Summary Plan Description

News & Analysis as of

Recent Government-Issued FAQs Cause Plan Sponsors to Clarify Preventive Care and Wellness in Health Plan Communications

On October 23, 2015, the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and Treasury issued frequently asked questions (FAQs) on the implementation of preventive care and wellness provisions of the...more

Checklist for Group Health Plan Participant Disclosure Requirements

There has been an explosion of participant disclosure requirements for group health plans in recent years. While health care reform created some of these new requirements, many of them became effective years earlier. For busy...more

IRS Announces Employee Benefit Plan Limits for 2016

Recently the Internal Revenue Service (IRS) and the Social Security Administration announced the cost-of-living adjustments to the applicable dollar limits on various employer-sponsored retirement and welfare plans and the...more

ERISA – Subrogation: Summary Plan Descriptions Can Be A “Controlling Document” Requiring Reimbursement… Sometimes

You already know that when a Summary Plan Description conflicts with ERISA plan language, the ERISA plan language controls. But what happens when all you have is a Summary Plan Description (SPD), and… no ERISA Plan? Can...more

Fifth Circuit Affirms Dismissal of Claims Involving De-risking of Pension Assets

In October 2012, a defined benefit plan sponsor amended its plan to provide that, effective Dec. 7, 2012, the plan would purchase an annuity to cover the plan’s obligations to make payments to the roughly 41,000 participants...more

Don’t Play Hide the Ball with Your Claims Procedure

ERISA does not have a statute of limitations for lawsuits brought by participants to check claim benefits under the plan. Instead, courts borrow from similar state statutes of limitations. In a decision two years ago, the US...more

A Summary Plan Description Can be a Plan Document

In a decision issued a couple of years ago, the United States Supreme Court held that a summary plan description that differed from the plan document could not be enforced as the plan document. The Court said that the summary...more

The Future Of ERISA Litigation — Sleeper Supreme Court Case Worth Watching — Part II

On May 12, 2015, we reported at here on a non-ERISA case accepted for review by the Supreme Court in the 2015-16 Supreme Court Term that has ERISA Litigation implications. Now, as that Term is set to begin on October 5,...more

Plaintiffs’ Misdirected Demand for Documents Fails, and Their Claim for ERISA Civil Penalties Is Dismissed: Boyd v. Sysco...

A federal court dismissed the plaintiffs’ claim to recover civil penalties for failure to provide plan documents requested by the plaintiffs. Boyd v. Sysco Corporation, No. 4:13-cv-00599 (D. S. C. September 3, 2015), provides...more

Third Circuit Says ERISA Administrative Appeal Denial Letters Must State Plan-Imposed Time Limits

The Third Circuit recently held that ERISA administrative appeal denial letters must include plan-imposed time limits for commencing a lawsuit challenging the claim denial, and the failure to provide such notice warranted...more

Sixth Circuit Enforces Subrogation Clause

The Sixth Circuit rejected a participant’s argument that the plan’s subrogation provision was not enforceable because it was only in the plan’s summary plan description, and not in the trust agreement that the participant...more

New Final Regulations and FAQs Provide Guidance on Preventive Services Coverage

Through new FAQs and final regulations, the U.S. Departments of Labor (“DOL”), Health and Human Services (“HHS”) and the Treasury (the “Departments”) have further clarified various issues related to the preventive care...more

Tenth Circuit Addresses ERISA Limitations Provision in Class Action Decision

In Fulghum v. Embarq. Corp., 785 F.3d 395 (10th Cir. 2015), the Tenth Circuit Court of Appeals considered the claims of a class of telephone company retirees whose life and health insurance benefits were reduced or eliminated...more

Reminder: Non-Grandfathered Plans Must Implement Embedded Out-of-Pocket Maximums

As employers and plans prepare for 2016 open enrollment, they must be sure to address in their benefit design and with their third party vendors the new embedded out-of-pocket maximum limitations on individuals that were...more

New ruling limits out-of-pocket expenses at individual level in 2016

Most health plan and health insurance policies include strategies that require persons covered under them to share in the costs that are paid. This strategy, often referred to as cost-sharing, serves two purposes. First, it...more

Internet Posting of SPD is Insufficient

Employers know that they must prepare and distribute a summary plan description (SPD) for their ERISA benefit plans, including retirement benefits, health insurance, life insurance and disability insurance. Because of the...more

More ERISA Complications

In passing the Employee Retirement Security Act of 1974 (“ERISA”), Congress sought to make it as easy and economical as possible for employers to provide benefits to their workers; for example, pensions, health insurance,...more

Starting a New Business: What Employers Need to Know About Health Benefits

Starting a new business can be very stressful, and with any successful business comes the added stress of hiring and retaining employees. To attract good employees, employers generally need to offer health benefits. ...more

Survive The Season With Our Open Enrollment Checklist

It’s that time of year again, when fall weather brings with it a host of legal obligations for plan sponsors running open enrollment. Here’s what you need to know to survive the season....more

The Affordable Care Act – What You Need to Know Checklist

In This Presentation: - Review Employer Information - Fees - Mandates - Additional Points - Communications - Excerpt from Review Employer Information. Employer’s Health Plans - 1. Identify the...more

Plan Document Mistakes a Retirement Plan Sponsor Should Avoid

One of the major things that plan sponsors forget about their retire- ment plans is the plan document. ERISA (the Employee Retirement Income Security Act of 1974 for those scoring at home) requires all retirement plans to...more

When Silence Isn't Silence: What is the Silence of Your ERISA Summary Plan Description Actually Saying?

It is well known that in enacting the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et. seq., Congress set forth a requirement that a Summary Plan Description ("SPD") be furnished to participants...more

ERISA 8th Circuit: Deciding Who Is The Beneficiary — The Abuse Of Discretion Standard Trumps The Substantial Compliance Doctrine

Sometimes determining the correct beneficiary for ERISA-governed life insurance benefits can present real challenges. Can the deceased’s will prove the deceased’s intent designating the correct beneficiary? It...more

A Recent Stock Drop Case Reminds Plan Sponsors That Clear Plan Language Is The Primary Defense To Benefit Plan Litigation

Recently, a federal district court in Georgia, on remand from an appellate court, dismissed a suit brought by participants of the SunTrust Bank 401(k) savings plan alleging fiduciary breaches based on defendants’ decision to...more

Court Holds That Plan Sponsor’s SEC Filings Were Incorporated By Reference Into Retirement Plan’s Summary Plan Description and...

The U.S. Court of Appeals for the Ninth Circuit has held that an ERISA-regulated employee stock-ownership retirement plan’s incorporation by reference of the plan sponsor’s statements to the Securities and Exchange Commission...more

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