FAQ

1. Any entity that satisfies all of the following is an eligible participating employer:
2. at least one of the working physicians of the entity is a member of SCMA;
3. the entity has at least two employees;
4. the entity maintains 50% participation in the Plan, based on all of its eligible employees and Physicians;
5. the entity adopts the Plan by properly completing a Participating Employer Agreement and executes any additional documents as required by MIT;
6. MIT accepts the entity for participation; and
7. the entity contributes employer premiums toward its eligible employees’ coverage equal to at least 50% of the cost of employee-only coverage.

For purposes of calculating the 50% participation threshold for any participating employer, any eligible employee or physician who provides a valid waiver of coverage is counted as participating.  SCMA is also treated as a participating employer for purposes of the Plan.

Full-time employees of a participating employer – reasonably expected to work 30 hours/week or more – along with their spouses and dependents.

Based on a recent court opinion in SC, MIT recognizes common law marriages entered into on or prior to July 24, 2019.

Your participating employer selects the Plan offerings that will be made available to its employees.  You may choose your coverage each year during open enrollment.  Open enrollment for employees generally occurs during December prior to the start of a plan year.

MIT coverage can be obtained outside of open enrollment if you have a qualifying event or meet the Plan’s special enrollment provisions. Please consult your MIT Summary Plan Description for more information.

You must notify MIT in writing within 31 days of the birth or adoption of your child to add your child to the Plan. Failure to enroll the child by this deadline will result in coverage not being extended to your child. If you are not already enrolled in coverage under the Plan, you will need to enroll both yourself and the child.

Yes, until age 26 (extended coverage may be available for handicapped children). Eligible dependents include:

• your natural children,
• your adopted children (and those placed for adoption),
• your stepchildren,
• Children for whom you have legal custody and who live with you in a parent-child relationship and who are dependent upon your support and maintenance (such parent-child relationship shall not be considered to exist if either of the child’s parents also resides with you).

Yes, special provisions exist for continued coverage of a dependent child over age 26 who is mentally disabled or physically handicapped and unable to earn a living and who is dependent upon you for support. In order to qualify your child for coverage under the Plan, you must notify MIT and submit an application and adequate proof within 31 days of the date your handicapped child reaches age 26. Please consult your MIT Summary Plan Description for additional information. If you fail to meet this deadline, your handicapped child’s right to continue Plan coverage as your dependent will be lost.

Yes, if you die and your surviving spouse was covered by MIT continuously for the previous three (3) years, and your surviving spouse files an application and agrees to make any required contribution within 31 days of your death, coverage under the Plan may be continued by your spouse. Please consult your MIT Summary Plan Description for additional information as to how long this surviving spouse coverage will last.

The 1^st day of the month following the satisfaction of your participating employer’s waiting period or the 91^st day of employment, whichever is earlier.

Your participating employer can choose to apply a waiting period that ends on the 1^st of the month following your date of hire, or either 30 or 60 days of employment.  Special exceptions may apply when a participating employer first joins MIT or acquires another business.

No later than 31 days from the first date you become eligible and satisfy the waiting period.

No. Each participating employer must select one waiting period that will apply to all of its employees. Current choices are: 1st day of the calendar month following date of hire, or either 30 or 60 days of employment; but in all events by the 91st day after hire. A participating employer cannot agree to waive the waiting period for an employee or group of employees. Such a waiver could subject the participating employer or the employee to taxation or penalties. Such a waiver also may be considered by MIT to be a breach of the Participating Employer Agreement, causing the loss of the participating employer’s eligibility to participate in MIT.

Note that there are certain special situations where waiting periods may be waived, with MIT approval. These special waivers are generally limited to the date the participating employer first joins the Plan and acquisitions by a participating employer of another business.

Yes. If an eligible employee or his or her spouse or dependent has one of the qualifying events or meets the Plan’s special enrollment provisions, he or she will be able to enroll in the Plan mid-year. In all events, eligible employees, spouses or dependents will have the opportunity to enroll in the Plan each year during open enrollment.

This depends. If your spouse purchased a private individual medical insurance policy that she did not purchase through a state health exchange, her voluntary cancellation of the insurance policy is not considered a qualifying event that would allow her to enroll in our Plan mid-year. However, if your spouse purchased an individual medical insurance policy through a state health exchange or she was enrolled in coverage through an employer-sponsored medical plan, she can drop that other coverage during the open enrollment period for that other coverage and enroll mid-year in our Plan.

MIT or SCMA Members’ Insurance Trust is the casual name used to refer to the South Carolina Medical Association Voluntary Beneficiary Association Welfare Benefit Plan and Trust.

Our Mission: To serve physicians, families, employees and other healthcare-related industries by providing and administering group health insurance, personal customer service and other embedded benefits.

Our Vision: To be recognized as an industry leader for providing the most cost-effective, sustainable health insurance products and embedded benefits that maintain the highest level of customer service, incentivize health and wellness, and proactively engage and educate our members on how to be good stewards of the Trusts’ resources.

Our Values: Customer Service, Health & Wellness, Relationships with Members, Communication, Member Engagement, and Education

No, MIT is a self-funded multiple employer welfare arrangement (MEWA) sponsored and maintained by the South Carolina Medical Association (as a bona fide association of employers). For over 40 years, MIT has provided group health coverage and other embedded benefits to employees of the employer-members of the SCMA across the state of South Carolina, and their spouses and dependents.  MIT’s board of trustees serves as the plan administrator and as the trustees of the Plan and Trust.

MIT is led by a 5-member physician board of trustees.  The board serves as the plan administrator of the Plan and the trustees of the Trust.  In these roles, the board owes fiduciary duties under the Employee Retirement Income Security Act of 1974 (ERISA), including an obligation to protect and preserve the Trust’s assets under ERISA, and is subject to regulatory oversight by the Department of Labor.  SCMA serves as the “Plan Sponsor” which means that the Plan exists to provide benefits to employees of employer-members of the SCMA.

No, because MIT is a bona fide association MEWA, we will file a single return on behalf of all participating employers in MIT. You are not required to file either form.

MIT feels a lot like a “fully insured” model in that each participating employer pays premiums and does not face additional financial exposure in the event of high dollar claims, nor does it have the burden of completing yearly documents to meet regulatory compliance with government agencies.  Yet, as a self-funded health plan, MIT offers participating employers several advantages over a fully insured health plan.  One advantage is that participating employers are generally able to decrease their health care premiums by joining together with other similarly-situated employers to create a larger experience pool.  Another advantage is participating employers’ abilities to directly affect their premium costs through wellness and other health initiatives.

By virtue of participating in MIT, your business and employees have access to a plethora of resources to more efficiently run your business operation while assisting your employees in making prudent healthcare decisions. At MIT, you’ll not only have access to seasoned insurance professionals, but you will also have access to team members who have operated health systems and physician practices and understand how to navigate the complex healthcare environment so that the right care is delivered in the right location at the right cost.

Not only will you have access to your claims data (subject to certain HIPAA protections), but you will also have resources and support from MIT to act on the data, stabilize your costs, and engage your employees! MIT will assist you in analyzing your organization’s health care spend and to develop strategies to reduce costs while still receiving high quality services.

Yes, a list of these procedures may be found in the “Precertification and Prior Authorization” section of your MIT Summary Plan Description. The prior authorization list changes periodically. Please call Planned Administrators, Inc. Utilization Review at 1-800-652-3076 for prior approval before any major elective procedure.

It is your responsibility to make sure that you or your provider obtain the required prior authorization before undertaking any of these procedures. If you fail to obtain the required prior authorization, you may be entitled to only a portion of the payment that the Plan would have otherwise paid for the procedure.

All coverage terminates on the last day of the month. Thus, employees are covered until the end of the calendar month in which their employment with the participating employer terminates or they become ineligible (e.g., switch from full-time to part-time status).  Premiums for employees whose coverage has terminated will only be credited back to the participating employer for periods following the later of the actual termination effective date or, if later, the last day of the calendar month prior to the date notice of cancellation is received by MIT.

If the participating employer ceases its participation in MIT, the effective date of such termination and the corresponding loss of coverage for all employees of that participating employer is the last day of the month in which such notice was received by MIT (not your insurance agent) at MITinfo@scmedical.org or P.O. Box 11188, Columbia, SC 29211, or the last day of any later month that is specified by the participating employer in its cancellation notice.

Participating employers may cancel their participation in MIT at any point during the plan year. Requests for termination must be submitted in writing to MIT (not your insurance agent) at MITinfo@scmedical.org or P.O. Box 11188, Columbia, SC 29211. Effective dates of termination will be considered is the last day of the month in which such notice was received by MIT (not your insurance agent), or the last day of any later month specified by the participating employer in its cancellation notice.

Yes, a participating employer has a duty to notify MIT in writing within 31 days after the following events:

• death of a covered employee,
• termination of employment of, or reduction of hours of, a covered employee making him/her ineligible for MIT coverage,\
• a covered employee becomes entitled to Medicare (regardless of whether he/she enrolls).

Failure of the participating employer to timely and properly notify MIT may prevent the employee and his or her covered dependents from being able to elect COBRA continuation coverage under the Plan, may obligate the participating employer or the employee or dependent to repay the Plan for any expenses it incurs for ineligible expenses, and may subject the participating employer to legal liability.

An employee of a participating employer must notify MIT of the following COBRA-qualifying events within 31 days:

• The employee’s divorce or legal separation
• A covered dependent child of the employee losing dependent status under the Plan.

Your failure to timely and properly notify MIT by this deadline may prevent you or your covered dependent from being able to elect COBRA continuation coverage under the Plan and may obligate you to repay the Plan for any expenses it incurs for ineligible expenses.

You must also notify MIT within 31 days of the date you incur a family status change event or special enrollment event, or the date your handicapped child reaches the age 26 limit, as described in the MIT Summary Plan Description.  Your failure to timely and properly notify MIT by this deadline may prevent you or your covered dependent from obtaining coverage under the Plan and/or may obligate you to repay the Plan for any expenses it incurs for ineligible expenses.

The participating employer must notify MIT of any change in an employee’s eligibility status within 31 days of the beginning of the leave. The participating employer’s failure to timely and properly notify MIT by this deadline may prevent the employee and his or her covered dependents from being able elect COBRA continuation coverage under the Plan, may obligate the participating employer or the employee/dependent to repay the Plan for any expenses it incurs for ineligible expenses, and may subject the participating employer to legal liability.

When a covered employee enrolls in Medicare, this does not trigger an automatic loss of medical coverage under MIT.  The covered employee may continue his or her MIT medical coverage (and medical coverage for his or her eligible family members), in which case Medicare will usually pay secondary to MIT while the employee remains actively employed.  This means that if medical expenses are incurred by the covered employee, they must first be submitted to MIT for payment and then, to the extent that they are not covered by MIT they could be eligible for payment through Medicare.

Enrollment in Medicare is treated as an event that permits the covered employee to elect to drop MIT medical coverage mid-year.  However, you should be aware that if you choose to drop MIT medical coverage because you enrolled in Medicare, this is not a COBRA qualifying event and so your covered family members will not have any right to continue their medical coverage through MIT.  The only way to continue medical coverage for eligible family members is for the covered employee to remain in MIT medical coverage and elect to cover the eligible family member.

Medicare contains special rules that penalize eligible individuals who do not sign up for Medicare when they first become eligible.  These penalties, however, may not apply where the individual has employer-provided medical coverage, such as MIT.  While MIT can not advise you as to your Medicare rights, we urge you to consult your advisors to determine when you must enroll in Medicare.  For purposes of your analysis, it should be noted that because we are an association-sponsored health plan that covers one or more employers who have 20 or more employees, the medical coverage obtained through MIT is subject to the Medicare secondary payor rules, regardless of whether the participating employer has 20 or more employees (which is normally the threshold for an employer to become subject to the Medicare secondary payor rules).  MIT has not elected out of these Medicare secondary payor rules.

If an individual who is already on COBRA medical coverage through MIT later becomes entitled to Medicare, this triggers a loss of coverage for that person, but not for any family members who are also on COBRA.  Each family member retains his or her own right to continue COBRA coverage.

Eligibility for COBRA coverage may be affected if an individual is entitled to Medicare benefits.  an individual is considered to be “entitled” to Medicare upon the effective date of actual enrollment in either Part A or B. Merely being eligible to enroll in Medicare does not constitute being “entitled” to Medicare benefits. (Note that, while mere eligibility for Medicare does not service to terminate your COBRA coverage rights, it may impact your ability to qualify for ARPA Subsidized COBRA.  Please see the section of our FAQs entitled “COVID-19 National Emergency Relief” for more information).

The following situations demonstrate the interaction between Medicare entitlement and eligibility for COBRA coverage:

1. COBRA Election Made AFTER Medicare Entitlement. When a COBRA-eligible individual elects COBRA after enrolling in Medicare Part A or B, his or her rights to COBRA coverage are not impacted.  COBRA coverage may not be terminated early by the group health plan because of prior Medicare entitlement.

Example:  Employee A is covered under MIT’s group health plan. In April of Year 1, she applies for and enrolls in Medicare Part A. On July 18 of Year 1, she retires. As a result, she loses MIT plan coverage on July 31 of Year 1. She elects COBRA, which begins on August 1 of Year 1. She is entitled to COBRA for a maximum coverage period of 18 months even though she is already entitled to Medicare

2. COBRA Election Made PRIOR to Medicare Entitlement. When a COBRA-eligible individual elects COBRA prior to enrolling in Medicare Part A or B, his or her COBRA coverage may be terminated early by the group health plan upon subsequent enrollment in Medicare Part A or B.

Example:  Same facts as above, except Employee A does not apply for and enroll in Medicare Part A until November 1 of Year 1.  Since Medicare entitlement occurred after COBRA began, her COBRA coverage terminates effective November 1 of Year 1, due to Medicare entitlement.

3. Application to Employee’s Covered Spouse or Other Covered Dependent. The covered spouse and other covered dependent(s) of the employee are eligible for COBRA coverage upon the employee’s loss of MIT coverage due to retirement.  The length of COBRA coverage for the covered spouse and covered dependent will vary, however, based on the timing of the employee’s Medicare entitlement (if any).  When a covered employee’s Qualifying Event (for purposes of COBRA coverage) occurs within the 18-month period following the employee’s entitlement to Medicare, the employee’s covered spouse and covered dependent(s) are entitled to COBRA coverage for a maximum period of 36 months from the date that the employee became entitled to Medicare.  If the employee retires prior to Medicare entitlement, there is no extension of COBRA coverage available to the spouse and covered dependent(s) (they will be entitled to the normal 18 months).

Example: Employee B becomes entitled to Medicare on May 1 of Year 1. Employee B retires on May 1 of Year 2. Employee B elects COBRA for himself and his wife. Employee B is entitled to up to 18 months of COBRA from the date he retired.  Since Employee B’s retirement occurred less than 18 months after his Medicare entitlement, his wife is entitled to up to 36 months of COBRA coverage from the date of Employee B’s Medicare entitlement, or until April 30, Year 4.