The Summary Plan Description or SPD is an important written document that a plan administrator must provide automatically and free of charge to participants of an ERISA-covered health benefit plan. The SPD provides information on when an employee can begin to participate in the plan, how service and benefits are calculated, when and in what form benefits are paid, and how to file a claim for benefits.
Who Must Comply
The requirements apply generally to group health plans. A group health plan is an employee benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care to employees and their dependents directly or through insurance, reimbursement or otherwise.
Types of information covered in a SPD:
Provides plan participants and beneficiaries with information about their rights, benefits, and responsibilities under the plan and how it works, including:
- Basic rights and responsibilities of participants under ERISA (model language is available–see 29 C.F.R. § 2520.102-3(t)(2));
- Eligibility requirements;
- Description of plan benefits and how to file a claim for benefits;
- Applicable premiums, cost-sharing, deductibles and copayments; and
- Notices and descriptions required under COBRA, HIPAA, and other health coverage laws.
Which Members Must Be Provided the SPD:
- Each participant covered under the plan
- Plan participants and beneficiaries, as well as the U.S. Department of Labor, or DOL, also have the right to obtain a copy of the SPD upon request
When is the SPD Due:
- Within 90 days after the employee becomes covered under the group plan. (New plans have 120 days after becoming subject to ERISA to distribute the SPD.)
- The SPD must be current within 120 days prior to the date of distribution, and must be accompanied by any summary of material modification or change in information required to be included in the SPD which has not been incorporated into the document being furnished.
An updated SPD must be furnished every 5 years if changes are made to SPD information or the plan is amended. Otherwise, it must be furnished every 10 years.