.com from their respective plan documents as of Feb 2015. Keep this in mind when you are making your own comparisons using the data here.
I created a table to bring common aspects of each plan along side each other for comparison. This table is NOT exhaustive of the plans' benefits. It has been compiled from sagph.org & aftrahr.com from their respective plan documents as of Feb 2015. Keep this in mind when you are making your own comparisons using the data here.
(1) Important to note: that even if you are not paying the premiums on plans your are eligible for, you are still considered qualified, eligible, or covered by that plan. The idea of being COVERED by the other plan, even if you won't receive benefits from the other plan because you haven't paid the premiums can very confusing.
(2)The actual verbiage they use to ask this question is a little different than that which I am paraphrasing above.