Group Health Plans

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 group 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 must be made available upon request, free-of-charge or for copying fees.

Requirements for Group Health Plans

The major categories of notices required for group health plans included in this section are organized as follows:

• Summary Plan Description (SPD)
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• Summary of Material Modifications (SMM)
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•   Plan Documents
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• Health Care Reform (PPACA) Notices
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• COBRA Notices
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• HIPAA Portability and Nondiscrimination Notices
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• Special Health Care Notices (Women's Health and Cancer Rights Act, Mental Health Parity and Addiction Equity Act, CHIP)
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• Notices Related to Benefit Claims
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• Non-ERISA Notices (HIPAA Notice of Privacy Practices for Protected Health Information, 
• HIPAA Notice of Breach of Unsecured Protected Health Information, Medicare Part D 
• Creditable Coverage Notices)

Who Must Comply Disclosure Requirements for Group Health Plans

These disclosure requirements apply generally to group health plans. An ERISA-covered group health plan is an employment-based plan that provides coverage for medical care to employees and their dependents, including hospitalization, sickness, prescription drugs, vision, or dental. A group health plan can provide benefits by using funds in a plan trust, the purchase of insurance, or by self-funding benefits from the employer's general assets...

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