ERISA-required Summary Plan Descriptions (SPDs) are the obligation of the employer/plan-sponsor, and not the obligation of insurance carriers. It is important to realize that Certificates of Coverage are not SPDs, and that most Certificates do not satisfy the complete requirements of ERISA. While the checklist below is not an exhaustive list of the provisions required in a SPD, it does address some of the most common SPD elements missing from carrier-issued Certificates of Coverage:

• Plan Identification and Fiduciary Information.
• Description of Eligibility,including but not limited to classes of eligible employees, employment waiting periods, and effective dates of participation.
• Summary of Plan provisions governing the benefits, rights, and obligations of Participants under the Plan, upon termination or amendment of Plan or upon elimination of benefits.
• Claims and Appeals procedures.
• A Statement clearly identifying circumstances that may result in loss or denial of benefits, including but not limited to subrogation, coordination of benefits and/or or other offset provisions.
• The Standard of Review for benefit decisions made by the Plan Administrator.
• ERISA Model Statement of Participants’ rights.

If you are depending upon your Certificate of Coverage to satisfy ERISA requirements, the failure of that Certificate in covering any one of these checklist items can leave you non-compliant in the event of a Department of Labor (DOL) audit.

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