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

With the industry’s continuing recovery from the COVID-19 pandemic, the Equity-League Health Fund (the “Fund”) is able to return to a simpler plan design and offer coverage options with more choice and flexibility between tiers, lower work week requirements for eligibility, and an easier path to continuous coverage.

Eligibility and Tiers: 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, and the Health Fund will eliminate Tier 3 In-Network Only coverage as shown in the chart below*.

You qualify for six months of coverage in…	If you work in covered employment…
	Current	Effective for coverage that starts  on or after January 1, 2024
Tier 1	16 weeks or more	15 weeks or more
Tier 2	At least 14 weeks	At least 11 weeks
Tier 3 In-Network Only	At least 12 weeks	No longer offered

In other words, as long as you have worked at least 11 weeks in a 12-month period, you will have a minimum of Tier 2 coverage.

*For those that are currently enrolled in Tier 3, please read the “Making the Transition” section listed below to learn what will happen to your coverage as of January 1, 2024.

Changing Tiers: A New Option Has Been Added to Buy Up to Tier 1

• • The health care coverage in Tiers 1 and 2 are very similar. The main difference is that participants enrolled in Tier 2 pay more out of pocket when they receive health care services.
  • The rules for “buying up” and “buying down” when enrolling in Cigna coverage have changed.  As of January 1, 2024:
    • • If you qualify for Tier 1, you can enroll in Tier 2 and preserve 4 weeks to use towards future eligibility determination. In other words, if you earn Tier 1 coverage at 15 or more weeks, you could use only 11 weeks to enroll in Tier 2 and save at least 4 weeks for your next Accumulation Period.
      • If you qualify for Tier 2, you can “buy up” to Tier 1 by paying an additional $95 per month (or $285 per quarter).  Please note that the additional premium to “buy up” will be reviewed on an annual basis and the amount could change each calendar year.

Continuous Coverage: 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.

Enhanced Benefits in Tier 1

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.

What Isn’t Changing

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. Click on Benefits Explained 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.

Making the Transition

If you are enrolled in Tier 3 In-Network Only coverage that will continue into 2024*, beginning January 1, 2024:

• • You will be moved into Tier 2.
  • If you “bought up” to Tier 2 from Tier 3, your monthly cost of that “buy up” will be reduced from $195 to $100. In the event you already prepaid the $195 - $585 per quarter – the Fund Office will refund you the difference.
  • If you “bought down” from Tier 2 to Tier 3 BY October 11, 2023, you will continue to pay the $15 per quarter until your 6-month coverage period ends.
  • If you “buy down” from Tier 2 to Tier 3 AFTER October 11, 2023, your member premium requirement will be $100 per month (instead of $5) as of January 1, 2024. This means the billed quarterly amount that includes coverage periods beginning in January 2024 will include an additional $95 per month. For example, if you buy down for the 6 months of coverage that begins December 1, 2023, the quarterly amount due for the period of December 1, 2023, through February 29, 2024, will be $205 and not $15 - $5 for December 2023 and $100 per month for January and February 2024.

*This includes anyone who elected coverage at the start of the August, September, October, November, or December 2023 coverage periods.

Those who have Tier 3 In-Network Only COBRA and/or Self-Pay After COBRA coverage at the end of 2023 will also see specific changes beginning January 1, 2024:

• • You will be moved to Tier 2.
  • If you selected and paid for this coverage BY October 11, 2023, the Fund will subsidize the difference between what you would have paid for Tier 3 In-Network Only and the cost of the Tier 2 coverage for the remainder of your eligible self-pay period. For example, if Tier 3 In-Network Only COBRA coverage would have been $100 less than the cost of Tier 2, you will pay the lower rate with the Fund subsidizing the difference.
  • If you select Tier 3 In-Network Only COBRA coverage AFTER October 11, 2023, you will be transitioned to Tier 2 and be responsible for paying the full cost of the Tier 2 coverage.

For more information

If you have any questions, please contact the Benefit Services Department within 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.