You must complete and submit the MPI Change of Address form, including your signature and MPID or Social Security Number.
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.
After you initially qualify, you need to earn a minimum of 400 hours during each applicable Qualifying Period.
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.
MPI health benefits are available to qualified same-sex domestic partners of Health Plan participants. For Active Participants, refer to "Same-Sex Domestic Partner Coverage," on page seven of the Active Summary Plan Description . Retirees and Survivors should refer to "Same-Sex Domestic Partner Coverage" on page five of the Retiree Summary Plan Description.
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.
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.
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.
If there is a dispute as to whether the Plan has correctly denied a Claim in whole or in part on the basis that the service was not reasonable and necessary, the Participant or provider of service may request a re-evaluation of the Plan's decision through the Claims Appeals Procedures by writing to the Benefits/Appeals Committee as described on page 66 of the October 2013 MPI Active Health Plan Summary Plan Description.
If you suspect you are the victim of a billing error, immediately call your health care provider and confirm the accuracy of the bill. Next, send MPI a copy of your EOB along with a letter of explanation by email to firstname.lastname@example.org or by mail to
MPI Health Plan Claims Department,
P.O. Box 1999, Studio City, CA 91614.
MPI considers the decision of the BAC final and binding, but you may challenge it by bringing a civil action under Section 502(a) of ERISA within 180 days of the denial of your appeal.
Anthem Blue Cross
PO Box 60007
Los Angeles, CA 90060-0007
For reimbursement, use the claim submission forms available online at www.mpiphp.org.
A term that describes a shared payment between an insurance company and an insured individual.
In-network - $1,000 per person per calendar year, except when you have met your visit or procedure limits at the chiropractor, physical therapy, acupuncture, or other limitations on pages 55-62 of the 2013 Active MPI Health Plan Summary Plan Description (BENEFIT LIMITS SECTION).Out-of-network – None, but in emergency cases, your maximum for the emergency room facility and hospital facility Allowable Amounts is $1,000 per emergency.
Log into Participant Portal on the MPI website at www.mpiphp.org. Enter your user name and passcode. Once you are logged in, click on "Claims" in the menu at top, and type-in the desired date range to search your claims. Then, click on a specific claim to see your EOB for that service. Alternatively, you may contact MPI to request duplicate EOBs for a fee of $1.00 per claim.
The majority of claims are processed and paid within 30 days.
An "allowed amount" is the maximum amount a plan pays for a covered service. The allowed amount is determined by the provider networks (Anthem Blue Cross, Kaiser Permanente, Health Net, etc.). If you are enrolled in the Anthem Blue Cross PPO, MPI will pay 90% of the allowed amount if you stay in-network and 50% of the allowed amount if you see a provider or receive medical services out-of-network.
You will receive an Explanation of Benefits (EOB) shortly after each medical service. These should indicate the amount that has been or will be paid. You can also log into Participant Portal on the MPI website at www.mpiphp.org. Enter your user name and password. Once you are logged in, click on "Claims" in the menu at top, and type-in the desired date range to search your claims. Then, click on a specific claim to see your EOB for that service.
Notifying the Plan Office enables us to proceed with the processing of all related claims* in a timely manner. Also, the Plan can begin compiling a "Summary of Related Paid Claims," a tool used to negotiate a settlement of your claim against the third party. This Summary is required to proceed with the third party claims and to fully reimburse the Plan.
The Health Plan received a claim (or claims) indicating services rendered related to an injury or illness, possibly as a result of a type of accident or incident in which a third party is involved who may be responsible.
The Health Plan must have your information in writing to insure that information is accurate and complete. In addition, the participant’s signature is required in order for us to proceed with the processing of related claims.*
* "Related claims" are claims related to your third party injury or illness.
You must advise the Plan of all Third Party claims in order to avoid related claims being processed by the Plan, ultimately resulting in an "Overpayment." **
The Participant will still be responsible for any overpayments, even if you do not advise the Plan of the Third Party claim.
** An "overpayment" exists when the Plan pays out more than it should due to other health carrier payments, third-party liability, incorrect billings, miscalculations, etc. If this occurs, the Participant involved will be responsible for refunding to the Plan the overpaid amount.
It is the Participant’s responsibility to follow-up with the third party for claims relating to the incident or accident.
The MPI Health Plan does not cover expenses incurred as a result of, or in connection with, any of the following:
Under the California Workers' Compensation Act, and the laws of other states, medical treatment for injury or illness either caused or aggravated by your work activities is the responsibility of your Employer.
- Injuries sustained while performing any act pertaining to any occupation or employment for remuneration or profit, or
- Sickness, disease or injuries covered under any Workers' Compensation or Occupational Disease Act or Law.
You must notify your Employer as soon as you are aware of any medical problem that you think has been caused or aggravated by your work by filing a "Workers' Compensation Claim Form (DWC 1)" for Workers' Compensation Benefits in California, and comparable forms in other states.
If the MPI Health Plan determines that the injury or illness is work-related, no benefits will be payable. Therefore, if your Employer denies liability for your work-related injury or illness, you may wish to protect your rights by filing a Workers' Compensation Claim as soon as possible.
If you file a Workers' Compensation claim, the MPI Health Plan will be able to advance you payment for covered medical services rendered. The Plan would then file a lien claim on its own behalf before the Workers' Compensation Appeals Board for reimbursement by your Employer if it is determined that your condition was caused or aggravated by your work.
If you file a claim for Workers' Compensation Benefits, please notify the MPI Health Plan of the case number and the name of your attorney, if you have one.
In the event that you settle a Workers' Compensation claim, you should attempt to have your Employer agree to pay expenses for future medical treatment of the \ alleged work-related condition. If the Workers' Compensation settlement does not contain such an agreement, the MPI Health Plan will make its own determination whether future medical expenses related to your work-related condition are excluded from coverage under "1" or "2" (previously described).
Benefits from the MPI Health Plan are not intended to duplicate any benefits which are available under Workers' Compensation Law, whether or not you or your Employer has actually purchased Workers' Compensation insurance.
Participants and dependents are obligated to complete and submit the necessary claim forms, consents, releases, assignments and other documents requested so the MPI Health Plan may pursue its lien rights. Any Participant or dependent who fails to submit such documents or cooperate with the Plan in processing the lien will not be entitled to benefits under this provision of the MPI Health Plan until the documents are received by the Plan or the Participant or dependent cooperates in the Plan's efforts.
Additionally, any failure on the part of a Participant or eligible dependent to cooperate with the MPI Health Plan in pursuing its lien rights that results in a loss to the Plan may result in the Plan deducting the amount of the loss from all future benefit payments for the Participant or eligible dependents until the amount of the loss is recovered. A loss to the MPI Health Plan means any action or inaction on the part of the Participant or eligible dependent that prevents the Health Plan from obtaining reimbursement for health expenses that we otherwise would be entitled to.
A failure to cooperate could include, but is not limited to, any of the following acts:
A Participant or eligible dependent fails to:
- Notify the MPI Health Plan of the filing of a Workers' Compensation claim;
- Provide the MPI Health Plan with a copy of the Workers' Compensation Claim Form or Application;
- Complete and return a Questionnaire Form;
- Notify the MPI Health Plan of the approval of a Workers' Compensation Award;
- Provide the MPI Health Plan with a copy of a Workers' Compensation Award;
- Notify the MPI Health Plan of the approval of a Workers' Compensation Compromise and Release;
- Provide the MPI Health Plan with a copy of a Workers' Compensation Compromise and Release, Stipulation with Request for Award, and Findings and Award;
- Cooperate with the MPI Health Plan in litigating its lien rights before the Workers' Compensation Appeals Board; or
- Provide accurate information on the Questionnaire Form.
If you have Anthem Blue Cross PPO coverage, out of state claims should be submitted to your provider's local Blue Cross office. Outside of the United States, claims must be submitted by your foreign provider using the Blue Cross Foreign Claim form and with all supporting medical information to the
BlueCard Worldwide Service Center,
P.O. Box 261630
Miami, FL 33126
or you may email:
Until you become eligible for Medicare due to age or disability award, there will be little change to your health benefits. Once you are eligible for Medicare part B, you must enroll, and MPI will begin to pay claims as your secondary insurance. Failing to enroll in Medicare part B will cause MPI to overpay your health claims, and your benefits may be interrupted if you do not reimburse the Plan for any overpaid amount. Please see your (RETIREE SPD) and all relevant (PLAN UPDATES) for a complete description of your benefits in retirement.
Please see pages 63-64 of the 2013 Active MPI Health Plan Summary Plan Description for a list of non-covered benefits.
There is a difference. Any Participant who is currently covered by the MPI Health Plan is considered "eligible" for certain services. However, being eligible does not mean that all of your claims will be paid at the rate you may expect. Claims that are not deemed "medically necessary" or investigational and/or experimental may not be covered by MPI.
Preauthorization is not required, but MPI strongly advises that you seek confirmation of coverage from the Plan before proceeding with a course of treatment. To avoid any unnecessary out-of-pocket expenses or payments, it may be in your best interest to verify coverage by the Plan by having your physician send a letter of medical necessity to:
Medical Review, MPI Health Plan,
P.O. Box 1999, Studio City, CA 91614.
Please see pages 55-62 of the 2013 Active MPI Health Plan Summary Plan Description (BENEFIT LIMITS SECTION).
In accordance with the terms of the Trust Agreement , the Directors reserve the right to change the nature and extent of benefits provided by the MPIHP and to amend the rules governing eligibility at any time, consistent with applicable law.
In accordance with requirements of the Affordable Care Act, health plans like ours must provide coverage for patients with pre-existing conditions.
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.
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).
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."
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.”
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.
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.
Medicare Part D (Prescription Drug Coverage)
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 the MPI Health Plans include prescription drug coverage that is considered to be "Creditable Coverage," you are not required to enroll in the Medicare Part D prescription drug coverage program.
Creditable Coverage is defined by Medicare as:
Prescription drug coverage (for example, from an employer or union) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.
It is important to remember that if you enroll in a Medicare Part D prescription drug plan, you will forfeit your MPI prescription drug benefits.
For those without MPI prescription drug coverage, Medicare Part D offers prescription drug benefits through private insurance companies that are approved by, and under contract with, Medicare. Periodically you may receive advertisements from these companies encouraging you to enroll in one of their plans.
For more information about your MPI Health Plan benefits please email MPI’s Participant Services Center at email@example.com. If you prefer, you may send a fax to (818) 766-1229 or call toll-free (855) ASK-4MPI (855-275-4674), from 8 a.m. to 5 p.m. PST, Monday through Friday.
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.
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.
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.
- Lifetime maximums of medical coverage were removed.This change removed the $2 million lifetime maximum for Participants enrolled in the Active MPIHP Anthem Blue Cross plan.
- Certain annual dollar limits were removed.The annual limits on the following “essential health benefits” were eliminated from the MPIHP/Anthem Blue Cross Active Plan:
Note: These benefits will continue to be paid only if they are medically necessary.
- 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.
Health Net, Kaiser Permanente and Oxford Health Plans do not have lifetime maximums or annual dollar limits on essential benefits.
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.