EBSA Press Release: Labor Department Clarifies Rights of Participants to Health Plan Information [07/31/1996]

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The U.S. Department of Labor today clarified in a ruling the rights of millions of workers to important information concerning how their health plan benefits are calculated.

Many private-sector health plans that provide medical, surgical and other benefits to millions of workers base benefits on pre-established "usual and customary" fees or similar schedules.

Workers often may be denied access to underlying schedules, formulas, methodologies and other information used by plans to calculate benefit entitlement although the Employee Retirement Income Security Act requires that workers be given information concerning the benefits paid under their health plan.

"No right is more valuable than that of giving workers access to information about plan benefits," said Olena Berg, Assistant Secretary for the Pension and Welfare Benefits Administration. "The department's ruling is an important step in preserving rights to plan information, which may protect them from unnecessary loss of benefits."

The department received a request for an opinion on whether denying access to such fee schedules violates the law. In advisory opinion 96-14, the department concluded that plan documents which serve as the basis for determining benefit amounts must be disclosed when requested. The opinion concludes that the same principles would apply to the disclosure of schedules or formulas used in calculating pension benefits.

Advisory opinion 96-14 is available through PWBA's Public Disclosure Room at 200 Constitution Ave., N.W., Room N5638, Washington, D.C. 20210. The ruling also will be available on the Internet by Aug. 15, 1996 at http://www.dol.gov/dol/pwba.