Supreme Court Says SPD Does Not Constitute the Terms of the Plan
MyHealthGuide Source: Cigna Corp v Amara, No. 09-804, 5/16/2011. Supreme Court Opinon
The Supreme Court stated, “…we conclude that the summary documents, important as they are, provide communication with beneficiaries about the plan, but that their statements do not themselves constitute the terms of the plan for purposes of §502(a)(1)(B). This conclusion meant that the summary plan descriptions could not supply terms that would be the basis for benefits that a court could award under §502(a)(1)(B) of ERISA.However, Supreme Court conclusion appears to be in conflict with others cases that concluded that the summary plan description is a “plan document” which can be the source of plan terms. For example, this Newsletter published an article on 12/20/2010 authored by Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group. In the case Briglia v. Horizon Healthcare Services, District Court Judge Noel Hillman, concluded that a promise made in a self-funded plan’s summary plan description (SPD) was sufficient for the plan to pay a $660,000 claim.
It remains to be seen what the courts will now do, as far as using a summary plan description to communicate about the plan rather than constitute the plan.
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