SPD for health insurance plans

njjel

I have just been advised that an employer is not required to give the employee an SPD unless the employer is self insured. I always was under the impression that the employer was required to give one out. ????

FunHRBanker

I have never heard this. In fact, I was told that we should get a signed acknowledgement for receiving the SPD. Where did you get this advice?

njjel

I hadn't heard of it either which is why I brought it to the forum. My TPA is making this statement. would appreciate everyone's help on this!

Irie

I have never heard this before either. Unless it's a new rule maybe? You know things are always changing.

stilldazed

Maybe the message you heard was construed a little. Some insurance companies can issue an SPD if the employer & insuring company are agreeable. The requirement for the SPD doesn't go away, but the insuring company can fulfill the requirement for the employer. That's the only thing I can think given your info that self-insureds must and others are excused.

best wishes.

njjel

So bottom line then is that ALL employers must issue and SPD whether self insured or not correct? Where can I find this rule? I need to back up my statement to my TPA!

NaeNae55

If you are fully insured I would expect the insurance company, not necessarily your TPA, to provide your SPD. Here is a link for SPD information:

[url]http://www.dol.gov/dol/topic/health-plans/planinformation.htm[/url]

Hope this helps.


Nae

njjel

The TPA has told me that our carrier doesn't provide us with an SPD! That we had to do it ourselves with an attorney! I'll check the link you sent. Anyone else who wishes to weigh in please do. Thanks!