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November is Open Enrollment Month for the Equity-League Health Benefit Fund

The Health Fund has its Annual Open Enrollment Period in November. During this period, you can change your health benefit options, such as enrolling in or changing your:

– Dental coverage,

– Dependent medical and/or dental coverage,

– Medical coverage from an available HMO to the Cigna plan or vice versa

If you want to make a change, your enrollment form(s), and payment in full for the coverage(s) being elected, must be received by the Fund Office by November 30th, (all changes actually take effect on January 1, 2018). If you do not wish to make any changes to your present coverage, you needn’t do anything during the open enrollment period.

The fastest and easiest way to enroll is to use our Self-Service Portal. On the portal, you can select and pay for the coverage(s) you choose. You can even attach any required forms. If you haven’t registered on the portal, it is a quick and easy process.

Alternatively, you can call the Fund Office and submit a payment over the phone. Then, you can fax any of the required forms to (212) 869-3323 in order to complete the process. Finally, you are always very welcome to visit our office at 165 W. 46th Street, 14th Floor, where we will be happy to help you through the enrollment process.

Late Enrollment Is Permitted But Requires a $100 Penalty

The Trustees have agreed to permit those who miss the November 30th deadline, to enroll as late as January 2nd, 2018 with the payment of an additional $100 penalty. So those who enroll later than November 30th, but no later than January 2nd, 2018, will be required to pay a late payment penalty of $100, where coverage will begin on January 1, 2018. No late enrollments will be accepted after January 2nd, 2018.

Dental Payments Will Be Accepted Without Forms

In addition, for those that want to elect dental or change their existing coverage, if dental premium payments are received without the accompanying forms, and the premium amounts exactly match the premium rates required for a particular form of dental coverage, we will assume you are enrolling for that dental coverage. However, those who do not submit forms with their payments need to understand that there may be unintended consequences. For instance, in order to use the Dental HMO, you must have a primary care dentist. If you submit an HMO payment without including a form that elects a primary care dentist, you will be assigned one by Cigna. If you subsequently wish to change your assigned primary care dentist, you will need to inform Cigna and wait until the 1st of the subsequent month in order to so. Consequently, we urge you to submit your forms with your payment, to be sure the coverage choices you prefer can be activated without delay.

Penalty for Those Who Dropped Dental Coverage During 2017

An important caveat applies to dental coverage. Since this coverage is offered on a fully self-pay basis to participants who qualify for medical coverage, premiums for this coverage are based on the claims and administrative expenses incurred during a full year and are calculated on the assumption that all of those who are enrolled in the program will pay their premiums for the full year. It has come to our attention that a small number of participants stop paying dental premiums at some point during the year (e.g., when they believe they will not have any more dental work done that year) and then enroll in the dental plan again the following year. If such a pattern were to occur regularly, it would affect the premium levels for the entire plan, because premiums would fall short of estimates (which were based on the assumption that everyone would pay for a full year) and would have to be increased, hurting everyone else in the program, even those who paid their premiums for the full year.

As a result, anyone who applies for dental coverage during Open Enrollment will have their prior dental premium payment history reviewed. If you had coverage at any time during the prior calendar year and stopped paying for the coverage at some point during the year (other than if you dropped it the same time that you lost medical coverage through covered employment), then you will be required to pay the premiums that were due for the balance of that year, before coverage for the new year is activated.

For example, if you paid for coverage from January 1, 2017 through June 30, 2017 and then stopped paying premiums, you would not be permitted to enroll in the dental plan again on January 1, 2018, unless dental premiums for the July 1, 2017 through December 31, 2017 period are paid.

Please Help The Health Fund Go Green

In an effort to go green, the Fund Office no longer automatically mails paper enrollment packages to eligible participants. All forms and information pertaining to Open Enrollment changes (including adding dental and/or dependent coverage), can be located under the Health section of this site by clicking on the Benefits Explained, Health Forms, and FAQ tabs. If you prefer, you can call the Fund Office to speak to a Customer Service Representative within the Benefit Services Department and request a paper kit, at (212) 869-9380 or (800) 344-5220 Monday through Friday, from 9:30 AM to 5:30 PM EST.

What If You Won’t Qualify For Fund Medical Coverage On January 1?

If you won’t qualify for Equity-League medical coverage on January 1, we suggest that you consider obtaining assistance from the Actors Fund on the wide range of non-Fund health insurance options that may be available to you – including during the Affordable Care Act (ACA)’s Marketplace Open Enrollment Period. You can contact them directly at (917) 281-5975, or (855) 491-3357 for those residing on the West Coast. For more information pertaining to the ACA Market Place Open Enrollment period deadlines, please visit the Actors Fund website, http://www.actorsfund.org/health-insurance-hq-10.