AMERICAN GUILD
of
VARIETY ARTISTS
National Office:
363 Seventh Avenue
17th Floor
New York, NY 10001-3904
{212}675-1003
(212)633-0097 Fax
agva@agvausa.com
agvany@aol.com
West Coast Office:
11712 Moorpark Street
Suite 110
Studio City, CA 91604
(818)508-9984
(818)508-3029 Fax
agvawest@earthlink.net
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AGVA WELFARE TRUST FUND
363 Seventh Avenue, 17Th Floor
New York, New York 10001-3904
(212) 627-4820




The AGVA Welfare Trust Fund is a self-funded Major Medical insurance plan, governed by a Board of Trustees, for the purpose of providing medical, optical and dental insurance coverage to eligible AGVA performers.


What are the eligibility requirements for coverage?
All Performers/Stage Managers employed under an AGVA Collective Bargaining Agreement or Casual/Club date Contract may accrue medical coverage provided by the AGVA Welfare Trust Fund.

The Fund administers one Major Medical Healthcare plan, Plan A. Plan B is in effect after three (3) days of employment and is in place only during the waiting period between days 3 and 15, after which a Member is eligible for Plan A. Plan M dictates, for those Members covered by Medicare and eligible under Plan A, that all claims must first be paid by Medicare. [Plan B and Plan M are not Major Medical Coverage plans, and should not be viewed as such under the A.C.A. or otherwise.]

PLAN A - ELIGIBILITY:
Performers/Stage Managers engaged under an AGVA Collective Bargaining Agreement, accruing fifteen (15) days or three (3) consecutive weeks of employment within the past six (6) month period, meet Plan A eligibility, provided that their employer has contributed to the AGVA Welfare Trust Fund on their behalf. The length of coverage is determined as follows:

For ongoing engagements of twelve (12) consecutive weeks or longer, with continued contributions for every week of work, Plan A coverage is in effect after the first 15 days (necessary for eligibility), and benefits extend an additional five months beyond the last day of employment, unless otherwise modified by your particular Collective Bargaining Agreement (please refer to your CBA to access otherwise negotiated provisions of the term of coverage).

For engagements of less than twelve consecutive weeks, Plan A benefits extend an equivalent of the length of the engagement, unless otherwise modified by your particular Collective Bargaining Agreement (please refer to your CBA to access otherwise negotiated provisions of the term of coverage).


For example: if the engagement is for twenty (20) days, Plan A coverage is in effect after the first 15 days (necessary for eligibility), and benefits would then extend for another twenty (20) days following the last day of employment; if the engagement is for four (4) weeks, Plan A coverage is in effect after the first 15 days (necessary for eligibility), and benefits would then extend for another four (4) weeks following the last day of employment.






UPON EXPIRATION OF COVERAGE, IF A MEMBER QUALIFIES FOR COBRA AND WISHES TO CONTINUE WHEN COVERAGE TERMINATES, THE AGVA WELFARE TRUST FUND MUST BE NOTIFIED TO DETERMINE ELIGIBILITY AND COORDINATE PREMIUMS



Self-employed, casual and club date AGVA members who have registered fifteen (15) shows of employment under an AGVA contract within the six-month periods of January to June or July to December, are eligible for the self-pay plan. The self-pay plan payment schedule may be obtained, upon request, from the AGVA Welfare Trust Fund office.




PLAN A - REQUIREMENTS FOR REALIZATION OF BENEFITS:

• $100.00 DEDUCTIBLE (OF COVERED AMOUNT) PER CALENDAR YEAR
(1/1 to 12/31) APPLIES

• All SURGERY AND MEDICAL PROCEDURES INCLUDING AN MRI (must be requested by M.D.) MUST BE PRE-CERTIFIED WITH THE AGVA WELFARE TRUST FUND OFFICE, AND A SECOND SURGICAL OPINION IS REQUIRED FOR CERTAIN PROCEDURES

• MEMBERS REQUIRING HOSPITALIZATION MUST CONTACT CAREALLIES AT
1-800-331-0890

• CARE ALLIES MUST BE NOTIFIED PRIOR TO ALL HOSPITAL CONFINEMENTS AND IN CASE OF EMERGENCY HOSPITALIZATION, YOU MUST NOTIFY CAREALLIES WITHIN 48 HOURS – FAILURE TO DO SO WILL RESULT IN 50% REDUCTION OF ALLOWABLE BENEFITS

• MEMBERS MUST SUBMIT ALL CLAIMS VIA HARD COPY WITHIN 90 DAYS OF TREATMENT

• PROOF OF PAYMENT MUST BE PROVIDED IF BENEFITS ARE NOT TO BE PAID
DIRECTLY TO PROVIDER

• DEPENDENT CHILDREN COVERAGE IS AVAILABLE, AS PER THE A.C.A.
MONTHLY PREMIUM RATES CAN BE PROVIDED BY THE AGVA WELFARE TRUST FUND

• IF YOU HAVE EXISTING INSURANCE, YOU MUST DECLARE IT, AND A CO-ORDINATION OF BENEFITS FORM MUST BE ON FILE FOR BENEFITS TO BE PROCESSED AND COORDINATED
AN EXPLANATION OF BENEFITS FORM (FROM YOUR PRIMARY INSURANCE CARRIER) MUST BE PROVIDED WITH ALL BILLS SUBMITTED TO THE AGVA WELFARE TRUST FUND FOR PROCESSING






PLAN A - BENEFITS:


Major Medical:
- 80% of reasonable & customary covered expenses
- Includes: doctor visits (M.D.), Out-Patient Psychiatric Care only by: M.D., Ph.D. or C.S.W., Prescription drugs, X-rays (must be ordered by an M.D.), labs, etc.
- Letters of Medical Necessity may be required
- Please submit only original bills and original prescription receipts


Hospital Room Expenses:
- Semi-private room and board payable at 100%

Other In-Hospital Expenses:
- Payable at 100%

Outpatient Hospital Services:
- Payable at 80% for surgery
- Facility fee, medical care & treatment payable at 100% for hospital only

Surgical Care Centers: (located outside of Hospitals)
- 80 % of reasonable & customary charges
- Pre-Certification from AGVA Welfare Trust Fund is required for
Surgery and Medical Procedures including an MRI
- Letters of Medical Necessity may be required


Acupuncture by - M.D., O.M.D or Licensed Acupuncturist
- 10 visits per calendar year
- Payable at 80% up to a maximum of $50.00 per visit

Chiropractic Care by - D.C.
- 20 visits per calendar year
- Payable at 80% up to a maximum of $50.00 per visit

Vision Therapy by - M.D.
- 20 visits per calendar year
- Payable at 80% up to a maximum of $50.00 per visit

Physical, Speech & Occupational Therapy by - P.T., S.T. and O.T.
- 40 visits per calendar year
- Payable at 80% up to a maximum of $50.00 per visit

Special Mammogram Program:
- For women on Plan A over the age of 35: AGVA Welfare Trust Fund will provide a free
mammogram every other year (payable up to $150.00, for which the yearly deductible is
not applied). Up to $150.00 is paid at 100% and any charges beyond that are paid at
80%





Maternity Benefits:
- CAREALLIES must be informed at the beginning of your pregnancy 1-800-331-0890
- Members requiring Hospitalization at any time during and through the pregnancy
must contact CAREALLIES at 1-800-331-0890
- Prenatal visits paid at 80% of reasonable and customary charges
- Laboratory tests, Sonograms, Ultra-sound all paid at 80%
- Hospitalization - Semi-Private rate paid at 100%
- Vaginal delivery and C-Section are paid at 80%
- Delivered Dependents are NOT Covered under AGVA Welfare Trust Fund (unless dependent coverage has been pre-arranged and premiums are being paid)




VISION COVERAGE:
- OPTHAMOLOGIST: covered at 80% of all customary and reasonable charges - OPTOMETRIST: Glasses and or Contact Lenses are paid at up to $200.00
per calendar year. No deductible applies




DENTAL COVERAGE:
- $2000.00 maximum benefit paid per calendar year
- Benefits are paid according to a fee schedule
- $200.00 deductible is based on the WTF fee schedule for each procedure,
per calendar year
- A pre-treatment review of dentist’s proposed charges is available and recommended
- No coverage for: orthodontics, night guards or TMJ




DEATH BENEFIT:
- $5000.00 paid to designated Beneficiary or Member’s Estate
- Please ensure that a Death Beneficiary card is on file




THE BENEFITS DESCRIBED IN THIS SUMMARY ARE SUBJECT TO THE PLAN OF BENEFITS ADOPTED BY THE BOARD OF TRUSTEES, AS AMENDED FROM TIME TO TIME. WHERE A DISPUTE ARISES REGARDING THIS SUMMARY AND THE PLAN OF BENEFITS, THE DECISION OF THE BOARD OF TRUSTEES SHALL BE FINAL AND BINDING ON ALL PARTIES