Plan Document/SPD Requirement

[Madison71]

I am working with a small (under 50 FTEs) with company that sponsors a fully insured group medical plan. I was reviewing the insurance booklet and was told that is the summary plan description, but it does not contain much of what I believe would normally go into an SPD. Is a fully insured group health plan (no matter the size) required to have a plan document and/or SPD? I say no matter the size as I understand the value of a wrap plan document with 100 plus participants. If so, what is required to be contained in this plan? Thank you.

[QDROphile]

It is almost universal that (1) insurance companies tell their clients that the insurance booklet is the SPD, and (2) the insurance booklet does not comply with the SPD disclosure requirements. Even if the substance of the insurance coverage is adequately summarized (or presented, if the booklet is also the plan document), the booklet is typically deficient in procedural and formal aspects. The plan administrator can supplement the booklet to cover the missing material. That is not a bad thing, because the exercise will force the plan administrator to think about the claims procedures and compliance with the requirements for claims procedures and who is the fiduciary with responsibility for adjudicating claims.

[GMK]

^Well said.

A couple references:

https://www.shrm.org/hr-today/news/hr-magazine/pages/0113-wrap-documents.aspx

https://www.law.cornell.edu/cfr/text/29/2520.102-3

[Madison71]

Thank you!!