2023 ERISA Welfare Plan Automatic Participant Disclosures Checklist

 Summary Plan Description (SPD)

ERISA² requires plan sponsors to distribute SPDs to inform participants of their benefits, rights, and obligations under the plan and describe how the plan operates. Department of Labor (DOL) regulations (availablehere) prescribe an extensive list of contents that must be included in an SPD. Changes to the SPD are communicated to participants either through a summary of material modifications (SMM) or the issuance of an updated SPD.

Among other contents required to appear in the SPD, the following must be included: 

• Group health plans providing coverage for maternity or newborn infant care must include a description of the requirements for a hospital length of stay in connection with childbirth under federal or state law, as applicable (model language is provided here, see page 140, and language may need to be supplemented with additional state law requirements, if applicable).
• See the Patient Protections Notice requirement below.
• See the Notice of Grandfathered Health Plan Status requirement below.

 Provide SMM (or updated SPD) to all participants within 210 days of the end of the plan year in which the change was adopted.

However, any "material reduction" in covered group health plan services or benefits must be communicated to participants within 60 days of the adoption of the change (unless group health plan updates are instead provided at least quarterly) (but see also Summary of Benefits and Coverage (SBC) requirement below regarding mid-year material changes).

An SPD must be updated (incorporating all SMMs) and distributed to all participants at least every five years (10 years if no changes were made to the plan during that period).

Summary Annual Report (SAR)

ERISA requires a summary, in narrative form, of the Form 5500 Annual Return/Report of Employee Benefit Plan most recently filed for the plan (if applicable).

DOL-prescribed SAR contents.

General COBRA³ Notice

This notice describes to participants and their covered family members their right to purchase a temporary extension of group health plan coverage when coverage is lost because of certain "qualifying events" under COBRA.

Model notice in English; Model notice in Spanish.

Provide to each covered employee and covered spouse* no more than 90 days after group health plan coverage begins.

*A single notice may be mailed to the employee's home, addressed to both the employee and spouse if the spouse is known to reside there.

HIPAA⁴ Notice of Privacy Practices

A group health plan (or an insurer) subject to the HIPAA privacy rules must provide this notice describing the uses and disclosures of protected health information (PHI) and the individual's rights and the plan's (or insurer's) duties with respect to that PHI.

Model notice, scroll down to "NPP Health Plan Files"

At least once every three years, notify all participants of the availability of the Notice of Privacy Practices and how to obtain it.

If there is a material change to the notice:

• A group health plan that posts the notice on a website that is maintained for the plan must post the revised notice by the effective date of the material change and provide the revised notice in the next annual mailing to plan participants (e.g., open enrollment mailing).
• A group health plan that does not post the notice on a website must provide the revised notice (or information about the material change and how to obtain the revised notice) to plan participants within 60 days of the effective date of the material change.