EFT Form-WEB 20100916.doc - mpiphp 2026

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  1. Click ‘Get Form’ to open the EFT Form-WEB 20100916.doc - mpiphp in the editor.
  2. Begin by filling out the Recipient’s Information section. Enter your name and Social Security Number (SSN) accurately.
  3. If you are not the participant, complete the Participant’s Information section with their name and SSN.
  4. Provide your address and phone number in the designated fields to ensure proper communication.
  5. In the ACCOUNT INFORMATION section, enter your bank's name and indicate if it is a joint account by selecting 'Yes' or 'No'. If applicable, provide the joint account holder's name.
  6. Select your account type (Checking or Savings) and fill in the Routing or Transit Number along with your Account Number.
  7. Attach a voided check that displays your bank’s routing/transit and account numbers as instructed.
  8. Review the AUTHORIZATION AGREEMENT carefully, then sign and date where indicated. If applicable, have the joint account holder sign as well.

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Your Summary and Benefits should have information about the plan near the top, detailing whether your plan is a PPO or another type of insurance. If you still cannot find the answer, give the customer service number on the back of your insurance card a call and ask if your plan is a PPO plan.
There are two types of Medicare PPO plan: Regional PPOs, which serve a single state or multi-state areas determined by Medicare. Local PPOs, which serve a single county or group of counties chosen by the plan and approved by Medicare.
There are three health plan options, one PPO and two HMOs. The PPO plan is administered by the Motion Picture Industry Health and provided by Anthem/Blue Cross. The details of the coverage can be found between pages 35 and 67.

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MEDICAL/HOSPITAL COVERAGE. All members may enroll in the Motion Picture Industry Health Plan (MPIHP)/Anthem Blue Cross Preferred Provider Organization (PPO). Those who reside in California also have a choice of one of two Health Maintenance Organization (HMO) plans offered through Health Net and Kaiser Permanente
Your plan type If you forget or arent sure what type of health insurance plan you have (like an HMO or PPO), you can find out on your BCBS ID card. If you have an HMO, your card may also list the physician or group youve selected for primary care.