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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


GBA Home

  • Overview
  • Dual Coverage
  • Eligibility
  • Coverage
  • Cost
  • Enroll
  • Plan Details
SAG-AFTRA offers additional Dental Coverage

SAG-AFTRA has arranged for a Supplemental Dental insurance plan for Union members who are enrolled in the SAG-AFTRA Active Plan.

This Supplemental Coverage doubles your current dental benefit and will often reduce your out-of-pocket cost to $0.

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.

These programs are only available to SAG-AFTRA Union members in good standing, on honorable withdrawal, and employees of SAG-AFTRA who have coverage under the SAG-AFTRA Active Plan.

These programs have been arranged through your Union as part of its continuing efforts to provide members access to additional benefits and will be administered by Group Benefit Associates and Cigna.

Dual Coverage - a Great Benefit!

The GBA Supplemental Plan offers a Dual Coverage Feature. This feature allows the Cigna plan to step in to more than double your coverage and will often eliminate your out-of-pocket costs!

With your current insurance, Preventive Services such as cleanings are covered at 100%, but Basic and Major Services are only covered at 75% and 50%. This means you are still responsible for a significant outlay anytime you or a covered family member have any substantial dental work performed.

Preview the few examples below and see how quickly your out-of-pocket costs can add up if you don't have the GBA Supplemental Coverage.

 

Dental Needs - Each Individual

Dental Charges

Your Cost without GBA Supplemental
Your Cost with GBA Supplemental
Cleaning (1)
$0.00

$0.00 (1)

$0.00
Cleaning (2)
$233.00

$136.00 (2)

$0.00
2 surface cavity + composite filling
$236.00
$90.00 (3)
$0.00 (4)
Crown (and all necessary work)
$3,080.00
$1,098.50 (5)
$0.00 (6)

 

Notes:
1
In-network routine cleaning + periodic X-Rays are covered 100% with no deductibles.
2
Out-of-network routine cleaning + periodic X-Rays. Delta allowable charge of $190, less $100 deductible = $90 covered amount at 60%. Your out-of-pocket costs = $136 (40% of $90 + $100 deductible). Cigna reimburses you for 100% of your out-of-pocket costs.
3
Delta allowable charge of $135, less $75 deductible = $60 covered amount from Delta at 75%. Your out-of-pocket costs = $90 (25% of $60 + $75 deductible).
4
Cigna reimburses you for 100% of your out-of-pocket costs.
5
Delta allowable charge of $2,122 less $75 deductible = $2,047 covered amount from Delta. Your out-of-pocket costs = $1,098.50 (50% of $2,047 + $75 deductible).
6
Cigna allowable charge of $2,621 less $1,023.50 paid by Delta = $1,597.50 allowable Cigna claim. Cigna reimburses you 100% of your out-of-pocket costs.

 

Eligibility
  • SAG-AFTRA Union members in good standing or on honorable withdrawal
  • SAG-AFTRA members that ARE covered under the SAG-AFTRA Active Plan.

 

Eligible Dependents include:

  • Your legal spouse
  • 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

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

Note: Qualified Domestic Partners may enroll in their own individual plan. Click Here for more info.

THE DENTAL PPO BENEFIT

This plan offered by Group Benefit Associates and insured by Cigna gives participants the opportunity to more than double your current coverage and often eliminate any out-of-pocket costs. The Dental PPO Plan is offered in all 50 states.

The Dental PPO plan allows you to visit any dentist or specialist you choose anytime 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. Cigna deductible is usually satisfied by Delta deductible.

$50 Individual

$150 Family

$75 Individual

$225 Family

$75 Individual

$225 Family

Preventive Services

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

25% of fee schedule, no deductible

25% of fee schedule, no deductible

25% 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

50% 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

$2500, $2700, $2900, $3100

Years 1,2,3,4

$2500, $2700, $2900, $3100

Years 1,2,3,4

$2500, $2700, $2900, $3100

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.

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

 

All premiums are billed Quarterly

2022 Quarterly Premium

For Members Covered by the SAG-AFTRA Active Plan

 

Participant

Participant + 1

Participant + 2+

 Dental PPO

$90.96

 

$150.06

 

$228.57

 

 

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 March 15th, June 15th, September 15th, and December 15th. 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

Dual Coverage Flyer

Dental Summary

Dental Claim Form

Parental Consent Form for Children under age 13

 

Frequently asked questions:

Q: How can I cancel my policy?

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

 

Q: How can I get an ID card?

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