Most health and welfare plans offered by employers are subject to the Employee Retirement Income Security Act of 1974 (ERISA). Generally, ERISA envisions that employee benefit plans will have both a plan document and a summary plan description (SPD). However, in some cases, a single document may serve both purposes. Here we will look at the difference between the two and under what circumstances they may be combined.
Plan documents
Plans subject to ERISA must be “established and maintained pursuant to a written instrument” called the plan document. It comprehensively sets forth the rights of the plan’s participants and beneficiaries by describing:
- What benefits are available
- Who is eligible
- How benefits are funded
- Who is the named fiduciary
- How the plan can be amended
- The procedures for allocating plan responsibilities
The plan document also guides the plan sponsor and plan administrator in making decisions and executing their responsibilities.
SPDs
ERISA also requires employee benefit plans to have an SPD. A key function of the SPD is conveying plan information in an understandable summary to participants. The SPD must include many specified items, such as:
- Plan-identifying & eligibility information
- A description of plan benefits & circumstances causing loss or denial of benefits
- Benefit claim procedures
- A statement of participants’ ERISA rights
The SPD must be written in a manner calculated to be understood by the average plan participant and must be furnished at specific times to specific individuals.
Combining the two
Some health and welfare plans use a single document as both the plan document and SPD. If this approach is taken, the document must comply with both ERISA’s written plan document requirements and its SPD format and content rules.
Some courts and commentators have expressed the view that a combined plan document and SPD is unacceptable because it is impossible for a document to summarize itself, but at least two appellate courts have approved the combined approach for welfare plans.
Penalties possible
Participants and beneficiaries may request copies of the plan document and the SPD. Failure to furnish the documents within 30 days after the request may expose the ERISA plan administrator (typically the employer) to penalties of up to $110 per day — even if either document was already provided in the normal course, as may be the case with the SPD.
Finally, note that for group health plans a summary of benefits and coverage also is required but is separate from, and in addition to, the plan document and the SPD.
If you’re looking for assistance from experienced employee benefit plan auditors and consultants, KPM can help. Contact us today to learn how we can help you.