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November 3, 2008    DOL Home > Find It! By Topic > Health Plans & Benefits > Plan Information   

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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 plan, how service and benefits are calculated, when benefits becomes vested, when and in what form benefits are paid, and 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.

In addition to the summary plan description, the plan administrator must automatically give participants each year a copy of the plan's summary annual report. This is a summary of the annual financial report that most plans must file with the Department of Labor. These reports are filed on government forms called the Form 5500. The summary annual report is available at no cost. To learn more about the plan assets, participants may ask the plan administrator for a copy of the annual report in its entirety.

If participants are unable to get the summary plan description, the summary annual report or 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.

DOL Web Pages on This Topic

Compliance Assistance
Provides information to assist employers and employee benefit plan practitioners in understanding and complying with the requirements of ERISA as it applies to the administration of employee pension and welfare benefit plans.

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

EFAST — ERISA Filing Acceptance System
The EFAST system streamlines filing and processing of the annual return/report forms through the use of computer scannable forms and electronic filing technologies. This Web site provides assistance on using the EFAST system.

Questions & Answers: EFAST — ERISA Filing Acceptance System
Provides answers to commonly asked questions about the EFAST system.

Health Benefits Under the Consolidated Omnibus Budget Reconciliation Act (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.

How to File a Claim for Your Benefits
Provides advice 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.

Pension & Health Care Coverage...Questions & Answers for Dislocated Workers
Provides answers to commonly asked questions by dislocated workers about their pension and health benefits.

Question & Answer Guide: 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).

Health Coverage Portability (PDF)
Provides information about major provisions of the Health Insurance Portability and Accountability Act, the Newborns' and Mothers' Health Protection Act, the Mental Health Parity Act, and the Women's Health and Cancer Rights Act.

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 (WHCRA)
The WHCRA contains protections for patients who elect breast reconstruction in connection with a mastectomy. This fact sheet provides a brief overview of the law.

Work Changes Require Health Choices (Español)
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 pension plans and group health plans.

Frequently Asked Questions for Plan Sponsors, Fiduciaries, and Service Providers Related to the Events of September 11th
Answers to some of the most frequently asked questions by plan sponsors, fiduciaries, and service providers whose pension and health plans were impacted by the events of September 11, 2001.

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 as a result of the events of September 11, 2001. These questions and answers provide general information about the filing relief.

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