Document

Type of Information

To Whom

When

Summary Plan Description (SPD)

Primary vehicle for informing participants and beneficiaries about their plan and how it operates. Must be written for average participant and be sufficiently comprehensive to apprise covered persons of their benefits, rights, and obligations under the plan. Must accurately reflect the plan's contents as of the date not earlier than 120 days prior to the date the SPD is disclosed.

Participants and those pension plan beneficiaries receiving benefits. (Also see “Plan Documents” below for persons with the right to obtain SPD upon request).

There are special provisions on foreign language assistance when a certain portion of plan participants are literate only in the same non-English language.

Automatically to participants within 90 days of becoming covered by the plan and to pension plan beneficiaries within 90 days after first receiving benefits. However, a plan has 120 days after becoming subject to ERISA to distribute the SPD. Updated SPD must be furnished every 5 years if changes made to SPD information or plan is amended. Otherwise must be furnished every 10 years.

Summary of Material Modification (SMM)

Describes material modifications to a plan and changes in the information required to be in the SPD. Distribution of updated SPD satisfies this requirement.

Participants and those pension plan beneficiaries receiving benefits. (Also see “Plan Documents” below for persons with the right to obtain SMM upon request)

Automatically to participants and pension plan beneficiaries receiving benefits; not later than 210 days after the end of the plan year in which the change is adopted.

Form 5500

Detailed information regarding the plan benefits and appropriate Schedules. Independent Qualified Public Accountant Report may be required.

U.S. Department of Labor and IRS. Unfunded, fully insured and combination unfunded/insured welfare plans covering fewer than 100 participants at the beginning of the plan year that meet certain requirements are exempt from filing an annual report.

Must be filed by end of 7 th calendar month after end of Plan Year. 2½ month extension can be requested.

Summary Annual Report (SAR)

Narrative summary of the Form 5500.

Participants and those pension plan beneficiaries receiving benefits.

Automatically to participants and pension plan beneficiaries receiving benefits within 9 months after end of plan year, or 2 months after due date for filing Form 5500 (with approved extension).

Notification of benefit determination (claims notices or explanation of benefits)

Information regarding benefit claim determinations. Adverse benefit determinations must include required disclosures (e.g., the specific reason(s) for the denial of a claim, reference to the specific plan provisions on which the benefit determination is based, and a description of the plan's appeal procedures).

Claimants (participants and beneficiaries or authorized claims representatives).

Requirements vary depending on type of plan and type of benefit claim involved.

Plan documents

The plan administrator must furnish copies of certain documents upon written request and must have copies available for examination. The documents include the latest updated SPD, latest Form 5500, trust agreement, and other instruments under which the plan is established or operated.

Participants and beneficiaries.

Copies must be furnished no later than 30 days after a written request. Plan administrator must make copies available at its principal office and certain other locations.

Summary of material reduction in covered services or benefits

Summary of group health plan amendments and changes in information required to be in SPD that constitute a material reduction in covered services or benefits.

Participants.

Generally within 60 days of adoption of material reduction in group health plan services or benefits.

Initial COBRA notice

Notice of the right to purchase temporary extension of group health coverage when coverage is lost due to a qualifying event.

Covered employees and covered spouses.

When group health plan coverage commences.

COBRA election notice

Notice to qualified beneficiaries of their right to elect COBRA coverage upon occurrence of qualifying event.

Covered employees, covered spouses, and dependent children who are qualified beneficiaries.

The administrator must provide qualified beneficiaries with this notice, generally within 44 days after being notified of the qualifying event. The time period for the employer or qualified beneficiary to notify the plan administrator varies depending on the type of qualifying event that has occurred.

Certificate of creditable coverage

Notice from employee's former group health plan documenting prior group health plan creditable coverage.

Participants and beneficiaries who lose coverage.

Automatically upon losing group health plan coverage, becoming eligible for COBRA coverage, and when COBRA coverage ceases. A certificate may be requested free of charge anytime prior to losing coverage and within 24 months of losing coverage.

General notice of preexisting condition exclusion

Notice describing a group health plan's preexisting condition exclusion and how prior creditable coverage can reduce the preexisting condition exclusion period.

Participants.

Notification must occur before any preexisting condition exclusion may be applied to any individual. Notice may be included in a group health plan's enrollment materials.

Individualized notice of period of preexisting condition exclusion

Notice that a specific preexisting condition exclusion period applies to an individual upon consideration of creditable coverage evidence and an explanation of appeal procedures if the individual disputes the plan's determination.

Participants and beneficiaries who demonstrate creditable coverage that is not enough to completely offset the preexisting condition exclusion.

Within a reasonable time after participant or covered dependent provides evidence of prior creditable coverage.

Notice of special enrollment rights

Notice describing the group health plan's special enrollment rules including the right to special enroll within 30 days of the loss of other coverage or of marriage, birth of a child, adoption, or placement for adoption.

Employees eligible to enroll in a group health plan.

On or before the time an employee is offered an opportunity to enroll in the group health plan.

Women's Health and Cancer Rights Act (WHCRA) notices

Notice describing required benefits for mastectomy-related reconstructive surgery, prostheses, and treatment of physical complications of mastectomy.

Participants and beneficiaries.

Notice must be furnished upon enrollment and annually.

Medical Child Support Order (MCSO) notice

Notification from plan administrator regarding receipt and qualification determination on a MCSO directing the plan to provide health insurance coverage to a participant's noncustodial children.

Participants, any child named in a MCSO, and his or her representative

Administrator, upon receipt of MCSO, must promptly issue notice (including plan's procedures for determining its qualified status). Administrator must also issue separate notice as to whether the MCSO is qualified within a reasonable time after its receipt.

National Medical Support (NMS) notice

Notice used by State agency responsible for enforcing health care coverage provisions in a MCSO. Depending upon certain conditions, employer must complete and return Part A of the NMS notice to the State agency or transfer Part B of the notice to the plan administrator for a determination on whether the notice is a qualified MCSO.

State agencies, employers, plan administrators, participants, custodial parents, children, representatives.

Employer must either send Part A to the State agency, or Part B to plan administrator, within 20 days after the date of the notice or sooner, if reasonable. Administrator must promptly notify affected persons of receipt of the notice and the procedures for determining its qualified status. Administrator must within 40-business days after its date or sooner, if reasonable, complete and return Part B to the State agency and must also provide required information to affected persons. Under certain circumstances, the employer may be required to send Part A to the State agency after the plan administrator has processed Part B.