exempt from SPD's

[Guest markova]

A client is employed by a local school district, the client is having a claim problem, asked the school district for the SPD - the response was we don't have to provide them since we are a government agency - this doesn't ring true. The plan is self-funded. Can you provide some advice on this?

[J Simmons]

Take a look at ERISA sections 4(b)(1) and 3(32). If the local school district meets the ERISA definition of a governmental entity (many do), they might not be required to have an SPD.

However, without ERISA applying, there would not be preemption of state law for the self-funded health plan. That subjects the self-funded health plan to state law and regulation, perhaps including registration as an 'health insurer' if the state does not have a separate regulatory scheme for self-funded health plans, particularly where the employer is a governmental entity. In those state laws and regulations that apply, you might find disclosure requirements that might even include a summary be prepared and distributed to employees and other beneficiaries. So while there might not be an SPD requirement under ERISA, you might have a mimicking requirement under state law.

Also, being a public employer, you might have a freedom of information type of right under your state law to inspect the plan's governing documents and operational records as well.

[Guest taxesquire]

I agree. Also, even if you don't have an SPD, you should have a plan document and an insurance policy, which would also outline the claims procedures, so you still have something to provide the employee.

[Guest Ron Wohl]

As far as I know, public school districts are government entities and are therefore exempt from ERISA. However, They still are covered by the regulations of their state insurance commission and with regard to securities matters, by the required disclosure requirements of the SEC and possibly their state's own security regulation office. Check with your school district attorney or with the state insurance commission.

Also, you should check at the communication bulletin board on this website.

[Peter Gulia]

In helping a claimant consider his or her negotiation strength or weakness, be aware of the possibility that State law might impose special procedural requirements on a claim against a government entity. In some States, a claim against the State or its agency or political subdivision (which might include a public-schools district) can be submitted only to a special-jurisdiction court. In some States, this court sits only in the State's capital city. For claims against a government entity, often a shorter statute of limitations and statute of repose applies. Also, a failure to perform special service on the Attorney General or a similar official might destroy the claim.