Use Your Wellness Benefit and Be More Than Healthy

FYI MPI
August 2015
from
Use Your Wellness
Benefit and Be
More Than Healthy
According to the World Health Organization,
wellness is the active process of becoming aware
of and making choices that promote a healthy and
fulfilling life. More than being free from illness
or disease, it’s a state of well-being that MPI
believes is important for the long-term welfare
of all Participants.
That’s precisely why the MPI Health Plan
has adopted The Wellness Program for Health
Plan Participants and their eligible dependents.
Administered by UCLA Health, a variety of
special care and preventive medical services are
available to you at no cost.
continued on page 2
This publication contains important information about your rights under the
Motion Picture Industry Pension, Individual Account and Health Plans under ERISA.
Please keep it with your Summary Plan Descriptions for future reference.
2
ACTIVE | RETIREE
Use Your Wellness Benefit
continued from page 1
FYI from MPI is published for
Participants of the Motion Picture
Industry Pension & Health Plans.
This newsletter contains important
information, including changes to the
Plans and your benefits. Please keep it
with your Summary Plan Descriptions
for future reference.
Please note that as a result of
unique agreements associated with
mergers of various Locals throughout the years, information reflected in
this newsletter may not apply to
all Participants.
Contact Us
Participant Services Center
E-mail
[email protected]
Phone
Call toll-free
(855) ASK-4MPI (855-275-4674)
Fax
(818) 766-1229 (CA)
(212) 634-4952 (NY)
Web site
www.mpiphp.org
Mailing Address
MPIPHP
P.O. Box 1999
Studio City, CA 91614-0999
Preventive Care
As an important part of staying
healthy, preventive care screenings are available through the MPI
Wellness Program, including
colonoscopies,
Pap
smears,
mammograms and comprehensive
physical examinations.
Health and Lifestyle
Management
Additional wellness support is
available via lifestyle and healthmanagement programs, as well as
through a wide variety of courses.
•Picture Quitting:
The Entertainment Industry
Quit Smoking Program
This innovative program uses
scientifically
proven
methods
to help smokers quit for good.
Individual counseling is provided
by trained smoking cessation
counselors who help smokers
identify their smoking “triggers”
and develop individualized quit
plans. Additionally, and for a
nominal co-pay, you will have
access to a number of different
prescription and over-the-counter
medications. For more information, contact “Picture Quitting” at
(818) 640-3935.
•Lower Your Cholesterol
Taught by a registered dietitian,
this program discusses cholesterol
and where it comes from. It
teaches you how to manage high
cholesterol and reduce your risk
factors. You will be given the
tools to better control your
cholesterol
levels,
including
lab values, nutritional guidance, exercise, medications and
supplements.
Office Locations
11365 Ventura Boulevard
Studio City, CA 91604
Hours: 8 am to 5 pm (Pacific Time)
145 Hudson Street, Suite 6-A
New York, NY 10013-2103
Main Phone (212) 634-5252
Toll Free
(888) 758-5200
Hours: 9 am to 5 pm (Eastern Time)
•Manage Stress
Relaxation & Meditation, Mindfulness 101, Guided Imagery, Anger Management, Learn to Go
from Anxious to Calm, Quieting
the Noisy Mind and How to
Deal with Difficult People.
continued on page 3
© 2015 MPIPHP
AUGUST 2015
Use Your Wellness Benefit
continued from page 2
•Lose Weight
Winning at Weight Loss, How
to Give Up Dieting Forever and
Weight Loss in the 21st Century.
Physical Fitness
Physical fitness and exercise are
also important parts of well-being.
For that reason, new membership
discounts are available at various
health clubs, fitness facilities,
and yoga studios throughout the
greater Los Angeles area. To
obtain a discount voucher and a
listing of participating clubs, please
contact The Wellness Program at
(800) 654-WELL (9355).
•Improve Your Nutrition & Fitness
The Mediterranean Diet, Eating
Clean and Taking Control, Nutrition 101, Clearing Up the Confusion Among Dietary Supplements,
Maximizing Your Exercise Results
and Foods and Moods.
For more information about the Wellness Program,
to view a calendar of classes or to register online for a
Wellness program, visit the UCLA Health website at
www.uclahealth.org/MPIWellness.
Coverage of Your
Annual Physical
If you and your eligible
dependents (age 13 and
older) are Anthem Blue Cross
PPO Participants, you can
lower
your
out-of-pocket
costs for your annual Comprehensive Physical Exam (CPE)
by using a provider at one of
the five UCLA Health offices
that exclusively serve the
entertainment community.
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A C T I V E MPI Health Plan
Summary Plan DescriptionS
RETIREE
4
Plan Update
Brand Name Prescriptions
The following information regarding brand-name and generic medications
supplements existing language in the Prescription Drug Benefit sections of
both the Active SPD and the Retiree SPD. See “Costs and Co-Payments”
on page 115 of the Active SPD; page 97 of the Retiree SPD.
In order for a Participant to receive
a brand-name medication when
there is an FDA-approved generic,
the Participant’s physician must
(1) certify to the Plan that the
Participant had an adverse allergic
reaction to the generic equivalent due
to a specific color dye and (2) submit
to the Plan a copy of their voluntary
report of the adverse event to the
FDA’s Safety Information and
Adverse Event Reporting Program
on Medwatch. If these requirements
are satisfied, the Plan will approve the
brand-name medication.
Reminders
ACTIVE | RETIREE
Recent Benefit Changes
The following benefit changes, which became effective January 1, 2015, affect those enrolled in the Anthem Blue
Cross PPO health plan.
Coverage of Food
Allergy Testing
Reimbursement for Emergency, Out-of-Network
Physician Benefits at the Hospital
Food-allergy testing is covered
for all Participants when medically
necessary and when conservative
therapies, such as the avoidance
of foods that trigger allergies,
have failed. To be considered for
coverage, food-allergy testing must
be performed by a physician with
special training in the field of allergy
and immunology. Direct skin tests
are the recommended method of
testing for patients suspected of
having food allergies.
For emergency room visits and
emergency hospital admissions,
reimbursement for out-of-network
physician charges during the stay
increased from 50% to 90% of the
Allowable Amount, when admitted
through the emergency room. The
patient’s coinsurance for emergency
room
visits
and
emergency
admissions will accumulate toward
his or her annual in-network, out-of-
pocket maximum. The term “Allowable Amount” is defined in the SPDs.
For additional information or
questions regarding your benefits,
email MPI’s Participant Services
Center
at
[email protected]
or call toll-free (855) ASK-4MPI
(855-275-4674), from 8 a.m. to 5 p.m.
Pacific Time, Monday through Friday.
AUGUST 2015
ACTIVE | RETIREE
Are You In My
Network?
When it comes to
saving money using your
MPI health coverage, it
pays to ask each of your
physicians/providers one
simple question: “Are
you in my network?”
The answer could save
you thousands of dollars
in medical costs.
Don’t simply assume that a doctor or hospital is
part of your Anthem Blue Cross, Health Net, Kaiser
Permanente or Oxford Health Plan provider network.
Instead, remember that:
is also in-network. If you are undergoing a surgical
procedure performed by an in-network doctor, the
anesthesiologist and other associated physicians
may — or may not be — in-network doctors.
• When your network doctor refers you to a specialist
or lab, he or she is not required to make sure that
the specialist or lab is in-network.
The only way to ensure that all of your providers are
part of your network is to ask before you receive
medical treatment or services. This will allow you to
make informed decisions which could protect you
from unnecessary out-of-pocket costs.
• If you are having a procedure performed by a network
doctor, he or she is not required to use a facility that
To find a Network Doctor, visit or contact:
Anthem Blue Cross
www.anthem.com
800.688.3828
Health Net
www.healthnet.com
800.522.0088
Kaiser Permanente
https://healthy.kaiserpermanente.org
800.464.4000
Kaiser Permanente Senior Advantage
https://healthy.kaiserpermanente.org
800.443.0815
Oxford Health Plan
www.oxhp.com
800.444.6222
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Q&
A
MPI’s Most
Frequently Asked
Questions
and Answers
QQQ
AAA
Q
Q A
A
Q: After visiting a UCLA
Health-MPTF Health Center, I
obtained a referral to a TIHN
(The Industry Health Network)
provider. Should I bring a copy
of my referral to that TIHN
provider?
A: Yes, you should give the provider
the referral number. To ensure
proper payment, he or she must
include the referral number on claim
submissions.
Q: I want to get a physical with
my primary care physician. Will
this service be covered?
A: If you and your eligible
dependents (ages 18 and older) are
Anthem Blue Cross PPO enrollees
and live in Los Angeles County,
your physical will be a covered
benefit if you use a provider at one
of the UCLA Health-MPTF Health
Centers. Routine physicals with
other physicians will not be
covered. For more information, visit
www.uclahealth.org/mptf.
If you are outside of Los Angeles
County, you can see a provider of
your choosing, subject to in-network
and out-of-network coverage rates.
Q: When I go to the pharmacy, Q: How do I minimize my outwhat identification number of-pocket costs for prescription
should I use to obtain my drugs?
prescription?
A: Use generic drugs over brandA: Whether you are the Participant
or an eligible dependent, you must
use the Participant’s Social Security
Number
as
an
identification
number to receive the prescription
drug benefit.
Q: How do I maximize my benefits in the Anthem Blue Cross
PPO network with referrals to
doctors in TIHN?
A: Make sure to use UCLA HealthMPTF Health Center facilities and
get a referral from your UCLA
Health-MPTF primary care physician
to a doctor in TIHN.
If you receive an Explanation of
Benefits (EOB) for physician services
performed with a TIHN referral
which lists patient responsibility
beyond the $5 co-pay, contact your
medical provider to ensure that
he or she used a valid referral
and submitted the claim to
Anthem Blue Cross with that
referral number. (Otherwise, your
provider will need to resubmit
corrected billing).
name drugs, and use the Express
Scripts at Home pharmacy for
maintenance medications. If you
use a retail pharmacy for maintenance medications, only two
fills per prescription will be
covered. After that, you will pay
100% of the medication costs for
additional refills at the retail
pharmacy. Register for Express
Scripts at Home pharmacy online at
www.starthomedelivery.com to make
full use of your prescription drug
benefit. Contact Express Scripts at
(800) 987-5247 for more information, or visit www.express-scripts.
com. Your physician may contact the
Provider Help Line at (888) 327-9791
for detailed instructions.
Please
note
that
specialty
medications must be reviewed
by and obtained through Accredo:
(800) 753-2851. For a list of specialty
medications, visit www.accredo.com.
AUGUST 2015
ACTIVE | RETIREE
Out-of-Network Claims Reimbursement
If you’re an Anthem Blue Cross PPO enrollee, consult
your MPI Active Health Plan Summary Plan Description
(pages 55-64) for a detailed list of covered
vs. non-covered services and benefits
limitations. After confirming Plan coverage
for the services, you can follow the
procedure
below
to
submit
your
medical claims to Anthem Blue Cross for
reimbursement.
If you choose an out-of-network provider, you may be
asked to pay for services up front. If so, you can request
partial reimbursement from Anthem Blue Cross for
services covered by the Plan.
To minimize your out of pocket expenses,
use doctors and service professionals who
are in your provider network.
Out-of-Network Claims Reimbursement for
Services Rendered in the USA
1.Obtain a legible, itemized bill from your medical provider that includes the following:
• Patient information
• Provider information (including Provider Name, Address, NPI# (National Provider Identification #),
and Federal Taxpayer Identification #
• Date(s) of Service
• Description of services rendered
• Diagnosis Code(s)
• CPT/HCPCS Procedure Code(s) for each service provided, with a Total Billed amount and a Grand Total.
2.Complete an Anthem Blue Cross Member Claim form, which is available on our website at:
www.mpiphp.org under Your Forms > Claims> Anthem Blue Cross PPO> Claim Form.
3.Submit the completed Anthem Blue Cross Member Claim form with your itemized bill to the local
Blue Cross/Blue Shield office in the state where the services were rendered. Please refer to our website
at www.mpiphp.org for a list of offices outside of California.
• Keep a copy of your claim for future reference and allow 30 days from receipt for your claim to be processed.
Any allowable reimbursement will be mailed to you, attached to an Explanation of Benefits (EOB).
• After reimbursement, you are responsible for any remaining balance. Please note: Reimbursement for prescriptions, dental services and behavioral health claims must be submitted
separately to Express Scripts, Delta Dental or OptumHealth Behavioral Solutions.
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Your MPI Benefits and Your Dependents’ Insurance
Today’s multi-income households
are often covered by multiple
employer
health
plans,
and
sometimes it’s hard to understand
whose benefits apply. MPI has
defined specific procedures and
guidelines to help coordinate
benefits with other insurers and
apportion coverage.*
Your Spouse/Same-Sex
Domestic Partner
•Other Insurance Available
If health insurance is available to
your spouse or same-sex domestic
partner through his or her employer,
he or she must enroll in such
coverage, regardless of cost; if they
do not, they will not be covered by
MPI, and you will be responsible to
MPI for any benefits paid on their
behalf. Your spouse’s or same-sex
domestic partner’s other insurance will serve as his or her primary
coverage, and MPI will serve as
secondary insurance.**
• Other Insurance Unavailable
If your spouse or same-sex
domestic partner is unemployed,
or if health insurance is unavailable through his or her employer,
MPI will provide primary coverage
for medical, hospital, prescription
drugs, dental and vision benefits.
For Participants and their dependents enrolled in the Anthem Blue
Cross Preferred Provider Option
(PPO) and the Oxford Point of
Service (POS) plan, MPI requires
annual certification that other
insurance coverage is unavailable to your spouse or same-sex
domestic partner. Thirty days
before the required Coordination
of Benefits forms are due, MPI will
send you a reminder to submit them
to the Plan office. If they are not
timely received, health coverage for
your spouse or same-sex domestic
partner will be suspended.
Your Dependent Children
Unless coverage for your dependents is unavailable, or there is a
premium cost or your spouse/samesex domestic partner has a birth
month that falls after your yours
in the calendar year, eligible,
dependent children also must be
enrolled in the insurance available to
your spouse or same-sex domestic
partner through his or her employer.
If they are not enrolled, MPI will
provide no coverage for your
dependent child(ren).
* Rules governing the Coordination of Benefits may be found in the MPI Active and Retiree Summary Plan Descriptions.
** MPI will continue to serve as primary insurer for dental and vision benefits.
AUGUST 2015
RETIREE | PENSION
ACTIVE
Enhanced eBilling
Premium Payment
Website
Your MPI Disability
Pension Requires Proof of
Government Disability
Set Up Automatic
Payments and Notifications
Based on your feedback, we’ve
streamlined the site, and made it
much easier for you to pay your
MPI premiums.
Acceptable
Documentation
Acceptable proof of your continuous Social Security disability may
include any of the following:
Social Security Administration
SVG drawing
6/17/15 9:14 AM
•“proof of
income letter”
Visit www.mpiphp.org, and click the
green “Premium Payment Login”
button to check out the improved
eBilling website.
•“benefits letter”
•1099 form
•your payment
history
https://upload.wikimedia.org/wikipedia/commons/2/26/US-SocialSecurityAdmin-Seal.svg
Page 1 of 1
•cost of living increase document
According to Pension Plan rules,
if you receive a monthly Disability
Pension benefit from the Motion
Picture Industry (MPI) Pension Plan,
you must also receive disability from
the U.S. Social Security Administration. One benefit is tied to the other.
That’s why the Pension Plan monitors
your disability status with and
payments from the Social Security
Administration. The only exception
to the requirement of receiving
Social Security disability benefits
is for terminally ill participants who
are certified by their physician as
having less than two years to live.
Each year, in order to maintain
eligibility for your MPI Disability
Pension, you will be required to
provide proof of continuous Social
Security disability payments from
the date your disability pension
began to present.
FYIMPI
You can obtain these documents
by logging on to www.ssa.gov.
Then, click “Online Services,” and
select “Get a letter saying you
don’t [or do] receive benefits” from
the List of Services menu.
Other Acceptable Proof
•Bank Statement, reflecting your
regular Social Security Administration deposits
If you are no longer eligible for
Social Security disability, you must
notify MPI immediately to avoid
any MPI overpayments, which
the Pension Plan is obligated to
recover from you.
For more information, contact
MPI’s Participant Services
Center by email at
[email protected] or by
telephone at (855) ASK-4MPI
(855-274-7674) between
8 a.m. and 5 p.m. Pacific Time,
Monday through Friday.
There, you’ll find new functionality
and usability:
•Simplified recurring payments
Create a Payment Account and
use it to set up a Recurring
Payment schedule. The system
automatically searches for the
latest unpaid statement and
schedules it for payment.
•Automatic default notification
You’ll receive an email warning if
your credit card is about to expire
or your payment has failed.
•Forgot your User ID?
Click on “Forgot User ID” on the
Login page.
•“Scheduled Payments” box
New information item informs you
when your payment will occur.
•Recurring Payments “History”
New button shows when you set up
or canceled a Recurring Payment.
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ACTIVE | RETIREE
Memory Lo ss
Should You Worry or Just Forget About It?
Are you concerned about memory
loss? Aging patients, who may find
it increasingly difficult to remember
words and names, worry that their
symptoms are early indications of
Alzheimer’s disease. While memory
loss can indicate a specific condition,
gradual and limited impairment is
usually associated with normal aging
processes.
“Normal” Age-Related
Memory Loss
Minor memory loss can be the
result of stress or a lack of sleep,
or may be associated with
underlying medical conditions such
as thyroid disease. According to
Dr. Kirk Daffner, director of the
Center for Brain-Mind Medicine
at Brigham and Women’s Hospital
in Boston, there are six “normal”
memory problems that should not
cause concern:
1 a tendency to forget facts or
events over time
2absentmindedness
3 a temporary block in retrieving a
memory
4 recalling something accurately
only in-part
5 having a memory distorted by the
power of suggestion
6 having a memory influenced by
bias, experiences or mood*
Alzheimer’s Disease
On the other hand, Alzheimer’s
disease is a serious brain disorder
that gradually destroys memory
and cognitive thinking and leaves
people unable to carry out simple
tasks such as dressing or eating.
It is associated with abnormal and
fibrous proteins called amyloid
plaques that disrupt critical metabolic processes in the brain. Nerve cells
lose connection with other nerve
cells and die. This typically results
in memory failure, personality
* Jane Brody (blog), New York Times, May 19, 2015.
changes and difficulty performing
daily activities. According to the
National Institutes of Health (NIH),
Alzheimer’s disease is the most
common cause of dementia among
older adults, afflicting more than
5 million Americans.
While there is currently no
“gold standard” for diagnosing
Alzheimer’s disease, the following
warning signs may be indications
of Alzheimer’s disease:
•Memory loss that disrupts daily life
•Challenges in planning or problem
solving
•Trouble with new memories or
reliance on memory helpers
•Trouble understanding visual
images and spatial relationships
•Trouble finding words, or
problems with words when
speaking or writing
•Struggling to complete familiar
actions or tasks
continued on page 11
AUGUST 2015
RETIREE | PENSION
Use Direct Deposit to Receive
Your Pension Benefit
Safe, Reliable, Convenient
Retirees depend on prompt
and reliable delivery of their
monthly pension benefits. For
the majority of MPI Pension
recipients,
electronic
fund
transfers (direct deposit) are
the most reliable and efficient
method of receiving their monthly
benefit. Money is automatically
whisked into a specified savings
or checking account on the
first of each month (even earlier
when the first falls on a weekend).
Memory Loss
continued from page 10
•Visual and/or auditory
hallucinations
•Confusion about time, place
or people
•Misplacing familiar objects and
losing the ability to retrace steps
•Personality changes or onset of
new depression or irritability
Those who wait for checks
to be delivered by mail risk postal loss or delivery delay. In fact, the
MPI Pension Plan stops or reissues between 30 and 60 checks per
month, and that number rises significantly when natural disasters
such as earthquakes or tornadoes strike.
Electronic deposits cannot be stolen, lost or forged, and payments
can be tracked. Further, electronic fund transfers make use of the same
secure banking wire-system infrastructure used by the world’s leading
financial institutions, not the Internet or an online routing system that
might be more easily compromised.
For safe, reliable and convenient delivery of your monthly pension benefit,
sign up for direct deposit today.
•Loss of interest in important
responsibilities or withdrawal
from work or social activities
•Expressing false beliefs
If you or someone close to you
is experiencing these warning signs,
consult your physician and discuss
your concerns. In some cases,
consultation with a specialist may
be necessary to determine the
underlying
cause(s)
of
these
symptoms. But remember, it’s not
unusual to experience some memory
difficulties as we age.
FYIMPI
Sign Up Today for Direct Deposit
of Your Pension Benefit
Visit www.mpiphp.org, and under the “Forms” heading, click on
“Pension.” On the Pension page, click “Update Your Pension
Payment Information.” Then, select the Direct Deposit Form,
complete it, and return the form to the MPI Plan office at the
address below:
Pension Benefits
Motion Picture Industry Pension & Health Plans
P.O. Box 1999
Studio City, CA 91614-0999
11
12
P.O. Box 1999
Studio City, CA 91614-0999
Qualifying Periods for Monthly Health Eligibility
Eligibility for Active Health Plan Benefits is determined
on a monthly basis according to the schedule below. After
satisfying the initial eligibility requirement of 600 work
hours in one six-month Qualifying Period or two
consecutive Qualifying Periods, Participants must work at
least 400 hours in subsequent Qualifying Periods to maintain
health benefits during the corresponding Eligibility Period.
Qualifying Periods
Eligibility Periods
Work 400* or more hours
during this Period
Receive MPI Active Health
benefits during this Period
1/25/15 – 7/25/15
2/22/15 – 8/22/15
3/22/15 – 9/19/15
4/26/15 – 10/24/15
5/24/15 – 11/21/15
6/21/15 - 12/26/15
7/26/15 - 1/23/16
8/23/15- 2/20/16
9/20/15- 3/27/16
10/25/15- 4/23/16
11/22/15- 5/21/16
10/01/15 – 3/31/16
11/01/15 – 4/30/16
12/01/15 – 5/31/16
1/01/16 – 6/30/16
2/01/16 – 7/31/16
3/01/16 - 8/31/16
4/01/16 - 9/30/16
5/01/16-10/31/16
6/01/16-11/30/16
7/01/16-12/31/16
8/01/16- 1/31/17
*New Participants must first work a minimum of 600 work hours in one
six-month Qualifying Period or two consecutive Qualifying Periods.
table of contents
s
Use Your Wellness Benefitcover
s
Plan Update
4
s
Reminders: Recent Benefits Changes
4
s
Are You In My Network?
5
s
Frequently Asked Questions & Answers
6
s
Reimbursement from Anthem Blue Cross 7
s
MPI Benefits and Dependents’ Insurance
8
s
MPI Disability Pension
9
s
Enhanced eBilling Premium Payment
Website
9
s
Memory Loss. Should You Worry?
10
s
Direct Deposit for Your Pension Benefits
11
MPI Holiday Office Closures
Labor Day Thanksgiving
Christmas Day
September 7, 2015
November 26 - 27, 2015
December 25, 2015
AUGUST 2015