Health Plan SPD's

[alexa]

Several of our health plasn, HMO's etc.. are sending us EOC's, i.e. evidence of coverage to distribute to our employees. Will these staisfy our SPD requirements?

[Guest b2kates]

Generally no. They may be attempting to satisfy the certificate of credible coverage. DOL regs provide a detailed explanation of what is required in an SPD; such as who is eligible, how to file a claim, ERISA, COBRA, HIPAA, rights...

[Guest eafredel]

Many HMOs and insurance companies do publish documents entitled "evidence of coverage" that meet many of the requirements of an SPD. You need to check the document provided against the requirements for an SPD set out in the U. S. Department of Labor regulations. You can provide any additional materials in a separate document and then incorporate the "evidence of coverage" document into the SPD by reference. The SPD regulations spell out in some detail the requirements for a group health plan SPD. For example, group health plans that include "in network" benefits must offer a list of providers, although this list either can be included in the SPD or offered as a separate document.

[Christine Roberts]

If you search this forum for "wrap" documents you will find discussions of how to satisfy SPD requirements with a brief attachment that incorporates the insurance booklet by reference.

[alexa]

thanks

I am in discussiosn with outside ERISA counsel on doing a wrap document with wrap SPD incorporating the EOC's