Forms & Resources
Summary Plan Documents
- SCMA MIT 2023 Summary Plan Description – Effective 1/1/2023
- 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
2024 Plans
High Deductible
Major Medical
Preferred
2023 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
Claim Forms
- The Hartford Employee Benefit Claims Platform
- Sun Life Short Term Disability Claim Forms
- OptumRx Prescription Reimbursement Request
- CEC Vision Out of Network Claim
Additional Resources
- JetHealth Portal | JetHealth Group Portal User Guide
- PAI Member Portal | Instructions
- SCMA MIT HIPAA Notice of Privacy Practices
- OptumRx Formulary and Drug Lists
- 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.
