Compliance: <i>Cigna v. Amara</i> and how ERISA summary plan descriptions have changed
While it is possible that terms found only in an unintegrated SPD may be enforceable so long as there is no conflicting provision in the plan documents, the safest and most reliable course of action is to add a provision to the policy or SPD stating that the SPD is...
February 12, 2014 at 03:00 AM
5 minute read
The original version of this story was published on Law.com
Before the Supreme Court issued its 2011 opinion in Cigna v. Amara, an ERISA plan's summary plan description (SPD) was widely considered to be part of the plan's governing documents. Plan terms found only in the SPD were enforceable just like the provisions of the group policy and certificate of insurance. In Admin. Comm. of Wal-Mart Stores, Inc. Assocs.' Health and Welfare Plan v. Gamboa, the 8th Circuit ruled, “Where no other source of benefits exists, the summary plan description is the formal plan document, regardless of its label.”
That all changed, however, with the Amara decision. In that case, the Supreme Court rejected the argument that SPD terms were enforceable, holding that “the summary documents, important as they are, provide communication with beneficiaries about the plan, but . . . their statements do not themselves constitute the terms of the plan.”
The Supreme Court determined that while ERISA required an SPD, there was no statutory basis to conclude that SPD terms themselves were enforceable. The court also expressed concern that if SPD terms were enforceable, plan drafters might frustrate ERISA's objectives by using more complex language in describing the SPD terms. The court's opinion was also motivated by a desire to avoid the situation where the plan administrator, rather than the plan sponsor, controlled the terms of the plan.
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