The Equity-League Health Plan offers six months medical, dental and vision benefits to Actors’ Equity members who accumulate at least 12 weeks of work across a 12 calendar month period. Supplementary workers compensation benefits are also available, unlike other health benefits, these benefits begin with the commencement of covered employment.
Medical benefits include coverage of hospital, medical and prescription drugs, with richer benefits if you go to health care providers who are in CIGNA’s health care provider “network” (CIGNA is the Fund’s claims administrator (payer). However, very comprehensive coverage is also available if you use non-network providers.
In certain areas of the country, you can choose coverage through an HMO, instead of the CIGNA plan. In HMO plans, you must generally use only providers who are in the HMO’s network, and you must sign up with a primary care physician in the HMO’s network. That physician provides referrals to specialists.
As long as you are qualified for coverage through employment, you are required to contribute $300 per quarter if you wish to have coverage for yourself in the medical benefit plan (CIGNA or HMO). Your dependents are also eligible, but you must pay the full cost of their coverage.
Vision care benefits are available to all who are enrolled in either the CIGNA plan or with an HMO. And there is no extra charge for these benefits.
Dental benefits are also available, through a CIGNA Dental HMO or a Dental PPO (in the latter you can use non-network providers). You must pay the full cost of these benefits. However, unlike the Fund’s medical benefits, dental benefits can continue even after you are no longer eligible for medical coverage through employment, as long as you continuously pay the required premiums for dental coverage.
Health Summary Plan Description
Summary Plan Description (SPD)
The Equity-League Health Plan has changed since January 1, 2020, which changes are not yet reflected in the full Summary Plan Description (SPD) online, but are described separately. Listed below is a summary of recent key changes:
-
-
- Optum RX replaced ProAct as the Pharmacy vendor effective January 1, 2020 for those that elect Cigna medical coverage. This pertains to the details associated with the Pharmacy coverage explained within the contents of the Health SPD when electing Cigna medical coverage. Click here for more information regarding the change to Optum RX.
- The Health Plan increased its quarterly Health Premium from $100 to $300 for participants that elect health coverage through covered employment effective August 1, 2020. This pertains to the details within the SPD associated when making health premium payments once coverage through employment has been elected. For information, click here.
- The Health Fund changed its eligibility rules effective January 1, 2024. (The eligibility rules reflected in the full SPD no longer apply.) The Fund now offers two tiers of coverage, and the number of weeks required in order to qualify for health coverage has changed. In addition, certain copayment and deductible amounts were changed/added effective January 1, 2024 in conjunction with the addition of the two tiers of coverage. Click on these links for more details associated with these changes:
-
More specific copayment/deductible and benefit provision detail for each tier of Cigna and Optum RX coverage can be reviewed on this page under the section, Cigna Medical and Optum RX Pharmacy Plans.
Health Benefits
Critical Health Premium Payment Deadlines
Cigna Medical and OptumRx Pharmacy Plans 2024
CIGNA ACA Summary of Health Benefits Tier 1 – 2024
CIGNA ACA Summary of Health Benefits Tier 2 – 2024
Cigna Benefit Summary Plans for Tiers 1 and 2
CIGNA Benefits Plan Summary for Tier 1 – 2024
CIGNA Benefits Plan Summary for Tier 2 – 2024
This Cigna link leads to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed- amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data. The files though are large in size in which they can take some time to download. Therefore, we recommend that if you need information about the cost of services, you should leverage the pricing tools that are made available to you within your mycigna.com account.
HMO’s 2024
Emblem Health NY - HIP - 2024 - Tier 1
Emblem Health NY - HIP - 2024 - Tier 2
Kaiser Permanente (DC) – 2024
Kaiser Permanente (NoCA) – 2024
Kaiser Permanente (SoCA) - 2024
Dental
CIGNA Dental DPPO Advantage Overview
CIGNA Dental Care (DHMO) Overview
Vision Care
Current Premium Rates
Supplemental Workers Compensation
Supplemental Workers Compensation
Other Benefits
Quality and Cost Incentive Plan (QCIP) – Bonuses For Cost Effective Health Benefit Use