Health Plans & Benefits: Plan Information

The Employee Retirement Income Security Act (ERISA) requires plan administrators - the people who run plans - to give plan participants in writing the most important facts they need to know about their retirement and health benefit plans including plan rules, financial information, and documents on the operation and management of the plan. Some of these facts must be provided to participants regularly and automatically by the plan administrator. Others are available upon request, free-of-charge or for copying fees. The request should be made in writing.

One of the most important documents participants are entitled to receive automatically when becoming a participant of an ERISA-covered retirement or health benefit plan or a beneficiary receiving benefits under such a plan, is a summary of the plan, called the summary plan description or SPD. The plan administrator is legally obligated to provide to participants, free of charge, the SPD. The summary plan description is an important document that tells participants what the plan provides and how it operates. It provides information on when an employee can begin to participate in the planand how to file a claim for benefits. If a plan is changed, participants must be informed, either through a revised summary plan description, or in a separate document, called a summary of material modifications, which also must be given to participants free of charge.

Plans also must provide a Summary of Benefits and Coverage (SBC) that accurately describes the benefits and coverage under the applicable plan. The SBC is a uniform template that uses clear, plain language to summarize key features of the plan, such as covered benefits, cost-sharing provisions and coverage limitations. Plans and issuers must provide the SBC to participants and beneficiaries at certain times (including with written application materials, at renewal, upon special enrollment and upon request).

If participants are unable to get the annual report from the plan administrator, they may be able to obtain a copy by writing to the U.S. Department of Labor, EBSA, Public Disclosure Room, Room N-1513, 200 Constitution Avenue, N.W., Washington, D.C. 20210, for a nominal copying charge. Participants should provide their name, address and phone number to enable EBSA to contact them to follow up on the request.

Web Pages on This Topic

Compliance Assistance - Provides publications and other materials to assist employers and employee benefit plan practitioners in understanding and complying with the requirements of the Employee Retirement Income Security Act (ERISA) for the administration of retirement and health plans.

Consumer Information on Health Plans - Provides fact sheets, booklets, and other health plan information from the Department's Employee Benefits Security Administration (EBSA).

ERISA Filing Acceptance System (EFAST2) - EFAST2 is an all-electronic system designed by the Department of Labor, Internal Revenue Service, and Pension Benefit Guaranty Corporation to simplify and expedite the submission, receipt, and processing of the Form 5500 and Form 5500-SF.

Questions & Answers: ERISA Filing Acceptance System (EFAST2) - Provides answers to commonly asked questions about the EFAST system.

An Employee's Guide to Health Benefits Under COBRA (PDF) - COBRA gives workers and their family members who lose their health benefits in certain circumstances the right to choose to continue group health benefits provided by their health plan. This publication provides a detailed overview of the law.

Filing a Claim for Your Disability Benefits - Provides information to participants about how to file a claim for benefits and what to do if the claim is denied.

Filing a Claim for Your Health Benefits - Provides information to participants about how to file a claim for benefits and what to do if the claim is denied.

How to Obtain Employee Benefit Plan Documents from the Department of Labor - Describes the documents and materials available through the EBSA public disclosure room and how you can obtain the documents from them.

Retirement and Health Care Coverage...Questions & Answers for Dislocated Workers - Provides answers to common questions asked by dislocated workers.

FAQs on Filing the Form M-1 - Provides questions and answers about Form M-1 Annual Report for Multiple Employer Welfare Arrangements (MEWAs) and Certain Entities Claiming Exception (ECEs).

Top 10 Ways to Make Your Health Benefits Work for You (Español) - Provides ten tips to help make your health benefits work better for you.

Women's Health & Cancer Rights Act (WHRCA): Questions & Answers (Español) Provides answers to frequently asked questions about the enrollment and annual notice requirements under WHCRA.

Work Changes Require Health Choices - Provides information on making health care decisions when your work life changes.

Your Employer's Bankruptcy: How Will it Affect Your Employee Benefits? Provides information about bankruptcy's effect on retirement plans and group health plans.

Frequently Asked Questions for Plan Sponsors Related to Filing Relief - The Employee Benefits Security Administration, the Internal Revenue Service, and the Pension Benefit Guaranty Corporation have extended the deadline for filing the Form 5500s and Form 5500-EZs. These questions and answers provide general information about the filing relief.