Here’s a handy summary of the Health Fund eligibility rules and how the Fund will determine eligibility.

There are two key Health Fund terms that are needed when determining your eligibility under the Equity-League Health Plan:

• Benefit Credits which is referred to as weeks of covered employment.
  
• Accrual Period which is the 12-month period used to determine whether you have enough benefit credits to qualify for coverage.
  

Health Fund eligibility is established by earning enough benefit credits (that is, working the required number of weeks) during a 12-month period, known as the Accrual Period. Benefit credits earned in an Accrual Period are what enable you to qualify for coverage for a corresponding Benefit Period, which begins the next calendar quarter (three months after the Accrual Period ends). There’s a three-month gap between an Accrual Period and a Benefit Period, known as the Waiting Period.

ACCRUAL PERIOD 12 MONTHS COUNTING FROM:	WAITING PERIOD	BENEFIT PERIOD
FIRST SUNDAY IN: TO LAST SUNDAY IN :	3 MONTHS COUNTING FROM:	6 OR 12 MONTHS OF COVERAGE STARTING ON:
October September January December April March July June	October December January March April June July September	January 1 April 1 July 1 October 1

Four times each year—before each Benefit Period begins—the Fund looks back over the most recently completed 12-month Accrual Period to identify those participants who earned enough benefit credits to qualify for coverage in the next Benefit Period. For example, for January 1, 2011 coverage, the Fund will look at how many benefit credits you earned between the first Sunday in October 2009 and the last Sunday in September 2010. Your benefit credits determine the length of your coverage, as follows:

BENEFIT CREDITS	HEALTH FUND COVERAGE
20 or more	12 months
At least 12 but fewer than 20	6 months
Fewer than 12	No coverage

You can also delay your health fund coverage when you have at least 12 but fewer than 20 benefit credits in an Accrual Period and want to save them for the next Accrual Period (which you may want to do if you expect to earn enough credits to bring your total up to 20). You can save them until you have enough for 12 months of coverage, if you like. (But don’t hold on to them too long; remember, benefit credits expire after a year.)

Similarly, if you don’t want to start your Health Fund coverage as soon as you become eligible for it, you won’t have to. You can choose to put it off—say, until after your SAG coverage ends— as long as you still qualify for coverage in a later Benefit Period.

Once the Fund has determined if you are eligible for health coverage, the Fund Office will send you a election notice and billing invoice after the end of each Accrual Period for the next available Benefit Period informing you of the number of months of coverage for which you qualify for. In order to enroll for health coverage, you will be required to pay a $100 premium for each quarter (three months) of coverage you are eligible for. $100 Quarterly Premium page. When you receive this notice, you have a choice:

• Enroll for coverage now. As outlined above, if you wish to enroll in the Health Fund coverage for which you are eligible immediately, return the billing invoice and pay the $100 premium. The Fund Office will then bill you for each subsequent quarter of coverage you elect.
  
• Save your benefit credits for the future. If you wish to delay your eligibility for Health Fund coverage—and accumulate additional benefit credits—you do not need to take any action. Simply do not pay your $100 health care premium. You will receive an updated statement at the end of the next Accrual Period, three months later. If you go this route, make sure that you’ll have enough credits to qualify next quarter, and that none of the credits you’ll need will expire by then.
  

Once you qualify for Health Fund participation, your next look-back will be six months later (if you initially qualified for six months of coverage) or 12 months later (if you initially qualified for 12 months of coverage). In either case, once a benefit credit has been used toward one Benefit Period, you generally cannot use it again toward another Benefit Period. In other words, you can’t “spend” the same benefit credit twice.

The rules outlined describe how you qualify for coverage, which you do for either six or 12 months at a time. You pay for coverage three months at a time. Each calendar quarter, you make the decision to elect or decline any coverage for which you qualify. You may also pay for all of the quarters for which you have already earned eligibility for health coverage at one time. For example, if you are eligible for 6 (six) months of coverage, then you can make a $200 payment for the entire length of the 6 month coverage period. The same would apply for 12 (twelve) months of coverage, in which a $400 payment will cover you through the full 12 month period.

The following is an example of how you will be able to apply your benefit credits in determining health coverage under the Equity-League Health Trust Fund:

Anne begins working under an Actors' Equity Association contract in March, 2010. She works 22 weeks in 2010, as follows:

April	4
May	4
June	4
July	4
August	2
September	2
October	2
November	0
December	0

Here are the options for Anne under the current eligibility rules:

Anne earns 12 benefit credits by the end of June, 2010 (that is, she worked 12 weeks in covered employment from the first Sunday in July, 2009 through the last Sunday in June, 2010). In mid-July she receives an election notice and billing invoice from the Fund Office that tells her that she can choose to “spend” her credits on six months of coverage starting October 1, 2010. The notice also informs her that if she wants to do this, she must return her completed billing invoice, along with a $100 payment, to the Fund Office no later than September 1. Anne, however, knows that she has work lined up for the next few months—enough to earn 10 more credits. She decides to wait.

In mid-October 2010, the Fund Office sends her another election notice and billing invoice. This one shows that she now has 20 benefit credits (because she worked 20 weeks in covered employment from the first Sunday in October, 2009 through the last Sunday in September, 2010). She can choose to spend all of them on 12 months of coverage starting January 1, 2010, or spend none of them. Anne elects the first option (12 months of coverage) and returns her completed billing invoice, along with a $100 check, to the Fund Office by December 1. She keeps her coverage in effect throughout 2010 by paying the invoice the Fund Office sends her prior to the start of each of the next three calendar quarters.

Also note that as long as you qualify for Health Fund coverage, you may elect self-pay dental coverage even if you don’t elect to pay the $100 quarterly contribution for medical/vision coverage. (In this case, you would pay the applicable costs of dental coverage even though you would not be paying the $100 contribution for medical/vision coverage). This would be under the scenario in the event you prefer to defer your coverage by electing to receive 12 months of coverage as of a future quarter.

As a reminder, you can also pay the $100.00, along with any other coverage you are eligible for (dependent, dental), by credit card. Just click on the Health Care Payments link If you elect this payment option, please make sure that you provide us with your Actor’s Equity Association (AEA) Membership Identification Number in order to process your transaction.

If you need further information, please don’t hesitate to call the Fund Office at (212) 869-9380, or toll free at (800) 344-5220 Monday through Friday. A representative from the Health Department can assist you between the hours of 9:30 AM to 7:00 PM Eastern Standard Time.