How to find your Summary Plan Description or Evidence of Coverage
Your Summary Plan Description or Evidence of Coverage is the document that decides your case. It lists covered benefits, exclusions, and appeal deadlines. Employer plans call it an SPD; insured plans call it an EOC. You have a right to it in writing, and asking is one email.
Deadline. The one that matters here is the plan's, not yours: for an ERISA plan the administrator has 30 DAYS from your written request before the per-day penalty under ERISA section 502(c)(1) can attach. So date the request and keep proof of sending. Your appeal clock runs separately and does not pause while you wait for documents.
Applies to All plan types, though the appeal clock is not the same for all of them — check the deadline block below. Names differ; the function is the same.
How to read a health insurance denial letter
A denial letter contains four things you need: the specific reason for the denial, the criterion or exclusion applied, the deadline to appeal, and the instructions for external review. Everything you do next is built from those four. Read it with a pen before you read it with feelings.
Deadline. The letter you are holding started a clock. At least 180 days from RECEIPT for a group health plan; Medicaid and Medicare are far shorter. Find the date it arrived before you do anything else.
Applies to All plan types, though the appeal clock is not the same for all of them — check the deadline block below.
How to read an Explanation of Benefits
An Explanation of Benefits is not a bill. It shows what your provider charged, what the plan allowed, what it paid, and what it says you owe. Read it against the actual bill, because the two disagree more often than people expect, and the EOB is the one carrying appeal rights.
Deadline. An EOB with a denied line starts the same clock a denial letter does: at least 180 days from receipt under 29 CFR 2560.503-1(h)(3)(i), shorter on Medicaid and Medicare. A statement in a pile is a deadline running.
Applies to All plan types, though the appeal clock is not the same for all of them — check the deadline block below. Layout differs by insurer; the five numbers do not.
Last updated 2026-08-08 · Not legal or medical advice