Current Members:

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SAG-AFTRA Products:

Dental / Vision

Prescript Discount


Contact Info

OFFICE HOURS:

Mon - Fri   9am-5pm CST

PHONE:

800-450-1271

773-427-6875 fax

EMAIL:

CustomerService

POSTAL ADDRESS:

1701 E. Lake Avenue

Suite 400

Glenview, IL 60025


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  • Overview
  • Eligibility
  • Coverage
  • Cost
  • Enroll Now
  • Plan Details
SAG-AFTRA has brought you Dental and Vision coverage regardless of earnings requirements

 

SAG-AFTRA has arranged for a Stand Alone Dental and Vision insurance plan for Union members who are NOT enrolled in the SAG-AFTRA Health Plan I / II.

This benefit provides coverage for you and your eligible dependents for Preventive, Basic and Major dental services, such as exams, cleanings, x-rays, fillings, crowns, root canals, and Implants. In addition, this plan includes a vision benefit program through the Vision Service Plan network of providers.

These programs are only available to SAG-AFTRA Union members in good standing or on honorable withdrawal.

These programs have been arranged through your Union as part of its continuing efforts to provide members access to additional benefits. They will be administered by Group Benefit Associates and Cigna, not SAG-AFTRA or the SAG-AFTRA Health Plans.

Eligibility
  • SAG-AFTRA Union members in good standing or on honorable withdrawal
  • SAG-AFTRA members that are NOT covered under the SAG-AFTRA Health Plans I / II

In order to participate, the individual must be and remain current with any union dues that are required under SAG-AFTRA rules.

 

Eligible Dependents:

  • Your legal spouse
  • Qualified Domestic Partners
  • Your dependent children (dependent children are eligible until age 26)
  • Legally adopted children
  • Step-children who depend on you for most of their support and maintenance

THE DENTAL BENEFIT

This plan offered by Group Benefit Associates and insured by Cigna, gives members the opportunity to choose either a Dental PPO Plan or a Dental DHMO Plan. This flexibility allows you to select the plan that best fits your specific needs and budget. The Dental DHMO Plan is offered in California, New York, New Jersey, Illinois, Florida and Texas. The Dental PPO Plan is offered in all 50 states. Both the Dental PPO and the Dental DHMO Plan include a Vision benefit. See this DHMO FLYER for more information on the Cigna DHMO Plan.

The Dental PPO Plan option:

The Dental PPO plan allows you to visit any dentist or specialist you choose any time care is needed. If you elect to visit a Cigna network provider, you will receive the highest level of benefits and save on out-of-pocket costs. Best of all, the Cigna Dental PPO Plan features one of the industry's most extensive nationwide dental networks.

The plan pays a specific amount for each dental service based upon an established fee schedule. If you go to a Cigna Dental PPO provider, the benefits described below apply. If you go to a non-Cigna provider, the amounts charged over the scheduled fees are the patient's responsibility.

Cigna PPO Advantage

Cigna PPO

Out-Of-Network Providers

Calendar Year Deductible

(waived for Preventive services)

$50 Individual

$150 Family

$75 Individual

$225 Family

$75 Individual

$225 Family

Preventive Services

Exams, Cleanings, X-Rays, Fluoride, Sealants, Space Maintainers

100% of fee schedule, no deductible

75% of fee schedule, no deductible

75% of fee schedule, no deductible

Basic Services

Fillings, Oral Surgery, Anesthetics, Periodontics, Root Canal / Endodontics

Repair Bridge / Crown / Inlays / Dentures

80% of fee schedule, after deductible

80% of fee schedule, after deductible
 
50% of fee schedule, after deductible
 

Major Services

Crowns / Inlays / Onlays, Dentures, Bridges

50% of fee schedule, after deductible

50% of fee schedule, after deductible

50% of fee schedule, after deductible

Orthodontia
not an insured benefit
not an insured benefit
not an insured benefit
Implants

50% of fee schedule, after deductible, $1000 yearly

50% of fee schedule, after deductible, $1000 yearly
50% of fee schedule, after deductible, $1000 yearly
Calendar Year Maximum Benefit

$1000, $1200, $1400, $1600

Years 1,2,3,4

$1000, $1200, $1400, $1600

Years 1,2,3,4

$1000, $1200, $1400, $1600

Years 1,2,3,4

PRE-DETERMINATION: When a course of treatment is expected to cost $200 or more and is of a non-emergency nature, it is recommended to have your dentist submit a treatment plan before he/she begins.

This is intended only as a brief summary of benefits. It is not an official statement of those benefits. Please see additional docs under the "Plan Details" Tab above.

 

The Dental DHMO Plan option

(only available in CA, NY, NJ, IL, FL and TX):

The Dental DHMO Plan is designed to provide quality dental care while controlling the cost of such care. To do this, this plan requires participants to seek dental care from dentists that belong to the Cigna Dental DHMO network. All covered services must be provided by the participant's Primary Care Dentist selected at the time of enrollment.

You are only covered if you go to your assigned Primary Care Dentist
Specialty Referrals Must be coordinated by your Primary Care Dentist

Calendar Year Deductible

None

Office Visit Co-pay $5

Preventive Services

Oral Exams, Cleaning, X-Rays, Sealants, Space Maintainers

May be an additional fee. Refer to the DHMO Copayment Schedule for your state. See "Plan Details" tab.

Basic Services

Fillings, General Anesthesia, Scaling & Root Planing, Simple Extractions, Endodontics, Periodontics

Available for a Copayment. Refer to the DHMO Copayment Schedule for your state. See "Plan Details" tab.

Major Services

Dentures, Single Crowns, Prosthodontics

Available for a Copayment. Refer to the DHMO Copayment Schedule for your state. See "Plan Details" tab.

Orthodontia Available for a Copayment. Refer to the DHMO Copayment Schedule for your state. See "Plan Details" tab.
Calendar Year Maximum Benefit Unlimited

DHMO Copayment Schedules are available on the "Plan Details" tab above.

 

THE VISION BENEFIT

Vision benefits are provided through the Vision Service Plan network and include an annual eye exam for a $10 co-pay, in addition to discounted rates on frames, lenses, and other professional services at VSP network providers. This benefit also includes discounts on all covered services such as LASIK.

Our vision plan allows you to visit any eye doctor you wish. However, you save significantly on out-of-pocket costs when network providers are used. You will receive substantial coverage for annual eye exams and discounts on eyewear and contact lens professional services every 12 months.

Largest Quality Network

Our affiliation with Vision Service Plan (VSP) gives participants access to approximately 29,000 provider locations nationwide. All network professionals, includes licensed optometrist or ophthalmologist, are committed to delivering consistent and quality service.

You can find a VSP provider near you by:

  1. Looking up a VSP Provider online at www.vsp.com and selecting the "VSP Signature" network
  2. Requesting a provider directory from VSP by calling (800) 877-7195

 

Covered Services & Value Added Discounts

Eye Exams:

  • $10.00 copay, covered in full thereafter

Glasses:

  • 20% off lenses, frames and the industry's most extensive list of "cosmetic extras", including tints, special lenses (e.g. progressives) and scratch resistant coatings.
  • 20% off the retail price of additional glasses after initial pair is purchased.*

Contact Lenses and Professional Services

  • 15% off of the network doctor's evaluation and fitting services.
  • 20-25% off laser vision correction, or 5% off the laser surgery center's best promotional price, whichever is a better deal!**

You should call the VSP provider to schedule an appointment. When calling to schedule the appointment, identify yourself as a VSP member and give the insured's social security number. Before you go for the appointment, the provider will contact VSP to verify eligibility and coverage. You must go for services and materials within 60 days of VSP authorization.

*The claimant must go within 12 months to the same VSP doctor who provided the exam.
**Laser surgery is not an insured benefit. The surgery is available at a discounted fee. The covered person must pay the entire discounted fee. In addition, the laser surgery discount may not be available in all states. participant's out-of-pocket costs won't exceed $1,800 per eye for LASIK and $1,500 per eye for PRK.

The Stand Alone Dental and Vision Plan is offered as a combined package. All monthly premiums are collected on the 15th of the month prior to the month in which the premium is due.

Monthly Premium for Dental and Vision

The PPO Plan

 

Participant

Participant + 1

Participant +2+

All 50 States

$44.60

$79.06

$96.96

 

The DHMO Plan

 

Participant

Participant + 1

Participant +2+

California

$27.70

$41.47

$60.96

NY, NJ, TX

$26.34

$36.87

$47.93

Florida, Illinois

$29.18

$45.67

$68.84

The Dental DHMO Plan is only available in California, Florida, Illinois, New Jersey, New York, and Texas. Purchase coverage in the state where you receive your dental care.

Cancellation Requests: Cancellation requests must be received in writing by mail, fax, or e-mail. Cancellations will become effective on the last day of the month in which they are received.

Premium Payments: Your initial premium due will be collected within 5 business days of your enrollment. Subsequent premiums will be collected automatically from a Visa, MasterCard or direct debit from a checking account on the 15th of each month. If the 15th falls on a weekend or holiday, the charge will occur on the next business day.

Ready to enroll?

Enroll Now

OR

  • DOWNLOAD and print the enrollment form and fax or mail it to us

 

 

Forms & Documents

The following documents below are provided for your reference:

Enrollment Form

PPO Dental Summary

DHMO FAQ Flyer

Vision Summary

DHMO Copayment Schedule California

DHMO Copayment Schedule Florida

DHMO Copayment Schedule Illinois

DHMO Copayment Schedule New York, New Jersey, Texas

Dental Claim Form

Vision Claim Form

 

Frequently asked questions:

Q: How can I cancel my policy?

A: Please send your cancellation request by email, fax or mail.

 

Q: I did not receive an id card.

A: Please call Cigna at 800-244-6224 to request an id card.

 

Q: I have the DHMO Plan and I would like to change my provider?

A: Please call Cigna at 800-244-6224 to change your DHMO provider.