Summary Plan Descriptions (SPDs)

One of the most important documents participants are entitled to receive automatically when becoming a participant of an ERISA-covered retirement or health benefit plan or a beneficiary receiving benefits under such a plan, is a summary of the plan, called the summary plan description or SPD. The plan administrator is legally obligated to provide to participants, free of charge, the SPD. The summary plan description is an important document that tells participants what the plan provides and how it operates. The SPD provides information on when an employee can begin to participate in the plan, how service and benefits are calculated, when benefits become vested, when and in what form benefits are paid, and how to file a claim for benefits. If a plan is changed, participants must be informed, either through a revised summary plan description, or in a separate document, called a summary of material modifications, which also must be given to participants free of charge.

SPDs for Health Plans

Among other information, the SPD must describe:

• Cost-sharing provisions, including premiums, deductibles, coinsurance and copayment amounts for which the participant or beneficiary will be responsible
• Annual or lifetime caps or other limits on benefits under the plan
• The extent to which preventive services are covered under the plan
• Whether, and under what circumstances, existing and new drugs are covered under the plan
• Whether, and under what circumstances, coverage is provided for medical tests, devices and procedures
• Provisions governing the use of network providers, the composition of provider networks and whether, and under what circumstances, coverage is provided for out-of-network services
• Conditions or limits on the selection of primary care providers or providers of specialty medical care
• Conditions or limits applicable to obtaining emergency medical care
• Provisions requiring pre-authorizations or utilization review as a condition to obtaining a benefit or service under the plan

ERISA also requires that SPDs be updated periodically. Furthermore, ERISA requires disclosure of any material reduction in covered services or benefits to participants and beneficiaries generally within 60 days of the adoption of the change through either a revised SPD or a summary of material modification (SMM). Material changes that do not result in a reduction in covered services or benefits must be disclosed through an SMM or revised SPD not later than 210 days after the end of the plan year in which the change was adopted.

Summary Annual Report

In addition to the summary plan description, the plan administrator must give participants a copy of the plan's summary annual report each year. This is a summary of the annual financial report that most plans must file with the Department of Labor. These reports are filed on government forms called the Form 5500. The summary annual report is available at no cost. To learn more about the plan assets, participants may ask the plan administrator for a copy of the annual report in its entirety.

 If participants are unable to get the summary plan description, the summary annual report or the annual report from the plan administrator, they may be able to obtain a copy by writing to the U.S. Department of Labor, EBSA, Public Disclosure Room, Room N-1513, 200 Constitution Avenue, N.W., Washington, D.C. 20210, for a nominal copying charge. Participants should provide their name, address and phone number to enable EBSA to contact them to follow up on the request.

Electronic Disclosure

The administrator of an employee benefit plan can furnish documents to participants and beneficiaries through the use of electronic media if it meets certain requirements under the ERISA regulations.  The regulations essentially require that unless the participant, beneficiary, or other individual has access to documents as part of his or her job duties, the individual must consent to receive them electronically.  The plan administrator has to take steps to confirm that the individual can truly receive electronic documents through email or other electronic means.  Notice must also be given to individuals of their right to withdraw the consent to electronic delivery at any time without charge, and to obtain paper copies of the documents upon request.  For more information on distributing plan documents through the use of electronic media, please click here. 

The following are samples of SPDs to be used for general reference purposes only. All SPDs should be developed in conjunction with a professional group benefits expert. Please note that the length of your company's SPD will depend on the particular plan design and benefits offered. The SPD must contain all of the information required under ERISA, a summary of which is described above.

• Health Plan SPD Sample #1 
• Health Plan SPD Sample #2  
• Health Plan SPD Sample #3 (Self-Funded Plan)
• Retirement Plan SPD Sample  

• Sample Benefit Summaries and Handbooks 

• Sample SPDs (Defined Contribution/Retirement Plans) 

• Sample SPD from SBAM 

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