Forms & Resources

Summary Plan Documents

• • SCMA MIT 2025 Summary Plan Description – Effective 1/1/2025
    • Medical Coverages
    • Dental Coverage (Basic)
    • Dental Coverage (Enhanced)
    • Embedded Benefit – Life/AD&D (Physician)
    • Embedded Benefit – Life/AD&D and Disability (Non-physician)

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.

• • SCMA MIT 2024 Summary Plan Description – Effective 7/1/2024
    • Summary of Material Modifications

Summary of Benefits and Coverage

 

2025 Plans

 

 

2024 Plans

 

Total Trust Perks (Embedded Benefits)

 

Virtual Care

• MUSC 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)

• Vision Coverage Benefit Summary | CEC Portal

 

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

• Hospital Indemnity Benefit Plan
• Hospital Indemnity Benefit Highlights
• Health Screening Benefit

Accident Insurance

• Accident Insurance Benefit Plan
• Accident Insurance Benefit Highlights
• Accident Prevention Benefit

Forms

 

Automatic Bank Draft Forms

• SCMA Automatic Draft Authorization Form
• MIT Automatic Draft Authorization Form

Forms

• Members’ Insurance Trust Enrollment/Change Form
• Waiver of Coverage
• Beneficiary Form

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

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Additional Resources

Partner Resources

• JetHealth Portal  |  JetHealth Group Portal User Guide
• My Health Toolkit (Blue Solutions Administrators)
• 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
• 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.