Notices and Disclosures: SPD

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The Summary Plan Description (SPD) is the primary vehicle for informing participants and beneficiaries about their rights and benefits under the employee benefit plans in which they participate.

ERISA defines in general terms the content that must appear in the SPD. Because of differing benefits, this information can vary widely from plan to plan. However, various laws also require disclosure about specific rights and benefits. The chart below summarizes many of the disclosures that are applicable to these mandates and must appear in the SPD. If the disclosure or notice must also appear in other plan material, it is noted under “Other Disclosure Requirements.”

In addition, the Notices and Disclosures: Upon Initial Enrollment chart shows other notices that can be (and often are) included in the SPD. However, this is done primarily for convenience and these notices are not required to appear in the SPD.

Please note that the Affordable Care Act (ACA) mandated certain coverage requirements, such as the PHSA Mandates, which are not reflected in this chart.

SPD Distribution Requirements: The SPD must be provided to participants within 90 days of coverage. An updated SPD must be furnished every 5 years if the plan is amended or every 10 years if it is not. A notice or new SPD must be provided when there is a material change to the plan. Email and other Internet-based methods that comply with the DOL safe harbor can be used to distribute the SPD electronically.


Newborn’s and Mother’s Health Protection Act (NMHPA) Also include in the SBC?    No  
For group health plans providing maternity or newborn infant coverage, the SPD must disclose a mother’s and newborn’s rights after childbirth.


Qualified Medical Child Support Order (QMCSO) Also include in the SBC?    No  
The SPD must disclose the procedures for determining whether a Medical Child Support Order is qualified (QMCSO) or a statement indicating how a participant may obtain a copy of the procedures. A National Medical Support Notice (NMSN) might also be considered a QMCSO.
Other Disclosure Requirements: After receiving a medical child support order, plans must respond with letters to the participant and alternate recipients notifying them of the receipt of a medical support order and whether an order has been determined to be a QMCSO.


Continuation Coverage Also include in the SBC?    No  
The SPD must disclose continuation of coverage rights and requirements, such as those available under COBRA or state mandated continuation coverage.
Other Disclosure Requirements: Plan’s subject to COBRA must disclose COBRA rights to participants AND covered spouses in a COBRA Initial Notice that is often mailed to the employee participant’s home address. Additional notices are required when a participant or beneficiary experiences a qualifying event.



Grandfathered Status Also include in the SBC?    Yes  
All group health plans claiming “grandfathered status” under the ACA must disclose this in all plan materials distributed to participants describing benefits under the plan, including the SPD. A Non-Grandfathered plan does not have to disclose its status.
Other Disclosure Requirements: A plan’s grandfathered status should be included in all materials that describe benefits under the plan.



Patient Protections Also include in the SBC?    Yes  
Plans that require the designation of a primary care provider (PCP) must provide information relative to a participant’s rights under the ACA. The plan’s SPD should describe a participant’s rights when choosing a PCP.
Other Disclosure Requirements: A participant’s rights under the ACA relative to selection of a PCP must be included in all materials that describe benefits under the plan.



Wellness Incentive Disclosure (HIPAA Requirements) Also include in the SBC?    No  
The plan must disclose the availability of a wavier or alternative standard to receive a standard-based wellness incentive in all plan materials that describe the standard-based incentive. If the SPD describes this incentive, it must also include information about the availability of a waiver or alternative.
Other Disclosure Requirements: A notice of the availability of a waiver or alternative standard must be included in all plan materials that describe the standard-based wellness incentive.