Forms & Resources
Summary Plan Documents
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.
MIT Procedures
Summary of Benefits and Coverage
2025 Plans
High Deductible
Major Medical
Preferred
2024 Plans
High Deductible
Major Medical
Preferred
Total Trust Perks (Embedded Benefits)
Virtual Care
Embedded Insurance
- Basic Life and AD&D Benefit Plan (Physician)
- Basic Life, AD&D, and Short Term Disability Benefit Plan (Non-physician)
- Basic Life and AD&D Benefit Highlights
- Short Term Disability Benefit Highlights
Other
- Ability Assist
- Beneficiary Assist Counseling
- Estate Guidance
- Funeral Concierge Services
- Travel and ID Theft
Supplemental Insurance Benefit Highlights
Community Eye Care (CEC)
The Hartford
Voluntary Life and Accidental Death and Dismemberment Insurance
- Voluntary Life and AD&D Benefit Plan (Physicians)
- Voluntary Life and AD&D Benefit Plan (Non-Physicians)
- Voluntary Life and AD&D Benefit Highlights
Critical Illness Insurance
- Critical Illness Benefit Plan
- Critical Illness Insurance Benefit Highlights
- Health Screening Benefit
Hospital Indemnity Insurance
Accident Insurance
Forms
Automatic Bank Draft Forms
Forms
Claim Forms
- BSA International Claim Form
- PAI Claim Form | For claims prior to January 1, 2025
- OptumRx Prescription Reimbursement Request | For claims prior to January 1, 2025
- CEC Vision Out of Network Claim
Additional Resources
Partner Resources
- JetHealth Portal | JetHealth Group Portal User Guide
- My Health Toolkit (Blue Solutions Administrator)
- Express Scripts Portal
- Sun Life Dental | Dental ID Card
- The Hartford Portal | Certificate of Insurance
- The Hartford Notice of Conversion and/or Portability Rights | The Hartford ERISA Claim Procedures | Evidence of Insurability (SC)
- PAI Member Portal | For claims prior to January 1, 2025 | Instructions
- SCMA MIT HIPAA Notice of Privacy Practices
- SCMA MIT HIPAA Authorization for Use or Disclosure of PHI
To allow use or disclosure of your protected health information, please complete MIT’s Authorization For Use Or Disclosure Of Protected Health Information Form.
Print, sign and email to MITinfo@scmedical.org.
- SCMA MIT HIPAA Authorization for Use or Disclosure of PHI
- 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.
