Health Care Reform
Frequently Asked Questions
Last updated: December 2, 2010
Q. What is “Health Care Reform?”
A. “Health care reform” refers to the
Patient Protection and Affordable Care Act, which became effective on March 23, 2010. Among other things, the Act requires health insurance companies like the Motion Picture Industry Health Plans (MPIHP) to put into practice new rules for Participants.
Q. Has the Patient Protection and Affordable Care Act changed my health benefits?
A. 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 are three benefit changes for the Active Health Plan that will be effective on January 1, 2011.
1. Lifetime maximums of medical coverage will be removed.
This change removes the $2 million lifetime maximum for Active Participants who are enrolled in the MPIHP/Blue Shield Active Plan. If your coverage or the coverage of one of your dependents in the MPIHP/Blue Shield Active Plan ended because you or your dependent reached the lifetime maximum, you or your dependent can re-enroll during a 30-day special enrollment period from November 15 to December 15, 2010. Coverage will become effective January 1, 2011.
2. Certain annual dollar limits will be removed.
The annual limits on the following “essential health benefits” will be eliminated from the MPIHP/Blue Shield 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.
These benefits will continue to be paid only if they are medically necessary.
Q. If my children are already enrolled for coverage in the Motion Picture Industry Health Plans, do I need to re-enroll them due to these health care reform changes?
A. No. If your children are already enrolled in the Motion Picture Industry Health Plans (as full-time students, for example), you do not need to re-enroll them.
Q. Why does the removal of lifetime maximums or annual dollar limits for essential benefits only apply to the MPIHP/Blue Shield Active Plan?
A. Health Net, Kaiser Permanente and Oxford Health Plans do not have lifetime maximums or annual dollar limits on essential benefits.
Q. What is a “grandfathered” health plan?
A. 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 regulations 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 appeal on a claim is denied.
Q. Am I losing any benefits because MPIHP is grandfathered?
The Following is a Required Government Notice about MPIHP’s Grandfathered Status
MPIHP believes the Health Plans are “grandfathered health plans” under the
Patient Protection and Affordable Care Act. A grandfathered health plan can preserve certain basic health coverage that was already in effect when the law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Act that apply to other plans (for example, the requirement to provide preventive health services without any cost sharing). However, grandfathered health plans must comply with certain other consumer protections in the Act.
Questions about which protections apply to a grandfathered health plan and what might cause a plan to change from a grandfathered health plan status can be directed to the Employee Benefits Security Administration, U.S. Department of Labor, at (866) 444-3272, or visit
www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans. You may also contact the MPIHP Participant Services Center at (818) 769-0007, extension 244.