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SAGform-HIPAA 8/25/14 2:18 PM Page 1 HIPAA-Health Insurance Portability & Accountability Act Date: 1. I hereby authorize Surgical Associates of Gadsden, P.C. Its agents, employees & contractors, to
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What is sag hipaa form?
SAG HIPAA Form is a form that actors must fill out to report their earnings and contributions to the SAG Health Plan and AFTRA Health Fund.
Who is required to file sag hipaa form?
Actors who are members of SAG-AFTRA are required to file the SAG HIPAA Form.
How to fill out sag hipaa form?
Actors can fill out the SAG HIPAA Form online or by requesting a physical form from the SAG-AFTRA offices.
What is the purpose of sag hipaa form?
The purpose of the SAG HIPAA Form is to report earnings and contributions to the SAG Health Plan and AFTRA Health Fund in order to maintain eligibility for healthcare benefits.
What information must be reported on sag hipaa form?
The SAG HIPAA Form requires actors to report their earnings from SAG-AFTRA-covered work and any contributions made to the health plans.
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