AFTRA Foundation One

Overview
Eligibility
Coverage
Monthly Cost
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Forms & Documents

A Medical Reimbursement and Discount Plan Option for SAG-AFTRA Members

*This plan is no longer available to New York residents.

This plan is a medical reimbursement plan. These benefits are designed to help cover the deductibles and co-insurance in your Major Medical Health Plan. The plan is composed of three basic components:

Reimbursement for eligible medical expenses
Provider network access nationwide providing discounts on medical services
Prescription drug program

An affordable choice with no earnings requirement
This plan is not SAG-AFTRA Health insurance and it is not a COBRA plan. It is an alternative plan for members who do not qualify for the AFTRA Health plan.

Disclosure: This plan is NOT insurance. This is NOT a Medicare prescription drug plan. The plan provides discounts at certain health care providers for medical services. The plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. You have the right to cancel this plan within 30 days of the effective date for a full refund of fees paid.

Eligibility

SAG-AFTRA Union members in good standing or on honorable withdrawal
Employees of SAG-AFTRA and AFTRA Health & Retirement

Any SAG-AFTRA member can purchase this plan
There are no earnings requirements. It is a month by month program that you can terminate at any time. Seniors who are working might want to consider this plan for 'medigap' coverage. For others, it may work alongside a 'catastrophic only' plan or your existing insurance if it has a high deductible. This plan is not guarantee issue and each application is subject to underwriting.

In order to participate, the individual must be and remain current with any union dues that are required under SAG-AFTRA rules.

Enrollment and participation is subject to verification of primary participant's status as a member of the SAG-AFTRA union, employee of SAG-AFTRA or employee of the AFTRA H&R Funds.

How this plan works:
Group Benefit Associates has teamed together with American Public Life, Fidelity Security Life (CatalystRx) and and Best Benefits (Beech Street PPO) to bring you this program.

You will receive three ID cards upon enrollment in this plan.

American Public Life- This card enables your claims to be processed for reimbursement. Please note that you will receive the same amount of reimbursement for eligible medical expenses regardless of whether your physician is part of the PPO network. Additional information is online at www.ampublic.com
Best Benefits- This card identifies your membership to the Beech Street PPO Network. You are encouraged to utilize Beech Street PPO Network providers (www.findbestbenefits.com and log-in or enter promo code "692000") so that you will receive in-network discounts for eligible expenses in addition to any reimbursements you may be entitled to receive from American Public Life.
CatalystRx- This is your prescription drug card. You will want to present this card when filling prescriptions. As a cost effective measure, we encourage you to fill prescriptions with generic alternatives whenever possible. Additional information is online at www.catalystrx.com

BE SURE TO PRESENT YOUR AMERICAN PUBLIC LIFE AND BEST BENEFITS CARD TO YOUR PROVIDER TO ENSURE YOU RECEIVE ALL OF THE BENEFITS AVAILABLE TO YOU THROUGH THIS PROGRAM.

This is not a comprehensive health insurance plan. This plan is designed to help control costs and out-of-pocket expenses associated with medical treatment.

BENEFIT FROM AMERICAN PUBLIC LIFE:

BENEFIT TYPE	DESCRIPTION	Benefit Amount
Daily Hospital Confinement Benefit	Pays a daily benefit due to a covered injury or sickness, for an inpatient hospital confinement of at least 24 hours at the direction of a physician. Paid up to a maximum of 180 days per confinement, unless confinement is due to a mental or emotional disorder. Paid up to a maximum of 30 days per confinement for a mental or emotional disorder.	$500 per day
Intensive Care/Coronary Care Benefit Rider	Pays a daily benefit for confinement in a Hospital Intensive Care Unit or Hospital Coronary Care Unit due to an injury or sickness, up to a maximum of 20 days per confinement. Each period of confinement must be separated by a period of at least 30 days.	$1,000 per day
Annual First Occurrence Hospital Confinement Rider	Pays a lump sum benefit the first time each calendar year an Insured is confined to a hospital as an inpatient. The confinement must be due to an injury or sickness and at the direction of a physician.	$500 per year
Outpatient Sickness Rider	Pays the selected benefit for treatment of a covered sickness by a Physician in a Physician's Office, Clinic, Urgent Care Facility or Emergency Room subject to a 5 visit maximum per Covered Adult, except for Covered Dependent Children. The maximum number of visits for all Dependent Children combined is 5 visits per calendar year. The maximum number of visits is 10 per calendar year, per family	$50/visit $500 family max.
Prescription Drug Benefit	$5 Co-Pay for Covered Generic Drugs ($5,000 annual maximum for Generic Drugs) Up to 30% discount on Brand Name Drugs $20 Co-Pay on Brand Name Oral Contraceptives Generic oral contraceptives are covered, no waiting period for pre-existing conditions on the prescription benefits

CLICK HERE TO SEE POLICY LIMITATIONS AND EXCLUSIONS

*Please note that receipt of this summary does not guarantee coverage. In the event of a conflict between this information and your contract with the carrier(s), the terms of the contract(s) will prevail.

Primary insured age 18-54	Monthly Premium
Member Only	$117.34
Member & Spouse	$243.25
Member & Child(ren)*	$173.16
Member & Family*	$265.27

Primary insured age 55-59
Member Only	$146.74
Member & Spouse	$294.25
Member & Child(ren)*	$195.56
Member & Family*	$316.27

Primary insured age 60 and up
Member Only	$171.54
Member & Spouse	$337.60
Member & Child(ren)*	$214.36
Member & Family*	$359.62

**Dependent children are eligible for coverage to age 25 if they are unmarried and reside with the insured. Dependent children living outside of the insured's home qualify for coverage if they are attending an accredited school full time or if you are legally required to support such child.

Enrollment Deadline: Applications must be received by Group Benefit Associates (by mail or fax) prior to the 20th of the month for coverage effective on the 1st of the following month (example, applications must be received by October 20th for coverage beginning November 1st).