We advise selecting one of the first two options.
Option 1: “Transplant benefits are provided under a separate transplant program and will include the services of a transplant coordinator to assist you. Arrangements will be made at a facility approved by the Plan. Covered transplant services include room and board, physician’s fees, and other related services.”
Option 2: “Benefits are provided under a separate organ and tissue transplant policy. Potential donors and recipients must meet the terms and conditions outlined in the policy with no pre-existing conditions.” A separate policy/addendum to the SPD must be provided for transplant coverage.
The two options are available because there are many employers with specific transplant programs and/or policies. The SPD issued would then refer the employee to the separate program/policy. The policy itself can then be duplicated and distributed to employees with a note stating that it should be kept with their SPD. So long as the policy/procedure is made available to employees or upon request, an SPD can reference a separate policy or procedure.
Also, a plan amendment adopting the new benefit is allowed to be distributed with the SPD so long as it explains the features of the new benefit. The document can be formatted similarly to the SPD as in “Transplant Policy for (Name) Health and Welfare Plan”, the signatures are not necessary.
