Every eligible participant has the opportunity to select from either OPTION A or OPTION B.
This option offers a health insurance plan, designed to provide comprehensive medical and hospital coverage. There is also a comprehensive dental plan.
If you live in New York, New Jersey, or Connecticut, coverage is provided through Oxford Health Plans. If you live in California, coverage is provided through Kaiser Permanente.
If you live outside the Oxford or Kaiser service areas, you may purchase coverage through an insurance company of your own choosing. The Fund will then reimburse you for 85% of the actual cost of your premiums (not to exceed the cost of the premiums paid for Oxford or Kaiser participants).
Participant Contributions are charged for participation under Option A. For individual coverage you will be charged 15% of the actual cost of the underlying premiums. Family coverage is available for the full cost of the family portion of the premium, plus 15% of the cost of the individual premium.
SDC-League Health Plan Summary Plan Description
Oxford Summary of Coverage 2012
This option offers a $2,200 semi-annual ($4,400 annual maximum with continuing eligibility) medical spending account. This option is intended primarily for participants who are already covered under another health insurance plan. It is not intended as a replacement for basic 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
Option B provides reimbursement for expenses typically not covered under many plans, including dental, chiropractic, optical and mental health. In addition, any 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. 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).
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, when appropriate, documentation of other insurance coverage.
Once you are eligible, there is no charge to participate in Option B.
* These descriptions are SUMMARIES ONLY.
For more complete information, please consult your Summary Plan Descriptions, or contact the fund office.
toll-free: (800) 317-9373 in NYC: (212) 869-8129