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SAG-AFTRA Products:

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Contact Info

OFFICE HOURS:

Mon - Fri   9am-5pm CST

PHONE:

800-450-1271

773-427-6875 fax

EMAIL:

CustomerService

POSTAL ADDRESS:

3963 W. Belmont Ave.

Suite 6

Chicago, IL 60618


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  • Overview
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  • Coverage
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  • Welcome Letter
  • Plan Details
SAG-AFTRA has brought you Dental and Vision coverage regardless of earnings requirements

SAG-AFTRA has arranged for a Stand Alone Dental and Vision insurance plan for Union members who are NOT enrolled in the AFTRA Health Plan and their eligible dependents.

This benefit provides coverage for you and your eligible dependents for Preventative, Basic and Major dental services, such as exams, cleanings, x-rays, fillings, crowns, root canals, etc. In addition, this plan includes a vision benefit program through the Vision Service Plan network of providers.

These programs are only available to SAG-AFTRA Union members in good standing, on honorable withdrawal, and employees of SAG-AFTRA who do not have coverage under the AFTRA Health Plan.

These programs have been arranged through your Union as part of its continuing efforts to provide members access to additional benefits. They will be administered by Group Benefit Associates and Guardian, not SAG-AFTRA or the AFTRA Health & Retirement Funds.

Eligibility
  • SAG-AFTRA Union members in good standing or on honorable withdrawal
  • SAG-AFTRA members that are NOT covered under the AFTRA Health Plan
  • Employees of SAG-AFTRA and AFTRA H&R that are NOT covered under the AFTRA Health Plan
  • SAG-AFTRA Union members on Financial Core status are not eligible

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.

 

Eligible Dependents:

  • Your legal spouse
  • Qualified Domestic Partners
  • Your Qualified Domestic Partner's children
  • Your dependent children- dependent children are eligible until age 26
  • Legally adopted children
  • Step-children who depend on you for most of their support and maintenance

THE DENTAL BENEFIT

This plan offered by Group Benefit Associates and insured by Guardian, gives members the opportunity to choose either a Dental PPO Plan or a Dental DHMO Plan. This flexibility allows you to select the plan best fits your specific needs and budget. The Dental DHMO Plan is offered in California, New York, New Jersey, Illinois, Florida and Texas. The Dental PPO Plan is offered in all 50 states. Both the Dental PPO and the Dental DHMO Plan include a Vision benefit.

The Dental PPO Plan option:

The Dental PPO plan allows you to visit any dentist or specialist you choose any time care is needed. If you elect to visit a Guardian network provider, you will receive the highest level of benefits and save on out-of-pocket costs. Best of all, the Guardian Dental PPO Plan features one of the industry's most extensive nationwide dental networks with over 77,000 provider locations.

  • Cost Effective: Guardian network dentist fee discounts average 30% less than what dentists usually charge.

  • High Satisfaction: 97% satisfaction rate among members who have seen a dentist.

  • Maximum Rollover: Guardian's innovative plan feature which allows you to roll over unused dental premium for use in the future.

The plan pays a specific amount for each dental service based upon an established fee schedule. If you go to a Guardian Dental PPO provider, the benefits described below apply. If you go to a non-Guardian provider, the amounts charged over the scheduled fees are the patient's responsibility.

Guardian PPO Providers

NON Guardian Providers

Calendar Year Deductible

(waived for Preventive services)

$50

$75

Preventive Services

Exams, Cleanings, X-Rays, Sealants and Space Maintainers for Children

100% of fee schedule

75% of fee schedule

Basic Services

Fillings, Oral Surgery, Crown Repair, Bridge Repair & Denture Repair, Endodontics, Periodontics

80% of fee schedule

50% of fee schedule

Major Services

New Crowns, New Bridges, Inlays, Certain Prosthodontic services

50% of fee schedule

50% of fee schedule

Orthodontia not an insured benefit not an insured benefit
Calendar Year Maximum Benefit $1,000 $1,000
PRE-DETERMINATION: When a course of treatment is expected to cost $300 or more and is of a non-emergency nature, it is recommended to have your dentist submit a treatment plan before he/she begins.

This is intended only as a brief summary of benefits. It is not an official statement of those benefits.

 

The Dental DHMO Plan option (only available in CA, NY, NJ, IL, FL and TX):

The Dental DHMO Plan is designed to provide quality dental care while controlling the cost of such care. To do this, this plan requires members to seek dental care from participating dentists that belong to the Guardian Dental DHMO network. All covered services must be provided by the member's Primary Care Dentist selected at the time of enrollment.

You are only covered if you go to your assigned Primary Care Dentist
Specialty Referrals Must be coordinated by your Primary Care Dentist

Calendar Year Deductible

None

 

Office Visit Co-pay $5

Preventive Services

Oral Exams, Cleaning, X-Rays, Sealants and Space Maintainers for Children

 

May be an additional fee.

Basic Services

Fillings, General Anesthesia, Scaling & Root Planing, Simple Extractions, Endodontics, Periodontics

 

Available for a copayment. Refer to the DHMO Copayment Schedule for your state.

Major Services

Dentures, Single Crowns, Prosthodontics

Available for a copayment. Refer to the DHMO Copayment Schedule for your state.

 

Orthodontia Available for a copayment. Refer to the DHMO Copayment Schedule for your state.
Calendar Year Maximum Benefit Unlimited

DHMO Copayment Schedules are available on the "Plan Forms" section of our website.

 

THE VISION BENEFIT

Vision benefits are provided through the Vision Service Plan network and include an annual eye exam for a $10 co-pay, in addition to discounted rates on frames, lenses, and other professional services at VSP network providers. This benefit also includes discounts on all covered services such as LASIK.

Our vision plan allows you to visit any eye doctor you wish. However, you save significantly on out-of-pocket costs when network providers are used. There's more, you will receive substantial coverage for annual eye exams and discounts on eyewear and contact lens professional services every 12 months.

Largest Quality Network

Our affiliation with Vision Service Plan (VSP) gives members access to approximately 29,000 provider locations nationwide. All network professionals, includes licensed optometrist or ophthalmologist, are committed to delivering consistent and quality service.

You can find a VSP provider near you by:

  1. Looking up a VSP Provider online at www.vsp.com and selecting the "VSP Signature" network
  2. Requesting a provider directory from VSP by calling (800) 877-7195

 

Covered Services & Value Added Discounts

Eye Exams:

  • $10.00 copay, covered in full thereafter

Glasses:

  • 20% off lenses, frames and the industry's most extensive list of "cosmetic extras", including tints, special lenses (e.g. progressives) and scratch resistant coatings.
  • 20% off the retail price of additional glasses after initial pair is purchased.*

Contact Lenses and Professional Services

  • 15% off of the network doctor's evaluation and fitting services.
  • 20-25% off laser vision correction, or 5% off the laser surgery center's best promotional price, whichever is a better deal!**

You should call the VSP provider to schedule an appointment. When calling to schedule the appointment, identify yourself as a VSP member and give the insured's social security number. Before you go for the appointment, the provider will contact VSP to verify eligibility and coverage. You must go for services and materials within 60 days of VSP authorization.

*The claimant must go within 12 months to the same VSP doctor who provided the exam.
**Laser surgery is not an insured benefit. The surgery is available at a discounted fee. The covered person must pay the entire discounted fee. In addition, the laser surgery discount may not be available in all states. Member's out-of-pocket costs won't exceed $1,800 per eye for LASIK and $1,500 per eye for PRK.

The Stand Alone Dental and Vision Plan is offered as a combined package. All monthly premiums are collected on the 15th of the month prior to the month in which the premium is due.

Monthly Premium for Dental and Vision

The PPO Plan

 

Member Only

Member + Spouse

Member + Child(ren)

Family

California

$55.12

$101.83

$113.79

$161.54

New York/ New Jersey

$43.97

$80.12

$89.44

$126.80

Illinois

$36.31

$65.17

$72.43

$102.33

Florida/Texas

$37.64

$67.73

$75.45

$106.82

All Other

$37.74

$67.93

$75.68

$107.12

The DHMO Plan

 

Member Only

Member + Spouse

Member + Child(ren)

Family

California

$25.79

$40.51

$37.16

$55.15

New York/ New Jersey

$26.12

$41.54

$42.59

$59.20

Illinois

$25.16

$39.17

$41.42

$57.38

Florida/Texas

$25.23

$37.26

$40.50

$55.02

The Dental DHMO Plan is only available in California, Florida, Illinois, New Jersey, New York, and Texas. Purchase coverage in the state where you receive your dental care.

Termination Requests: Termination requests must be received in writing by mail, fax or e-mail within the same month of the requested termination date. Terminations can only be processed on the last day of the month, mid-month terminations are not allowable.

Ready to enroll?

Enroll Now

OR

  • DOWNLOAD and print the enrollment form and fax or mail it to us

 

 

SAG-AFTRA

Dear SAG-AFTRA Member:

In 2004 the AFTRA National Board made arrangements with Group Benefit Associates to provide supplemental dental and vision benefits to members who were covered by the AFTRA Health Plan. Subsequently, Group Benefit Associates has developed two plans for members who are not covered by the Health Plan. As a member of SAG-AFTRA, you have the option of enrolling in either program. Both provide dental and vision benefits. The programs are:

  • The PPO Dental and Vision Plan: This program provides preventive, basic and major services, as well as vision benefits, for members and their dependents.

 

  • The DHMO Dental and Vision Plan: This plan is designed for those who prefer a lower cost option for dental and vision benefits. It is available to members in California, Florida, Illinois, New York, New Jersey and Texas.

These programs are only available to SAG-AFTRA Union members in good standing, on honorable withdrawal and employees of SAG-AFTRA who do not have coverage under the AFTRA Health Plan.

These programs have been arranged through your Union as part of its continuing efforts to provide members access to additional benefits. They will be administered by Group Benefit Associates and Guardian, not SAG-AFTRA or the AFTRA Health & Retirement Funds. Please direct questions to Group Benefit Associates at 800-450-1271 or Guardian at 800-541-7846.

On behalf of the SAG-AFTRA National Board of Directors, we hope that you will find this coverage a welcome benefit to you and your family.

In Solidarity,

Roberta Reardon
SAG-AFTRA National Co-President

Forms & Documents

The following documents below are provided for your reference:

Enrollment Form

Dental Summary

Vision Summary

Maximum Rollover Summary

DHMO Copayment Schedule California

DHMO Copayment Schedule Florida

DHMO Copayment Schedule Illinois

DHMO Copayment Schedule New York/ New Jersey

DHMO Copayment Schedule Texas

Dental Claim Form

Vision Claim Form

PPO Temporary ID Cards (if you would like to request a new/ replacement PPO ID card, please call Guardian at 800-541-7846):

All DHMO ID cards are mailed directly from Guardian. If you have not received your ID card, please contact Guardian at 800-541-7846.

Frequently asked questions:

Q: How can I cancel my policy?

A: We must receive your cancellation request by email, fax or mail.

 

Q: I did not receive an id card.

A: Please call Guardian at 800-541-7846 to request an id card.

 

Q: I have the DHMO Plan and I would like to change my provider?

A: Please call Guardian at 800-541-7846 to change your DHMO provider.