Losing Coverage

When coverage ends

When your health coverage through covered employment ends, you have the opportunity to continue coverage through COBRA. You will pay the full cost of coverage under COBRA. You will receive a letter from the Fund Office at the mailing address on file for you, as well as an email, regarding your COBRA options.

Typically, COBRA coverage lasts for 18 months; if you’ve received a disability award from the Social Security Administration, you may remain on COBRA for an additional 11 months (a total of 29 months). Once COBRA ends, you may be eligible for the Health Fund’s Self-Pay Program.

Understanding your COBRA options

If you lose coverage and are offered COBRA, it is essential that you take action by the deadline provided on the notice you receive by mail. NOTE: It is important to notify the Fund Office when your contact information changes, so that you receive notifications in a timely manner. It is not sufficient to update your contact information only with Actors’ Equity. Equity-League is a separate legal entity from the Union. Visit the Self-Service Portal.

You will be offered COBRA for the same tier you were enrolled in when you lost coverage; however, you will have the option to change tiers in the same ways as an active participant who is eligible for that tier. The bullets below show your options, depending on the tier of coverage you have when you lose it.

• If you’re in Tier 1, you will be offered Tier 1 for COBRA but can elect and enroll in Tier 2, which has a lower premium.
• If you’re in Tier 2, you will be offered Tier 2 for COBRA but can elect and enroll in Tier 1, which has a higher premium.
• If you’re in an HMO, you must continue using that HMO plan for COBRA. You can only change plans at Open Enrollment.

Additionally, while on COBRA, you have the option to change tiers every six months, beginning with the date your COBRA coverage starts. Unless you notify the Fund in writing that you wish to change tiers—before the next six months of COBRA coverage starts—you will automatically continue in the same tier for the next six months of COBRA coverage.

For example, if you elected Tier 1 for COBRA starting on March 1, you can change to Tier 2 for the six months starting September 1, as long as you notify the Fund in writing before September 1.

If you later requalify for continuous coverage at a lower tier based on weeks worked, you will be offered COBRA for the higher tier you lost. In this case, you have the choice to continue with COBRA at the higher tier or enroll in the lower tier that you earned through employment.

For example, if you had the Tier 1 Plan through October and requalified for the Tier 2 Plan beginning November, you can either use your earned weeks to enroll in the Tier 2 Plan or buy up to Tier 1 or elect to continue to self-pay COBRA for Tier 1.

Another example, if you have a Tier 1 Plan through COBRA and qualify the next month for Tier 2 through employment, you can continue paying for Tier 1 COBRA as long as you are within your original 18-month period, until you become eligible for Tier 1 through covered employment., or instead elect Tier 2 and/or buy up to Tier 1.

COBRA Parental Benefit

The Health Fund will also subsidize the cost for three months of COBRA, reducing your cost for single coverage to $250 per month, if one of the following conditions are met:

• You have a child (either by birth or adoption) while you are covered by active employment and you lose coverage through employment three months or less after you have the child, and elect COBRA by your deadline, the subsidy will apply for your first three months of COBRA, or
• You have a child (either by birth or adoption) three months or less after losing coverage through active employment and you elect COBRA by your deadline, the subsidy will apply for the first three months of COBRA after you have the child.

Note: Only the cost for single coverage is subsidized. If you elect family coverage, you will need to pay the full additional cost for family coverage.

Self-Pay Program After COBRA

After your COBRA benefits end, if you have accumulated at least 10 separate years of vesting service under the Equity-League Benefit Funds Pension Plan, you may continue your benefits under the Self-Pay Program After COBRA (SPAC) for up to another 18 months. Note that the two-for-one rule does not apply to work reaching the required 10 years of vesting service that are required to qualify for this program. Learn more about SPAC.

The Health Fund will establish an extended health coverage “bank” for a participant who accumulates at least 10 years of service across their career. Such participants will have 18 months of extended health coverage eligibility placed in their “bank” accounts.

In addition, for each additional year of vesting service that such participants accumulate across their careers beyond the 10 years required to qualify for the initial 18-month extension, they will have one additional month of extended health coverage added to their “bank” accounts. These added eligibility months can be used as of the first of the month following the completion of a participant’s 18th month COBRA coverage period, but no more than 18 of the bank’s months can be used after any single period of COBRA coverage ends (unused months can be used to extend any subsequent periods of COBRA coverage). Months placed in an account can be used only one time. Once the total number of additional months is exhausted, there are no additional months beyond the 18-month COBRA coverage period.

The table below provides examples of bank account accumulations based on years of service:

Other options for care

If you are losing Equity-League coverage due to a loss of employment, the Entertainment Community Fund (formerly The Actors Fund) may be able to assist. Its Artists Health Insurance Resource Center provides a safety net for performing arts and entertainment professionals. Its Friedman Health Center for the Performing Arts accepts most forms of insurance, including workers’ compensation, Medicare, and marketplace or exchange plans.

Other coverage options include plans offered through public health insurance exchanges.