State mandated info on an SPD?

[Guest LLandau]

Question for a knowledgeable soul: What State information must be included in an SPD. Any State information? Depends on the State? Where would I find official guidance on this issue?

[mroberts]

It's going to be state by state, however, almost all of the requirements of the SPD stems from the federal goverment. Most states just follow what the government mandates, however, there are a couple states that will require more info.

[Guest LLandau]

Thank you for your help.

Just a follow-up question. Other than going on a state-by-state basis, is there any reference material available to show what each state requires?

Thanks again

[mroberts]

Where are you in IL by the way? I grew up in Chicago.

Are there any coverages in particular you are looking at this for? Texas and Florida has to have stuff put into the SPDs for certain coverages no matter where the contract is sitused. I would either go to your broker or the carrier in which you are insured through.

If you would like to discuss further, just send me an email.

[Guest LLandau]

Thank you from Chicago (Not enough cold weather/snow for you here?). Actually, there are many locations, so I was looking for an overall guide, but you gave me a great start and I appreciate it.

[GBurns]

An overall guide should be available from one of the national insurers such as United, Aetna, Humana or CIGNA. Try the large group or National account reps first.

You might want to start your own guide by trying this link:

http://www.insure.com/health/lawtool.cfm?C...FTOKEN=88329618

[mroberts]

Rochester gets tons more snow since we're on the east side of the lake, unlike Chicago being on the west side. Other than that, the temps are pretty similar. Are you right in Chicago or a suburb or down south?

[Guest Mfcavo]

ERISA disclosure rules require that the SPD contain a description of any benefits and limitation under the plan. If state insurance law requires that an insured plan provide certain mandated benefits, then the SPD should describe them although there is no specific provision of ERISA or the benefits provided.

If the plan is self-funded, then insurance law is not applicable.

If the plan is insured, then all benefits, mandated or not, should be described. This should happen as a matter of course since the insurance companies generally have to file insurance policies and certificates and have them approved byu state insurance agencies. Therefore, any any insurance policies or certificates the plan gets from the insurer should properly describe all state-mandated benefits in the state in which they were issued.