Every eligible participant has the opportunity to select from either OPTION A or OPTION B.
These descriptions are SUMMARIES ONLY. For more complete information, please consult your Summary Plan Description, or contact the Funds Office at (212) 391-1070 ext. 226 or ext. 227. Email us at Health@SDCweb.org.
OPTION A
This option offers a health insurance plan, designed to provide comprehensive medical and hospital coverage.
Coverage is provided through Aetna in all areas of the country. If you live in California, coverage is also provided through Kaiser Permanente.
Participant Contributions are charged for participation under Option A. For individual coverage you will be charged 12.5% of the actual cost of the underlying premiums. Family coverage is available for the full cost of the family portion of the premium, plus 12.5% of the cost of the individual premium.
AETNA
- Aetna Summary of Benefits and Coverage
- Find an Aetna Provider
- Get a Replacement ID Card
- Aetna Fitness Reimbursement Form
KAISER PERMANENTE (California Residents Only)
OPTION B
This option offers a $2,200 semi-annual ($4,400 annual maximum with continuing eligibility) medical spending account. This option is intended for participants who are already covered under another employer sponsored health insurance plan. Certification of employer-sponsored group health insurance is required. It is not intended as a replacement for health insurance, but was created to supplement the health coverage of eligible participants who may fall into one or more of the following categories:
- Qualified participant in another multi-employer health plan (DGA, AEA, SAG, etc.)
- Artistic or staff director covered by a theatre’s health plan
- Faculty member covered by a college’s or university’s health plan
- Qualified participant covered by a spouse’s or domestic partner’s health plan
- Free-lance director or choreographer qualified under a non-theatrical employer’s company health plan
Once you are eligible, there is no charge to participate in Option B.
Option B provides reimbursement for expenses typically not covered under many plans, including dental, chiropractic, optical and mental health. In addition, most other legitimate medical expense that the IRS qualifies as deductible on your personal income taxes may be submitted for reimbursement under Option B. This includes any deductibles or co-payments you may have under another health plan. It does not include premiums you pay for individual coverage purchased on the Affordable Care Act Marketplace or through Medicare. A complete listing of reimbursable expenses is outlined in IRS publication 502 (for a copy, contact the Fund office: Health@SDCweb.org, or go to www.IRS.gov).
**The IRS has announced that personal protective equipment (PPE) such as masks, hand sanitizer, or sanitizing wipes which are purchased on or after January 1, 2020 for the primary purpose of preventing the spread of COVID-19, are now considered medical expenses eligible for reimbursement. Participants in Option B who have certified that they have coverage under a group sponsored health plan may include the purchase of PPE in their reimbursement claims. The claim must include proof of payment and either an itemized invoice or corresponding product label that can be matched to the proof of payment.
If you elect Option B, reimbursements will be paid upon presentation of a receipt showing the name and address of the provider, the date of service, the service performed, and documentation of other insurance coverage.