COORDINATION OF BENEFITS

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Special Rules for Individuals Eligible for the SAG-Producers Health Plan
If you would have primary coverage under the SAG-Producers Health Plan but have failed to pay the quarterly premium required by the SAG Plan, the AFTRA Plan will process your claims as if you continued to be covered under the SAG Plan and will only pay benefits on a secondary basis. The AFTRA Plan will determine what would have been paid for primary coverage by calculating what the AFTRA Plan would have paid as primary and then process the claim as secondary payer.

Keep in mind that, unlike the other coordination of benefit rules, this rule applies even if you are not actually covered by the SAG Plan.

In addition, if a participant qualifies for coverage under both the AFTRA Health Fund and the SAG-Producers Health Plan on the same day, there are special rules regarding the order of coverage, as well as what happens if you pay the premium for one plan but not another. If this applies to you, contact the Fund office.
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