Scenario
I am not sure what mental health and substance use disorder treatments my plan will pay for, or if there are limits or exclusions on these benefits.
Where to start
Summary Plan Description and any Summaries of Material Modifications
Summary Plan Descriptions are important disclosure documents prepared by the plan that describe, in understandable terms, the rights, benefits, and responsibilities of participants and beneficiaries.
The Summary Plan Description must include important information regarding the plan, such as information on how the plan works, eligibility requirements, what benefits the plan provides, and how those benefits may be obtained, including how the plan covers mental health and substance use disorder benefits.
The plan’s claims procedure, including applicable time frames, must also be included in the Summary Plan Description or in a separate document distributed with the Summary Plan Description.
Summaries of Material Modifications describe important changes made to the plan and the Summary Plan Description.
When can I get these documents?
Summary Plan Descriptions are generally distributed within 90 days after the date a participant first becomes covered by the plan. They also must be provided upon written request, generally within 30 days.
Summaries of Material Modifications that describe an important reduction in covered services or benefits must generally be provided automatically within 60 days of the change taking effect.
