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Do We Have to Issue SPDs to Health and Welfare Plan Participants Annually?

08.30.2017

Question: In the past, we’ve provided participants with summary plan descriptions (SPDs) for our health and welfare plans every year. The plans are subject to the Employee Retirement Income Security Act (ERISA), but are we required to provide SPDs that often?

Answer: Health and welfare plan SPDs don’t have to be routinely provided every year. Generally, health and welfare plan SPDs must be furnished to participants when they first become covered by a plan and at specific intervals thereafter. For this purpose, “participants” are employees or former employees including:

  • Those who are or may become eligible for benefits
  • Whose beneficiaries are or may be eligible for benefits, including COBRA-qualified beneficiaries and covered retirees

Different deadlines apply in different situations, so you may wish to furnish SPDs sooner than absolutely required.

Reviewing the deadlines
Here’s a review of the pertinent deadlines:

Newly covered participants: For a new participant in an existing plan, an SPD must be automatically furnished within 90 days after the participant first becomes covered.

New plans: The plan administrator of a new plan must automatically furnish SPDs within 120 days after the plan is first established and becomes subject to ERISA.

Five-year rule: A plan administrator must automatically furnish an updated SPD at least every five years, or whenever changes are made within a five-year period. The updated SPD must be furnished no later than 210 days following the last day of the fifth plan year. The material change should be reflected in the most recently distributed SPD. It must incorporate all the amendments that occurred during the five-year period. Lastly, the material changes should be communicated via a summary of material modifications.

Ten-year rule: If no material changes were made during the immediate preceding ten-year period, the plan administrator must furnish a copy of the most recently distributed SPD within 210 days following the last day of the tenth plan year. The material change should be reflected in the most recently distributed SPD.

Furnishing quickly
Since the SPD provides participants with important information about their rights and responsibilities under the plan, it may be advisable to furnish SPDs soon after coverage begins. If a participant has not been notified of plan requirements, such as the need to follow the plan’s claims procedure, a court may not require the participant to comply with those obligations. As a result, furnishing SPDs as soon as possible is largely in the plan’s best interest.

In addition to the SPD, group health plans are subject to a variety of disclosure requirements. Many of these disclosure requirements have different distribution rules. For instance, if the SPD is used to convey information that’s subject to an annual notice requirement, the SPD must be distributed annually. Furthermore, SPDs are among the materials that must be furnished to participants, as well as other individuals, upon request.

Present_RonIf you have questions on how to get ahead of important SPD deadlines for your organization, please contact Ron Present, Partner and Health Care Industry Group Leader, at rpresent@bswllc.com or 314.983.1358.

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