Improvements Made to the Equity-League Health Fund – Effective January 1, 2024

Fewer Weeks Will Be Needed to Earn Coverage

For the past three years, the Fund has offered three coverage levels and required working at least 12 weeks in a 12-month period to earn 6 months of Health Fund coverage.

Beginning with coverage that starts on or after January 1, 2024, the eligibility requirements will decrease to at least 11 weeks worked for Tier 2 coverage and 15 weeks for Tier 1 coverage, as shown in the chart below. Please note that the Health Fund eliminated Tier 3 In-Network Only coverage effective January 1, 2024.

A New Special Rule Has Been Added

In addition, the Plan rules are changing to make it easier to maintain continuous coverage. Specifically, if you are currently covered and do not have enough weeks to continue health plan coverage or maintain your current Tier of coverage, you can use weeks you earn in the two-month “waiting period” to extend eligibility for continuous coverage.

For example, let’s assume you are currently enrolled in Tier 1 coverage that will end on January 31, 2024. Your next possible Benefit Period begins February 1, 2024. This means the Accumulation Period looks at the weeks earned between December 2022 and November 2023. Your “waiting period” is December 2023 and January 2024.

• If you earned 12 weeks during your Accumulation Period, but wish to remain on Tier 1, you can apply 3 additional weeks earned during your “waiting period.” If you do not earn additional weeks, you can enroll in Tier 2 or “buy up” to Tier 1.
• Or, if you earned only 9 weeks during your Accumulation Period, you can apply 2 weeks earned during the “waiting period” to enroll in Tier 2 or “buy up” to Tier 1.
• If you do not earn at least 11 weeks during the Accumulation Period and the additional weeks during your “waiting period”, you will not be eligible for continuous coverage.

Effective January 1, 2024, there will be important enhancements to Tier 1 Health Fund coverage with Cigna, specifically:

• All preventive care—including recommended screenings and immunizations—will be covered at 100%. This means that you will pay nothing out of pocket for these services.
• There will be no charge for generic preventative medications required under the Affordable Care Act (ACA), or preferred drugs when a generic is not yet available, or a brand/non-preferred drug if a generic or preferred drug is not medically appropriate.
• For in-network medical/hospital care, there will be an annual yearly out-of-pocket maximum of $4,550 for individual coverage and $9,100 for family coverage. Once you reach the maximum, the Plan pays 100% of your health care costs for the remainder of the year. Note: There is already an out-of-pocket maximum for prescription drugs of $4,000 per individual, which will remain the same, along with an $8,000 out-of-pocket maximum for family coverage being added.

As in the past, eligibility is reviewed monthly. There are still two months between the eligibility period and the start of coverage, and you have the option to defer your coverage start date, provided the required weeks are available in the subsequent lookback period. The premium to participate in the coverage for which you qualify is still $300 per quarter.

The deductibles, copays, and coinsurance in Tiers 1 and 2 are not changing. In addition, both Tiers continue to use Cigna’s nationwide provider network and cover the same kinds of services. Visit equityleague.org to see a comparison of the Tiers’ deductibles, copays, out-of-pocket maximums, and a few common expenses.

The Trustees remain committed to making improvements as possible. As employment levels, participation, and Fund assets change, we will continue to review eligibility requirements and plan design with the goal of providing meaningful coverage to working actors and stage managers.

If you have any questions, please call the Fund Office at (212) 869-9380, or toll free (800) 344-5220, Monday–Friday from 9:30 a.m. to 5:30 p.m. ET, or email us at health@equityleague.org.