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FAQ

The answers to frequently asked questions below are general in nature and do not modify the terms of their respective Plans. You should refer to the related Summary Plan Description for more specific information regarding each Fund's Plan.

Top Frequently Asked Questions

How do I know if I am a participant of Plan A?

You are a participant in Plan A if your employer contributes to Plan A and you are eligible under the Plan A rules. Participants of Plan A generally work in the live theatre industry under Collective Bargaining Agreements between I.A.T.S.E. and Theatrical Producers, such as the Travelling Employees (or “Pink Contract).

What is the definition of a “group health plan” as defined by ACA?

In order to qualify to enroll in a Health Reimbursement Arrangement (HRA), which is what the National Health and Welfare Fund’s MRP is, you must have primary health coverage that is a group plan sponsored by an employer (that is, obtained through employment) or sponsored by a union. Your primary health coverage cannot be “individual” coverage for this purpose.

How do I enroll in the stand-alone MRP option?

Annually, you must provide the following:

  1. Front and back copy of your other employer or union sponsored group health coverage ID card which clearly states GROUP coverage on the card.
  2. OR, a letter from your Plan-sponsor stating you are enrolled in an employer or union sponsored group health plan that meets the Affordable Care Act (ACA) minimum value standard
  3. The signed certification that comes with your annual open enrollment statement
  4. If you are enrolling on-line via the Funds website, there is an on-line certification that you electronically sign and you can upload your ID card or your plan sponsor letter.

What is the definition of individual health coverage?

Individual coverage is coverage that you purchase on your own (whether directly from an insurance carrier, such as Cigna, Aetna, United, BlueCross or BlueShield, or through a state insurance Marketplace (previously called the “Exchange” such as in the state of Massachusetts) or that you obtain through a government program such as Medicare, Medicaid, Veterans Administration, National Programs (such as the U.K.) etc.

I recently heard that the federal government has issued new rulings regarding Individual Coverage HRA’s and reimbursements. Does this pertain to the Medical Reimbursement Program Plan (MRP)?

We have received several questions about the new rules issued by the federal government regarding Individual Coverage Health Reimbursement Arrangements (“Individual Coverage HRAs), which may be offered by employers beginning January 1, 2020 as an alternative to traditional group health coverage. Individual Coverage HRAs may reimburse employees for premiums for individual health insurance chosen by the employee, as well as other medical care expenses. However, the IATSE National Health Plan C is not permitted to offer participants an Individual Coverage HRA because these HRAs may only be offered to groups of employees who are not offered traditional group health coverage (such as coverage under IATSE National Health Plans C-1, C-2, C-3 and C-4). Under the new rules, employees cannot be offered a choice between an Individual Coverage HRA and traditional group health coverage. Accordingly, because the IATSE National Health Plan C offers traditional group health coverage to those who qualify, it cannot also offer an individual coverage HRA. More information is available on the website of the Department of Health and Human Services at the following link: https://www.hhs.gov/sites/default/files/health-reimbursement-arrangements.pdf. See in particular Q&A 5, discussing which employees can be offered an Individual Coverage HRA.

How are contributions to Plan A determined?

The Collective Bargaining Agreements determine the employer contribution rate for each day of your covered employment. However, the employer must meet the minimum daily contribution rate established by the Trustees. The Plan is supported by employer contributions; employees cannot contribute to Plan A.

Can I waive Plan coverage and buy coverage on the Marketplace?

No! You may not waive coverage under the Fund’s Plan C1, C2, C3, C4 or Triple S options.

When do I become eligible for benefits under Plan A?

You must work in “covered employment" and work a minimum of 60 days in a six month period to qualify for coverage under Plan A.

Can I submit a reimbursement claim from last year if I am no longer enrolled in the MRP Plan?

No. You must incur the claim while enrolled in MRP AND reimbursement can only be made if you are enrolled in the MRP Plan at the time the claim is received.

If you incurred the claim while enrolled in the MRP Plan and submit it while you are in active coverage but you have excess balance available for reimbursement, you have 12 months from the date of service to submit the claim or if incurred with excess balance available and submitted when enrolled in MRP or with a continuing excess balance, you have 12 months from the date of service to submit that claim for reimbursement.

When does my Plan A coverage begin?

Your coverage begins the first of the month following the second month in which you work a minimum of 60 days in Covered Employment within six months or less. For example, if you work 60 days in Covered Employment in the six-month period ending November 30th, your coverage will start January 1st.


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