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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.

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 long the plan has to send documents

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.

What to do

  1. Work out which document you need

    Employer or union plan: Summary Plan Description, and also the full plan document. Insured plan: Evidence of Coverage, sometimes called a certificate of coverage or policy.

  2. Ask the right party

    Employer plan: HR or the benefits administrator. Insured plan: the insurer's member services, or the member portal, where it is often a download.

  3. Ask in writing, and ask for the plan document too

    For an employer plan, request both the SPD and the governing plan document. Where they disagree, the plan document controls.

  4. Search it for five things

    The exclusions list, the definition of medically necessary, the prior-authorization rules, the appeals section with its deadlines, and the limitation of actions clause. That last one is the easiest to miss and the most expensive: it sets a private contractual deadline for suing the plan, and the Supreme Court held in Heimeshoff v. Hartford Life, 571 U.S. 99 (2013), that such a clause is enforceable even when its clock starts running before your appeal is finished. Find yours before you assume you have years.

  5. Save a copy with the date you received it

    Plan terms change annually. The version in force when your claim was denied is the one that governs it.

What you are looking for once you have it

Read the exclusions before anything else. If gender-affirming care is excluded outright, your case is about whether that exclusion is lawful for your plan type. If it is not excluded, your case is about medical necessity. Those are different arguments and the document tells you which one you are in.

Common questions

Can my employer refuse to give me the plan document?
For an ERISA plan, no — and this is the most enforceable right on this site, which is why so many pages here say ask in writing. ERISA entitles a participant to plan documents on written request to the ADMINISTRATOR, and provides a separate per-day penalty where the administrator fails to comply within 30 days. The penalty regulation at 29 CFR 2575.502c-1 was read directly: it adjusts the civil penalty under ERISA section 502(c)(1), and the text in the database reads $110 a day. DOL adjusts that figure for inflation, so check the current amount before naming a number. Address the request to the plan administrator by name, say you are requesting plan documents under ERISA, and keep proof of the date — the 30 days runs from the request. SCOPE LIMIT: ERISA plans only. It does not reach governmental plans, most church plans, or coverage you bought yourself.
Which version applies to my claim?
The one in force on the date of service or the date of the denial. Plans change yearly, so note which year's document you are reading.

Where to go next

Sources for the legal points on this page

ERISA plan documents on written request, with a per-day penalty for delay

Federal — ERISA-covered plans · effective in force

29 CFR 2575.502c-1 (adjusted civil penalty under ERISA section 502(c)(1)) — READ DIRECTLY. The underlying statutory provisions, ERISA section 104(b)(4) for the document request and section 502(c)(1) for the penalty and its 30-day trigger, were NOT read: the US Code is outside the regulation corpus this site verifies against.

Status: settled · source-checked 2026-08-08 · primary source verified: 2026-08-08 (penalty regulation only; statutory sections not read)

Also on this page, without a citation yet

  • That your plan will send the document promptly, or at all, on a first request. The timeframe and the enforcement route are cited above for ERISA plans; for governmental, church and individual-market coverage they differ and are not cited here. If a written request goes unanswered, that non-response is itself worth documenting.

These are specific and checkable and we have not yet checked them against a primary source. Treat them as a starting point rather than as settled, and do not put them in an appeal without confirming them.

Last updated 2026-08-09Not legal or medical advice