Welfare Fund

The Welfare Fund provides medical and prescription drug benefits to eligible members and their qualified dependents.

Eligibility and Enrollment

Wellness Incentive

When Coverage Ends

Medical Coverage

Hospital Indemnity Plan

Retiree Medical Coverage

Prescription Drugs

Friedman Center

Member Assistance Program

New to IATSE?

If you’re eligible for welfare benefits for the first time, you can elect only Basic coverage. Basic Coverage consists of Tier I hospital/medical coverage and coverage for generic drugs only under the pharmacy benefit.

The self-pay premium for Basic Coverage is the same as Tier I for Participant Only coverage, and if you would like to add any eligible family members to your coverage, you will be charged the full cost of coverage for those dependents.

After qualifying for Basic coverage for five (5) consecutive open enrollment periods, you’ll be eligible for Tier I, II, and III coverage based on the eligibility rules in effect at the time. Current eligibility rules are shown below.

There’s More To Know

For detailed medical and prescription plan information, review the Benefits Booklet, the Summary of Benefits and Coverage (SBC), the Summary Plan Description (SPD), and the notifications of plan changes on the Resources page.

Eligibility and Enrollment

As an active participant, your covered earnings during previous specified 12-month work periods determine whether you are eligible for medical benefits during two six-month coverage periods. Covered earnings are earnings on which employer contributions are payable to the Fund.

Coverage Period

January 1-June 30

July 1-December 31

Earnings Work Period

October 1 through September 30

April 1 through March 31

The Plan provides three levels of benefits (Tiers I, II, and III) and three types of coverage (participant only, participant + 1, and family). The level and type of insurance you qualify for depend on your covered earnings and the self‐pay premium you send the Fund Office. Your eligible family members are also eligible for coverage.

Coverage Tier

Tier I

Tier II

Tier III

Covered Earnings

$37,500-$55,000

$55,001-$85,500

$85,501+

You can track your earnings progress for each applicable work period on our Benefit Portal.

Unless you’re a new participant, you have self-pay buy-up options for coverage at a higher tier than you qualify for based on your covered earnings. For details, see the Summary Plan Description (SPD).

Quarterly Self-Pay Premium Amounts

Class

Basic¹

Tier I

Tier II

Tier III

Buy-up from Tier I to Tier III²

Buy-up from Tier II to Tier III³

Coverage

Participant only
Participant + 1
Family

Quarterly Rates

$270
$953
$1,610

$270
$338
$405

$354
$442
$530

$556
$695
$834

$1,841
$2,843
$4,274

$748
$969
$1,286

¹Tier 1 Basic applies only to new participants who have met the earnings requirement but have not yet had five consecutive open enrollments of eligibility.
²Includes the self-pay premium for Tier III coverage.

Initial Enrollment

When you become eligible for benefits, the Fund Office will automatically send you an application to enroll in the plan. Complete the enrollment application, including the required information for any eligible family members you want to cover, and return it with the required self-pay premium to the Fund Office. You can pay online by using our Benefit Portal.

Open Enrollment

During our open enrollment periods (with coverage effective January 1 and July 1), you have the opportunity to:

Enroll for the first time
Add or drop family members for coverage (and possibly elect a different type of coverage)
Elect to buy up to Tier III coverage

Open Enrollment changes and self-pay premiums can be made online using our Benefit Portal.

Notifying the Fund of Life Events

Life events can affect your or your dependents’ eligibility for Plan benefits. If you experience any of the following life events, notify the Fund Office and submit supporting documentation within 60 days of the event:

Marriage, divorce, or legal separation
Spouse or dependent gains or loses coverage under another plan
Birth or adoption of a child
Death in the family
Change of address
Change in employment status
A dependent child turns 26 years of age

In the event of your death, your spouse or a dependent should notify the Fund Office immediately.

Wellness Incentive

When you meet specified wellness-related goals, the Fund will reduce your self-pay premium by $100 per quarter.

The Trustees believe it is vitally important that all members see a doctor at least once a year. Early detection of chronic diseases like high blood pressure or diabetes generally results in better outcomes for patients and lower costs for treatment. Annual Wellness visits help ensure that we receive recommended screenings and care, and that when we do get sick, we have an ongoing relationship with a doctor and don’t end up in an emergency room. (Improper use of ERs is a huge area of waste.)

For details, read the Fund’s notice about the Wellness Incentive. If you still have questions, contact the Fund Office.

When Coverage Ends

Coverage ends for you and/or your covered family members:

At the end of the enrollment period (June 30 or December 31) in which you don’t meet the covered earnings requirement for the upcoming open enrollment
At the end of the quarter for which you have paid the self-pay or buy-up premium
When your child is no longer qualified as eligible for coverage
If you and your spouse legally separate or divorce, your spouse’s coverage ends at the end of the month in which your separation is final.
On the date the plan is terminated
The date you or a covered family member enters the military

If you lose coverage, you may be able to continue coverage under the Plan through COBRA. You will pay the full cost of COBRA coverage. See the Summary Plan Description (SPD) for details.

Medical Coverage

You have comprehensive coverage through the medical plan. The plan is a point-of-service (POS) plan that uses Aetna’s network of preferred providers to offer cost savings for you and the Welfare Fund. Although you can see any doctor you want, you will pay more if your doctor is not part of the Aetna network.

The level of benefits you receive, what you pay out of pocket for care, and your self-pay coverage rates all depend on your plan coverage tier. For details, see the Summary Plan Description (SPD) and 07-01-2024 Eligibility changes Summary of Materials Modifications (SMM) on the Resources page.

What you pay for In-Network care

Annual Deductible
(July 1-June 30)

Annual Out-of-Pocket Maximum

Office Visits

Urgent Care

Hospital Emergency Room (copay waived if admitted)

Inpatient Hospital

Lab Tests and Imaging

Tier I/Basic Coverage

Individual: $500
Family: $1,250

Individual: $5,350
Family: $10,700

Primary Care: $50 copay, deductible waived
Specialist: $50 copay, deductible waived

$50 copay, deductible waived

$200 copay per visit, then 30% coinsurance after deductible

$500 copay, then 30% coinsurance after deductible

Lab and X-rays: $0 CT/PET scans, MRIs: $50 copay, deductible waived

Tier II Coverage

Individual: $300
Family: $750

Individual: $2,750
Family: $5,500

Primary Care: $35 copay, deductible waived
Specialist: $50, deductible waived

$35 copay, deductible waived

$200 copay per visit, then 20% coinsurance after deductible

$250 copay, then 20% coinsurance after deductible

Lab and X-rays: $0 CT/PET scans, MRIs: $50 copay, deductible waived

Tier III Coverage

Individual: $0
Family: $0

Individual: $2,000
Family: $4,000

Primary Care: $25 copay
Specialist: $50 copay

$25 copay

$200 copay per visit

$0

Lab and X-rays: $0
CT/PET scans, MRIs: $50 copay

Out-of-Network care

Out-of-Network benefits are significantly more expensive. It is important to confirm with each of your providers that they are in network with our Aetna coverage in order to avoid high out-of-network deductibles. The deductible for out-of-network care is $10,000 for an individual and $20,000 for a family. There is no Maximum Out-of-Pocket protection for out-of-network services.

No Surprises Act

The No Surprises Act is a law that protects you from balance billing if you receive care from an out-of-network provider at an in-network hospital or emergency room. Balance billing happens when an out-of-network provider charges you the difference between the total cost of your care and what your health plan agreed to pay.

Sometimes, in-network emergency rooms and hospitals employ out-of-network doctors. In these cases, you might receive care from an out-of-network provider, through no fault of your own. Also, in a medical emergency, you might not have time to choose between an in- or out-of-network provider. The No Surprises Act is designed to ensure that you aren’t balance billed if you receive care under these circumstances. It protects you from paying extra when the circumstances are beyond your control.

For more information, refer to these resources:

You should still use network providers whenever possible. Visit your insurance carrier’s website to find a list of network providers near you:

Hospital Indemnity Plan

If you’re receiving Tier I or Tier II coverage, you’ll also be automatically enrolled for supplemental hospital indemnity coverage through Aetna. If you or your covered dependents are hospitalized for any reason, this coverage pays cash benefits that you can use as you wish:

Covered Hospital Stay

Hospital admission

Hospital daily stay¹ (includes substance use or mental health)

Intensive Care Unit

Rehabilitation facility

Nursery admission (non-NICU)

Cash Benefit Amount

$1,000 (once per participant, per plan year)

$50 per day

$100 per day

$25 day

$100 per day

¹Daily stay benefits begin on day 2 and pay up to a maximum of 15 days (per type of stay) per participant for the Plan year.

Download and complete a claim form to receive benefits.

Retiree Medical Coverage

If you’re a retired participant, you and your eligible family members can enroll for self-pay medical plan benefits if you meet certain conditions. For plan details and self-pay premium information, review the Summary Plan Description (SPD) and the 07-01-2024 Eligibility changes Summary of Materials Modifications (SMM) on the Resources page.

When you’re eligible for Medicare, you must enroll in Medicare Parts A (hospital insurance) and B (medical insurance). Your Fund medical benefits will move to a Medicare Advantage Plan managed by Aetna.

SilverSneakers

The Medicare Advantage Plan includes SilverSneakers membership. SilverSneakers is a health and fitness program for adults 65 and older that provides access to exercise classes, thousands of gyms, and online workouts. It offers a variety of classes for different fitness levels, including strength training, yoga for flexibility, and water-based exercises. The program also emphasizes community and social interaction to promote both physical and emotional well-being. For more information and to check your eligibility, visit silversneakers.com.

Prescription Drugs

Your prescription drug coverage is administered on behalf of the Welfare Fund by Express Scripts.

If you’re an active participant, review the table below to see what you’ll pay out of pocket for prescription drugs. If you’re Medicare eligible, review the Aetna Medicare Advantage Plan Summary of Benefits on the Resources page.

What you pay for prescriptions

Copay at participating pharmacy (30-day supply)

Copay for mail order (3-month supply)

Generic

$5

$10

Brand Name Preferred¹

$45

$90

¹Daily stay benefits begin on day 2 and pay up to a maximum of 15 days (per type of stay) per participant for the Plan year.

The Plan does not cover brand name non-preferred (non-formulary) drugs.

If you’re prescribed a specialty drug, you will be contacted to enroll in the SaveOnSP program to save on your copay with drug manufacturer copay assistance. If you do not enroll in the program and your medication is eligible for copay assistance, your required copay will be the maximum allowable under the Plan.

Friedman Center

The Friedman Center is Local One’s “medical home,” and there is no copay for any primary care visit if you have health coverage. The Center is located at 729 Seventh Avenue (between 48th and 49th Streets), 12th floor, New York, N.Y.

Please contact the Friedman Center at 1-212-930-7300 to schedule an appointment and let them know you are a Local One member.

Member Assistance Program

If you or a family member is struggling with mental health, substance use, financial, or other well-being issues, you can find confidential support through the Entertainment Community Fund (formerly The Actors Fund). Programs and services include:

Short-term counseling
Help accessing government and community benefits
Employment counseling, training, and other work-related services
Legal referrals
Work/life enrichment workshops around financial planning, debt management, housing, stress and time management
Support groups
Health advocacy and wellness information
Health fairs
Housing services