FAQ

Business Operations

  • Who is an eligible participating employer to purchase MIT insurance?
    1. Any entity that satisfies all of the following is an eligible participating employer:
    2. all of the working physicians of the entity are members 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.

  • Who is eligible for coverage on MIT insurance?

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

  • Does SCMA MIT recognize common law marriage in its eligibility?

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

  • When may coverage be purchased?

    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.  For example, for the 2020 plan year, all employees must elect coverage no later than December 27, 2019.

  • Can coverage be obtained in the middle of the 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.

  • I recently had a baby. How and when do I add the child to my Plan coverage?

    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.

  • Are dependent children covered under the Plan?

    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).
  • Are handicapped children eligible for coverage beyond age 26?

    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.

  • Does MIT provide a surviving spouse benefit?

    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.

Enrollment

  • When can newly-hired employees enroll on the Plan?

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

    Your participating employer can choose to apply a waiting period that ends on the 1st 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.

  • When must MIT receive your application to enroll on the Plan?

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

  • Can a participating employer opt to waive the waiting period for MIT coverage for a particular employee or group of employees?

    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.

  • If an employee or his or her spouse or dependents waive coverage, can they ever enroll in MIT again?

    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.

  • My spouse has her own coverage and decides to cancel her coverage because she received a large premium increase at her normal open enrollment. Can she enroll on MIT mid plan year?

    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.

General Inquiries

  • What is MIT’s Mission, Vision and Values?

    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

  • Is the SCMA Members Insurance Trust (MIT) a health insurance company?

    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 the last 38 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.

  • How is MIT governed?

    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.

  • If my business entity joins MIT, do I need to complete tax documents such as IRS Form 5500 or IRS Form 990?

    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.

  • Why is MIT different from other health insurance products in the commercial market?

    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.

  • How can enrolling as a participating employer in MIT help reduce my healthcare spend?

    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.

  • Will I have access to my claims data?

    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.

Prior Authorization

  • Is prior authorization required by MIT for certain procedures?

    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.

Termination

  • When does employee coverage terminate with MIT?

    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.

  • When can a participating employer request to terminate its coverage?

    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.

  • As a participating employer, do I have a duty to notify MIT of certain COBRA-qualifying events?

    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.

  • Do employees have a duty to notify MIT of certain events relating to their spouse or dependents?

    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.

  • Who is responsible for notifying MIT of a leave of absence and what timeframe?

    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.

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