• Eligibility
    • General
    • Enrollment and Qualifications
      • 1. How do I initially qualify for benefits?
        If you have never been eligible before, or have been ineligible for 5 (or more) preceding six-month eligibility periods (2.5 years or 30 months), you need to earn a minimum of 600 hours in one (or 2 consecutive) six-month Qualifying Periods.
      • 2. How do I maintain my current coverage?
        After you initially qualify, you need to earn a minimum of 400 hours during each applicable Qualifying Period.
      • 3. If I don't earn enough hours, can I use my bank?
        As long as the number of hours in your bank combined with your worked hours equal 400 or more and you are still available for work in the motion picture industry, any available banked hours will be automatically used, if necessary, to establish your eligibility.
      • 4. I've been on disability. What will happen to my benefits?
        If your disability claim date is within 180 days of your last date of covered employment in the industry, MPI will calculate your disability benefits at 40 hours per week during the Qualifying Period. If this adds up to at least 400 hours (within the Qualifying Period), you will be eligible for a 6-month extension of benefits. Please note that disability hours are not banked or combined with hours in the bank. Additionally, you may not have two consecutive, temporary disability extensions; nor may you have two disability extensions based on the same disability claim.
      • 5. What happens if I still don't qualify after all of my extensions have been used up?
        You will be given the option to continue your coverage by self-payment of premiums through COBRA for a maximum of 18 months, less any temporary disability extensions granted after your initial qualifying event. Once you have exhausted 18 consecutive months of extended coverage, you will be offered a direct conversion policy through the hospital/medical plan in which you are enrolled. You also have the option to enroll directly into the conversion policy, within 31 days of your loss of eligibility and without first paying for COBRA.
      • 6. How long can I pay for COBRA and how much will it cost?
        The maximum period for extended coverage is 18 months. For example, if you use a temporary disability extension and do not qualify for the next benefit period, you will be entitled to 12 months of COBRA coverage. If you are a California resident enrolled in the Health Net or Kaiser Permanente HMO plan, you may be eligible for an additional 18 months of California COBRA through that HMO plan. The cost of these benefits will depend on the number of dependents you wish to cover and whether you elect the Core or Noncore benefits. Noncore benefits include hospital, medical, prescription, dental and vision; Core benefits include hospital, medical and prescription only.
      • 7. How do I switch my HMO coverage for the MPI PPO (Anthem Blue Cross) Plan or from my pre-paid dental plan to the Delta Dental PPO?
        To change your medical and/or dental plans to the MPI PPO (Anthem Blue Cross) Plan or the Delta Dental PPO plan, you must complete and submit a Benefit Selection form indicating the desired change. Alternatively, you can send a letter to MPI, stating that you would like to change from the plan in which you are currently enrolled to the MPI PPO (Anthem Blue Cross) Plan or the Delta Dental plan, as applicable. The letter must be addressed to the MPI Health Plan, contain the Participant’s full name, be signed by the Participant and identified by the Participant’s Social Security number or identification number.
      • 8. When can I enroll into an HMO or prepaid dental plan?
        You can enroll in an HMO or prepaid dental plan during Open Enrollment, which takes places annually in July for an effective date of August 1.
    • Dependents
      • 1. I have a new dependent and need to add him/her to my coverage.
        You need to complete a new beneficiary/enrollment card. Mail this card to the West Coast Plan office with a copy of the marriage/birth certificate (or hospital record), and we will add your dependent. For non-biological children, a separate application and additional documentation (e.g. placement agreements, legal guardianship documents) will be required.
      • 2. Can I add my same-sex domestic partner?
        No. In 2013, the Board of Directors of the Motion Picture Industry Health Plan (“the Plan”) adopted a policy of terminating Plan coverage for same sex/domestic partners in those states that permitted same sex marriage. On June 26, 2015, the United States Supreme Court legalized same-sex marriage in those remaining states where it was not previously permitted. Accordingly, the Plan will cease coverage for unmarried same-sex domestic partners.
      • 3. My divorce is final this month and I need to take my ex-spouse off of my coverage. What do I need to do?
        You need to complete a new beneficiary/enrollment card indicating the date of divorce. Mail this card to the West Coast Plan office with a copy of the divorce documents indicating the dissolution of marriage date (full document if there are eligible dependent children). As long as your premium payments are current, your ex-spouse will be covered through the end of the month. He/she will be given the option to continue coverage by self-payment through COBRA, provided MPI is notified within 60 days of the date of divorce. If a current mailing address for the ex-spouse is not provided to MPI, the COBRA notification will be sent to the last known address.
      • 4. My child will be 19 next month. What happens to his/her coverage?
        Full-Time Student
        As long as s/he is enrolled in an accredited school or college on a full-time basis, MPI will continue to provide medical, hospital, prescription, dental and vision insurance benefits until age 23 or graduation, whichever comes first. You must certify that s/he is a full-time student by submitting the Full-time Student Certification form. To be considered full-time, the student must complete 12 units per semester or 10 units per quarter (additional information regarding schools is available).

        Dependent Disability extensions
        If s/he is disabled and incapable of self-sustaining employment, MPI will continue to provide medical, hospital, prescription, dental and vision insurance benefits upon receipt of a statement from his/her physician verifying the diagnosis, the date of the commencement of the incapacity and the expected date of recovery (if any).

        Affordable Care Act (For Active Participants Only)
        Under the Affordable Care Act, MPI’s paid health coverage for adult children between the ages of 19 and 26 does not include vision and dental benefits.

        If s/he does not currently meet any of the above eligibility requirements, you must notify MPI in writing immediately. If his/her coverage ends and MPI has paid any health claims following the termination of your Dependent’s coverage, you will be responsible for reimbursing MPI for any resulting overpayments, plus interest.
      • 5. What if my over-19-child withdraws from a class and suddenly becomes a part-time student?
        Student eligibility will terminate at the end of the month in which he/she withdrew from class, and become a part-time student. He/she will be given the option to continue coverage under the provisions of the Affordable Care Act (for dependents in the Active Health Plan) and via COBRA.
  • Claims
  • Third Party Liability
  • Health Benefits
    • Medical Coverage and Limits
    • Network and Provider
      • 1. What is the difference between an HMO and a PPO?
        An Health Maintenance Organization (HMO) is a plan in which you pay a fixed fee for service by physicians under contract by that HMO. In this type of plan, you must work through your primary care physician and referrals are required to see specialists.

        A Preferred Provider Organization (PPO) provides different levels of benefits for services received from physicians depending on their contracting status with the Anthem Blue Cross PPO network. With the PPO, while you don't need a referral to enjoy some level of coverage with specialists, it is to your advantage that you visit in-network providers. Further, if you are located in the Los Angeles area, you can fully maximize your benefit by visiting any of the UCLA-MPTF Health Centers and seeking a referral to The Industry Health Network (TIHN) providers.
      • 2. As a PPO plan Participant, how do I get a referral to a provider within The Industry Health Network (TIHN)?
        Schedule an appointment with your UCLA-MPTF (EIMG Group) primary care physician to get a referral to a specialist within The Industry Health Network (TIHN).
      • 3. Where can I find a list of Anthem Blue Cross doctors?
        To locate an Anthem provider or check to see whether your doctor is a member of the Anthem Blue Cross network, log in here using your Anthem username and password, then click "Find a Doctor."
      • 4. My condition requires a provider who is out-of-network. What can I do?
        If you're enrolled in MPI's Anthem Blue Cross PPO, coverage is provided when you go out-of-network at 50% of the usual and customary rates (UCR), which may not equal 50% of the bill. It may be significantly less, depending on the UCR rate, and you will be responsible for the remainder even if there are no in-network providers available. If you can stay in-network, you will reduce your out-of-pocket costs. To locate an Anthem provider or check to see whether your doctor is a member of the Anthem Blue Cross network, log in here and click “Find a Doctor.”
      • 5. What will be my responsibility if I see an out-of-network provider?
        50% of the usual and customary rates (UCR), which may not equal 50% of the bill. It may be significantly less, depending on the UCR rate, and you will be responsible for the remainder.
      • 6. How can I get a Chiropractic referral and minimize my out-of-pocket expense?
        If you are enrolled in the Anthem Blue Cross PPO health plan, you don’t need a referral to see a chiropractor, but in order to minimize your out-of-pocket expenses, see an in-network provider. A licensed, in-network provider will be covered at 100% for up to 20 visits per calendar year. The maximum Allowable Amount for an Out-of- Network Provider is $54 for the initial office visit, $34 per follow- up treatment, and $159 per year for x-rays. Follow-up office visit charges are not covered.
    • Government Drug Program
      • 1. What is Medicare Part D coverage?
        Medicare Part D, a Government-sponsored healthcare option, offers prescription drug benefits through private insurance companies that are approved by and under contract with Medicare.
      • 2. Do I need to enroll in Medicare Part D?

        You are not required to enroll in Medicare Part D, and it is important to remember that if you do enroll in a Medicare Part D prescription drug plan, you will forfeit your MPI prescription drug benefits.
      • 3. When I become eligible for Medicare coverage, must I enroll in Part D to cover my prescription drugs?
        When you become eligible for Medicare, the Motion Picture Industry (MPI) Health Plans require you to enroll in Medicare Part A (hospital insurance) and Part B (medical insurance). However, because your MPI prescription drug coverage is greater than or equal to Medicare Part D’s coverage, you are not required to enroll in the Medicare Part D prescription drug coverage program.
      • 4. What are the benefits for staying with the MPI / Express Scripts Prescription Plan?
        • MPI Health Plan’s existing prescription drug benefits have been determined to be "creditable coverage," which means that the Health Plan is expected to pay as much in claims for all Participants as standard Medicare prescription drug coverage. Because the MPI drug coverage is comparable to the standard Medicare drug benefits, you do not need to enroll in a Medicare Part D plan as long as you have coverage under the Health Plan.
        • Prescription drug coverage is available as long as you or you and/or your dependent remain eligible for coverage under the MPIHP.
        • Currently, there are no additional monthly premium payments for prescriptions, and your co-payments will remain the same.
      • 5. How is MPI notified that I am enrolled in Medicare Part D?
        CMS Centers for Medicare & Medicaid Services send a report to ESI, our Prescription Benefit Manager, when you or your dependent enrolls in a Medicare Part D Prescription Plan.
      • 6. How could I be enrolled in a Medicare Part D Plan when I didn’t sign up?
        Under certain circumstances, you or your dependents may be automatically enrolled in a Medicare Part D Plan. There are many event triggers for such action, including: low income or Medicaid circumstance, losing employer coverage, retiring or becoming disabled.
      • 7. How do I drop a MEDICARE PART D PLAN and re-enroll in MPI’s prescription drug coverage?
        In order to re-enroll in MPI’s prescription drug coverage, you must first opt-out of your Medicare Part D coverage.

        To Disenroll from Medicare Part D
        Contact CMS at 1-800-MEDICARE (633-4227). TTY users should call 877-486-2048 to obtain the name of your supplemental Medicare Part D plan. Then, ask for the telephone number to "Opt Out" of that Part D Plan.

        To Re-enroll in MPI Coverage
        Mail a copy of your Part D disenrollment letter from Medicare to MPI, including your termination date from the Part D plan.
    • Prescription Drug Coverage
    • Dental
        Dental Dental Coverage
      • 1. Where can I find a summary of my benefits with Delta Dental?
        Whether you have Delta Dental PPO coverage or the DeltaCare USA prepaid plan, visit www.deltadental.com , create an account and log in to see a description of your benefits.
      • 2. Who is covered under my dental plan?
        You and your enrolled dependents are covered. (Unmarried children up to age 19 or full-time students up to age 23.)
      • 3. How do I find a network dentist?
        Maximize your benefit and find an in-network dentist by visiting the Delta Dental website and using the "Find a Dentist" search feature on the home page. For assistance in selecting a Delta Dentist you may call 800.4AREA-DR (800.427.3237).
      • 4. How are routine dental exams and cleanings covered?
        Every six months you are eligible for coverage of routine dental exams and cleanings. Coverage for such visits will vary according to provider network (Delta Dental PPO or Delta Dental Premier).
        [See table of dental benefits.]
      • 5. Should I get a pre-determination of coverage prior to treatment?
        If extensive services are to be provided, such as crowns or bridges, or if the cost of treatment will be greater than $300, you should have your dentist obtain a predetermination of coverage prior to treatment.
      • 6. How do I minimize my out-of-pocket costs and maximize my dental benefit?
        You can save money by seeing a Delta Dental PPO or Delta Dental Premier network provider for your dental needs. Because PPO network dentists have agreed to accept lower contracted fees for covered services, your costs are usually lower when you use a dentist who is in one of the Delta Dental plan networks. Seeing a Delta Dental PPO dentist provides you with maximum savings and benefits, while seeing a Delta Dental Premier Network dentist offers you some savings over non-network dentists.
        [See table of dental benefits.]
      • 7. What is the annual maximum benefit Delta Dental will pay on my behalf?
        The annual maximum is $2000 for PPO Participants. For Delta Care USA Participants, there is no annual maximum benefit.
      • 8. What dental services are not covered through Delta Dental?
        Delta Dental does not provide:

        1. Services for injuries covered by Workers’ Compensation or Employer’s Liability Laws, or services which are paid by any federal, state or local government agency, except Medi-Cal benefits
        2. Services for cosmetic purposes or for conditions that are a result of hereditary or developmental defects, such as cleft palate, upper and lower jaw malformations, congenitally missing teeth, and teeth that are discolored or lacking enamel
        3. Treatment which restores tooth structure that is worn; treatment which rebuilds or maintains chewing surfaces that are damaged because the teeth are out of alignment or occlusion; or treatment which stabilizes the teeth. Examples of such treatment are equilibration and periodontal splinting
        4. Any single procedure, or bridge, denture or other Prosthodontic service which was started before you were covered by this program
        5. Prescribed drugs
        6. Experimental procedures
        7. Charges by any hospital or other surgical or treatment facility and any additional fees charged by the dentist for treatment in any such facility
        8. Anesthesia, except for general anesthesia given by a dentist for covered oral surgery procedures
        9. Grafting tissues from outside the mouth to tissue inside the mouth (extra-oral grafts), implants (materials implanted into bone or soft tissue), or the removal of implants
        10. Services for any disturbances of the jaw joints (temporomandibular joints, or TMJ) or associated muscles, nerves or tissues
        11. Orthodontic services, except those provided to eligible Dependent children
        12. Charges for replacement or repair of an orthodontic appliance paid in part or in full by this program
      • 9. Are Delta Dental products available in all states?

        You can visit a dentist anywhere within the 50 states and Puerto Rico and receive the same benefits you would receive at home.
      • 10. Can I receive dental treatment when I am out of the country?
        Delta Dental coverage may be available for dental care or services received outside of the United States. Visit www.deltadental.com for more information.
      • 11. I'm covered under more than one dental plan. How does my coverage work?
        Typically, one of your dental plans will be considered your primary plan. It will be the first payor of your dental care. Additional plans under which you are covered will then pay toward any remaining balance. Your MPI Summary Plan Description has a Benefit Coordination section that further describes how this is handled by the MPI Health Plans.
      • 12. What happens if I have an accident that causes dental injury?
        Services which would be normally covered by your health benefits (subject to the same limitations and exclusions) are instead covered by Delta Dental’s Dental Accident benefits when provided for conditions caused directly by external, violent, and accidental means.

        There is a $2,000 annual maximum benefit for dental accidents. However, Delta Dental will only pay Accidental Benefits when services are provided within 180 days following the date of accident, and benefits will not include any services for conditions caused by an accident occurring before your eligibility date.
    • Vision
      • Coverage
        • 1. Who is covered for vision benefits?
          Eligible Active or Retiree Participants, their spouses and unmarried children up to age 19 or full-time students up to age 23 in the Plan PPO or HMO health plans.
        • 2. What does it cover?
          The Vision Benefit covers annual eye exams and a portion of costs annually for spectacle lenses. Frames are covered once every two years. In lieu of glasses, elective contact lenses are available annually. Additionally, you can receive 15% off contact lens exams from a network provider. (Please see the Active MPI Health Plan Summary Plan Description (SPD) p.119 for more detail).
        • 3. What is not covered?
          Orthoptics or vision training and any associated supplemental testing
          • Two pair of glasses in lieu of bifocals
          • Any eye exam or corrective eyewear required by an Employer as a condition of employment
          • Corrective vision treatment of an experimental nature
          • Plano lenses (nonprescription)
          • Medical or surgical treatment of the eyes
          • Replacement of lenses and frames furnished under this program, which are lost or broken except at the normal intervals when services are otherwise available
        • 4. Do I have co-pays?

          There are co-pays: $20 for an annual eye exam and/or eyewear and there are co-pays for various lens enhancements. Please log into the www.vsp.com website for more information.
        • 5. Does the Plan pay for lasik?

          However, a discount may be available on corrective laser surgery from VSP-approved laser surgeons and centers. You may also receive a discount on preoperative and postoperative care. You'll save an average 15% off the regular price or 5% off the promotional price from participating providers. Log into the www.vsp.com to find a network provider or call 800.VSP.7195 (800.877.7195).
      • Provider and Network
        • 1. What is VSP?
          VSP is a nationwide network of ophthalmic care and eyewear providers for patients covered by VSP. VSP is designed to encourage you and your Dependents to maintain your vision through regular eye examinations and to help with vision care expenses for required glasses or contact lenses.
        • 2. Where can I find a provider?
          If you need help locating a VSP Choice Network doctor, visit www.vsp.com or call VSP at 800.VSP.7195 (800.877.7195).
        • 3. How does it work?
          Call the VSP network doctor of your choice for an appointment, identifying yourself as a VSP patient. The network doctor will then contact VSP for authorization and detailed information about your eligibility and Plan coverage. No up-front paperwork or preauthorization is required.
        • 4. Are out-of-network providers covered, and will I be reimbursed for my out-of-pocket payments?

          but at a reduced rate. Seeing a non-network provider will increase your out-of-pocket expenses. However, you may obtain covered services from any licensed optometrist, ophthalmologist or optician of your choice. If he or she is out-of-network, you must pay the provider in-full and submit an itemized receipt to VSP. VSP will reimburse you according to its out-of-network reimbursement schedule. Please note that all claims must be filed within six months from the date services were rendered in order to receive reimbursement. [ Click here for the VSP Member Reimbursement Form.]
    • Patient Protection and Affordable Care Act (ACA)
      • 1. What is Patient Protection and Affordable Care Act (ACA)?
        The Patient Protection and Affordable Care Act became effective on March 23, 2010 and provides basic health care coverage for most Americans through state-established Health Insurance Marketplaces. It requires that health insurance companies and organizations like the Motion Picture Industry Health Plans (MPIHP) put into practice new rules for Participants.
      • 2. What if I lose MPI Health Plan eligibility due to insufficient work hours or failure to pay my premium?
        If you are without qualified health coverage for three or more months, you may have to purchase health insurance on your own – or pay a penalty on your annual federal income tax return for each month that you lacked coverage. For more information, visit the Federal Government ACA website at www.healthcare.gov or in California, visit www.coveredca.com.
      • 3. Has the Patient Protection and Affordable Care Act changed my health benefits?
        If you are a Retiree, no. There are no benefits changes to the Retiree Health Plan. Health care reform does not apply to plans that cover only retirees or to separate dental and vision plans.

        If you are an Active Participant, there were two benefit changes to the Active Health Plan that became effective on January 1, 2011.

        1. Lifetime maximums of medical coverage were removed.
        2. This change removed the $2 million lifetime maximum for Participants enrolled in the Active MPIHP Anthem Blue Cross plan.
        3. Certain annual dollar limits were removed.
        4. The annual limits on the following “essential health benefits” were eliminated from the MPIHP/Anthem Blue Cross Active Plan:
          • The $300 annual limit for physicals performed by providers outside the Motion Picture and Television Fund service area; and
          • The $2,500 limit for temporomandibular joint (TMJ) services every two years.
          Note: These benefits will continue to be paid only if they are medically necessary.
      • 4. Why does the removal of lifetime maximums or annual dollar limits for essential benefits only apply to the MPIHP/Anthem Blue Cross Active Plan?
        Health Net, Kaiser Permanente and Oxford Health Plans do not have lifetime maximums or annual dollar limits on essential benefits.
      • 5. What is a “grandfathered” health plan?
        A plan is “grandfathered” if it existed before March 23, 2010 (the date health care reform was passed) and if plan benefits have not significantly changed since then. The Motion Picture Industry Health Plans have been in existence prior to March 23, and no benefit changes have been made.

        Grandfathered plans follow some different rules than non-grandfathered plans under the Patient Protection and Affordable Care Act. For example, non-grandfathered plans are required to provide free preventive health services, without deductibles or co-pays. Non-grandfathered plans also must provide Participants access to an additional and independent appeal board, if their initial claim appeals are denied.
      • 6. Am I losing any benefits because MPIHP is grandfathered?