alexa48
Jan 15 2004, 11:44 AM
Several of our health plasn, HMO's etc.. are sending us EOC's, i.e. evidence of coverage to distribute to our employees. Will these staisfy our SPD requirements?
b2kates
Jan 15 2004, 12:49 PM
Generally no. They may be attempting to satisfy the certificate of credible coverage. DOL regs provide a detailed explanation of what is required in an SPD; such as who is eligible, how to file a claim, ERISA, COBRA, HIPAA, rights...
eafredel
Jan 25 2004, 03:32 PM
Many HMOs and insurance companies do publish documents entitled "evidence of coverage" that meet many of the requirements of an SPD. You need to check the document provided against the requirements for an SPD set out in the U. S. Department of Labor regulations. You can provide any additional materials in a separate document and then incorporate the "evidence of coverage" document into the SPD by reference. The SPD regulations spell out in some detail the requirements for a group health plan SPD. For example, group health plans that include "in network" benefits must offer a list of providers, although this list either can be included in the SPD or offered as a separate document.
Christine Roberts
Jan 26 2004, 01:24 PM
If you search this forum for "wrap" documents you will find discussions of how to satisfy SPD requirements with a brief attachment that incorporates the insurance booklet by reference.
alexa48
Jan 26 2004, 07:03 PM
thanks
I am in discussiosn with outside ERISA counsel on doing a wrap document with wrap SPD incorporating the EOC's
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