SAR Required for Fully Insured Health Insurance Plan

[austin3515]

Client has a regular health insurance program, more than 100 lives covered. Let's say its BC/BS, fully insured, no trust fund, etc. Monthly premiums paid by Employer and that's that.

Do they need to distribute an SAR or is there some sort of an exemption?

[Flyboyjohn]

No exemption, if you file an Annual Report (5500) you have to distribute a Summary Annual Report to participants

[lvena]

Here you go.

https://www.dol.gov/general/topic/health-plans/planinformation

[Peter Gulia]

I remember a PWBA (in the 1980s) staffer's seminar-law explanation that went like this:

A summary annual report is a summary of the annual report's financial statements and schedules.

If, obeying the Form 5500 Instructions, the plan's annual report has no financial statements and no schedules, there would be no such information for the SAR to summarize.

A regulation allows the administrator to omit information that is not required to be reported on the annual report. 29 C.F.R. 2520.104b-10(d)(1).

However, the SAR form for a welfare plan has a paragraph captioned "Insurance Information" in which the administrator names the insurance company the plan has a contract with, and the total amount of premiums paid for the plan year.

Also, an instruction in the SAR form's "Your Rights to Additional Information" portion states: "list only those items [that] are actually included in the latest annual report[.]" This way the disclosure text doesn't invite a participant to request a document that does not exist.

For the health plan you described, it seems the SAR might be a few succinct paragraphs and tidy on one page.