It is required that an SPD contain the following information:
-The Plan name
-The Plan Sponsor/Employer’s name and address ( as well as whether the employer is a participating employer or a member of a controlled group)
-The Plan Sponsor’s employer identification number (EIN)
-The Plan administrator’s name, address, and phone number
-Designation of any Named Fiduciaries, if other than the Plan Administrator
-The Plan number used for ERISA Form 5500 purposes, e.g., 501,502,503, etc.
-Type of Plan or brief description of benefits, e.g., life, medical, dental, disability
-The Plan Year (used for maintaining the Plan’s fiscal records which may be different than the insurance policy year)
-The Trustee’s name, title, and address, if the Plan has a Trust
-The name and address of the Plan’s agent for service of legal process, along with a statement that service may be made on a Plan Trustee, Plan Administrator or Insurer
-The type of Plan administration, e.g., administered by contract, Insurer, or Sponsor
-Eligibility terms, e.g., classes of eligible employees, employment waiting period, and hours per week, and the effective date of participation, e.g., next day or first of month following satisfaction of eligibility waiting period
-The sources of Plan contributions, whether from employer and/or employee, and the method by which they are calculated
-How Insurer refunds (e.g., dividends, demutualization) are allocated to Participants
-Plan Sponsor’s amendment and termination rights and procedures, and what happens to Plan assets, if any, in the event of Plan termination
-Summary of any Plan provisions governing the benefits, rights, and obligations of Participants under the Plan upon termination or amendment of Plan or elimination of benefits
-Claims and appeals procedures—may be furnished separately in a Certificate of Coverage, provided that the SPD explains that claims procedures are furnished automatically, without charge, in the separate document (e.g., a Certificate of Coverage), and time limits for lawsuits, if the Plan imposes them
-A statement clearly identifying circumstances that may result in loss or denial of benefits (e.g., subrogation, coordination of benefits or other offset provisions)
-The standard of review for benefit decisions made by the Plan Administrator
-ERISA model statement of Participants’ rights
-Whether the Plan is maintained pursuant to one or more collective bargaining agreements, and that a copy of the agreement may be obtained upon request
-A prominent offer of assistance in a non-English language if applicable (depending on the number of participants who are literate in the same non-English language)
-Identity of Insurer(s), if any
-Additional requirements for Group Health Plans:◦Detailed description of Plan provisions and exclusions (e.g., co-payments, deductibles, coinsurance, eligible expenses, network provider provisions, prior authorization and utilization review requirements, dollar limits, day limits, visit limits, and the extent to which new drugs, preventive care, and medical tests and devices are covered) A link to network providers and a notice that a listing of network providers may be obtained at no cost to the participant
-Plan limits, exceptions, and restrictions
-Information regarding COBRA, HIPAA, and other federal mandates such as Women’s Health Cancer Rights Act, preexisting condition exclusion, special enrollment rules, mental health parity, coverage for adopted children, patient protection rights on selecting a health care provider, Qualified Medical Support Orders, and minimum hospital stays following childbirth, FMLA, USERRA,
-Description of the role of Insurers (i.e., whether benefits are insured by the Insurer)
Recommended, but not required:
-For insured arrangements, reference to the Summary of Benefits or certificate of insurance or coverage
-Claims administrators
-Language that in the event there is a conflict between the Plan Document, the SPD, and a Certificate of Insurance, which document controls
-Rescission of Coverage
-Independent External Review Organization
