Frequently Asked Questions

1. Who is eligible for coverage through the AGMA Health Fund Standard Plan?
A. You will receive one month of health insurance for each month that a Company contributes to the Standard Plan the required monthly contribution on your behalf pursuant to a collective bargaining agreement with AGMA. Generally, AGMA collective bargaining agreements require monthly health contributions to the Standard Plan for Artists on a weekly contract of 4 weeks or more. Such collective bargaining agreements generally require a contribution for each month in which you are contracted to work at least 7 days. They also generally require that if you are contracted to work 16 or 20 weeks or more, the Company must make the monthly the Standard Plan health contributions for a full 12 months. If you actually work more than the 16 or 20 weeks within a period of 12 months, you do not earn more than 12 months of coverage.

See question number 2, below, as to when your coverage begins. If the Company contributes the amount for single coverage, then only you are covered. If the Company contributes the amount for family coverage, then your eligible dependents are also covered once enrolled. In most CBAs, you generally must bear the additional cost of dependent coverage, but the Fund requires the Company to forward the amount of your additional premium to the Standard Plan. Please contact the Fund Office for the additional cost of family coverage. See questions 4 and 5 regarding open enrollment and adding dependents.

2. I have just started with the Company, when does my insurance begin?
A. If this is the first time you’ve worked for an AGMA Company, or you have had a break in service with an AGMA Company, your insurance will begin two (2) months after your contracted start date. Your insurance would then terminate two (2) months after your employment has terminated. If you have had no break in service with an AGMA Company, and have been on health insurance through the AGMA Health Fund, your insurance will continue in force and any changes must be made during Open Enrollment

3. Why do I have to wait two (2) months for my insurance to begin?
A. The process begins when the Company notifies the Fund Office that they employ you; this happens on or around the 15th of the month following the beginning of your employment. Once we are notified, we send out enrollment information to the participant. The participant then needs to fill out the forms and return them to the Fund Office. If we do not have an address or have incorrect information, this can delay the enrollment. While there is a delay in beginning coverage, you will also receive two (2) months of coverage after the Company contributions end to balance out the lag time.

4. What are the key differences between the Standard Plan and the Healthy Savings Plan?
A. There are two type of coverage available through the AGMA Health Fund: the Standard Plan (Traditional POS Plan) and the Healthy Savings Plan (High Deductible Health Plan). To more easily understand the differences of the Standard Plan and the Healthy Savings Plan, we have created a side by side comparison of the deductibles, copayments, and coinsurances for the two plans, which can be seen in this link. Included in that comparison are some examples of general medical expenses, and how they would be prices by each specific plan.

5. I just got married/had a child. Do I have to wait until Open Enrollment to add them to my coverage?
A. No. You have within 30 days of your marriage or birth of a child to notify the Fund Office in writing that you want to add your family to your insurance, and that you have agreed to a payroll deduction covering the cost of family coverage, which is in addition to the contribution the employer pays for your coverage. You must also submit supporting documents (i.e. Marriage License) to the Fund Office when adding family to your insurance.

6. Does the Fund offer Domestic Partner Insurance?
A. The Fund Office does offer Domestic Partner Coverage. In order to qualify for Domestic Partnership coverage, you must both be over 18 years of age, live together for at least 6 months, and intend to continue living together indefinitely, not be related by blood, you must be financially dependent on one another, have an exclusive, close and committed relationship with each other and have not terminated the Domestic Partnership. If you meet these qualifications you will need to submit an affidavit of domestic partner status and a declaration of financial interdependence, linked here. You are able to request Domestic Partner Coverage at the time of your initial employment, when you fulfill the six month co-habitation rule, or at Open Enrollment, which is January 1. Once the Fund Office receives your notarized documents and supporting documents, we will notify you in writing that your Domestic Partner is eligible for coverage. The cost of Domestic Partner coverage is the same as family coverage. The monthly premium must be submitted via your employer with their regular monthly contribution. We cannot accept the money directly from the member.

1. Who is eligible for dental insurance through the AGMA Health Fund?
A. Any member who is enrolled in AGMA Health Fund Standard or Health Savings Plan is also eligible to enroll in the dental insurance plan. Please contact the Fund Office for plan options, plan costs, and enrollment forms.

2. Do I have to choose an in-network dentist?
A. No. AGMA Health Fund offers both the Freedom of Choice DMO plan and the Freedom of Choice Indeminity Plan. The DMO plans similar to an HMO plan where you go to an in-network dentist and your out-of-pocket costs are minimal.

3. How do I know if a particular dentist is in-network?
A. You can either call Aetna Dental member services at 1-877-238-6200 or check their Web site at www.aetna.com/docfind

4. How will I know what percentage of a particular dental service is covered?
A. For specific questions about coverage of services and amounts covered, please call Aetna Dental Member Services at 1-877-238-6200.

5. If I go to an out-of network dentist, do I have to pay for services “up-front?”
A. That will depend upon the billing practices of your particular dentist. It is best to ask your dental office this question when scheduling an appointment.

6. How long are dependents covered under the dental plan?
A. Coverage for dependents under family plans last until the end of the month in which the dependent turns 26 years of age.

1. Who is eligible for vision insurance through the AGMA Health Fund?
A. As of January 1, 2015, the AGMA Health Fund will offer eligible members the opportunity to enroll for vision coverage on a self-pay basis.

2. What benefits are offered in the Vision plan?
A. Aetna’s Vision Preferred Plan offers a variety of benefits – please see the summary for more information.