Forms & Resources
Summary Plan Documents
- SCMA MIT 2024 Summary Plan Description – Effective 7/1/2024
- Summary of Material Modifications
- Click Here to order a paper copy of the Summary Plan Description that describes what the plan provides and how it operates including our medical and dental plans.
Summary of Benefits and Coverage
2025 Plans
High Deductible
Major Medical
Preferred
2024 Plans
High Deductible
Major Medical
Preferred
Embedded Benefits
Virtual Care
Embedded Insurance
Other
- Ability Assist
- Beneficiary Assist Counseling
- Estate Guidance
- Funeral Concierge Services
- Travel and ID Theft
Supplemental Insurance Benefit Highlights
- Vision Coverage
- Voluntary Life and Accidental Death and Dismemberment
- Critical Illness Insurance | Health Screening Benefit
- Hospital Indemnity | Health Screening Benefit
- Accident Insurance | Accident Prevention Benefit
Forms
Automatic Bank Draft Forms
Forms
- Members’ Insurance Trust Enrollment/Change Form
- Waiver of Coverage
- Leave of Absence
- Beneficiary Form
Claim Forms
- PAI Claim Form
- OptumRx Prescription Reimbursement Request
- CEC Vision Out of Network Claim
- The Hartford Employee Benefit Claims Platform
Additional Resources
Partner Resources
- JetHealth Portal | JetHealth Group Portal User Guide
- PAI Member Portal | Instructions
- Optum Rx | Optum Rx Formulary and Drug Lists
- Sun Life Dental | Dental ID Card
- CEC
- The Hartford | Certificate
- SCMA MIT HIPAA Notice of Privacy Practices
- Transparency in Coverage Rule
- This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
