The Employee Retirement Income Security Act (ERISA) oversees group benefit plans, and with the onset of the Affordable Care Act, the ERISA Summary Plan Description (SPD) requirements are in the spotlight. More often than not, a plan administrator assumes that a Certificate of Insurance qualifies as an SPD, and that either the insurance company or their broker is responsible for preparing and delivering SPD’s. In this instance, the employer (plan administrator) is solely responsible for ERISA compliance.

An employer must have a written SPD, which serves as the main vehicle for communicating plan rights and obligations to participants and beneficiaries. An SPD that includes the plan’s terms and conditions, such as a Certificate of Coverage, and includes (or ‘wraps’) it with the specific ERISA disclosure language is considered a ‘Wrap SPD.’ One step further would be to produce a mega-wrap document which would encompass all benefit lines into one document, which is HIPAA compliant as long as none of the benefits are self-funded.

ERISA requires that a SPD be distributed to enrolled participants within 90 days of coverage, or 120 days of a new plan being established. If an SPD has not changed, an employer is required to furnish another copy to all participants every five years.

An example of some of the information required in an SPD:

• Plan name
• Employer’s name and address
• Employer’s EIN
• Plan Administrator’s name, address, and phone number
• Type of plan and description of benefits
• Effective and End Dates of the plan
• Eligibility terms
• How refunds are allocated to plan participants
• Claims procedures
• ERISA legal disclosure of participants’ rights
• Sources of plan contributions
• Details descriptions of plan provisions and exclusions
• Information regarding COBRA, HIPAA, and other federal mandates
• Summary of Benefits (SBC)

While it may be a bit overwhelming if your group is not currently in compliance – we are here to help. We offer all of our clients a Wrap SPD that is co-developed and maintained by a major ERISA law firm, and has successfully passed DOL audits.

Feel free to contact us to ensure your group is in compliance.