What must the summary plan description provide?
The plan must provide: • Cost-sharing provisions, including premiums, deductibles, coinsurance and copayment amounts for which the participant or beneficiary will be responsible • Annual or lifetime caps or other limits on benefits under the plan • The extent to which preventive services are covered under the plan • Whether, and under what circumstances, existing and new drugs are covered under the plan • Whether, and under what circumstances, coverage is provided for medical tests, devices and procedures • Provisions governing the use of network providers, the composition of provider networks and whether, and under what circumstances, coverage is provided for out-of-network services • Conditions or limits on the selection of primary care providers or providers of specialty medical care • Conditions or limits applicable to obtaining emergency medical care and • Provisions requiring preauthorizations or utilization review as a condition to obtaining a benefit or service under the plan T
