Every plan gets summary documents, one for the plan and one for members
What the document says“a summary document for plans and issuers to provide to participants and beneficiaries, which shall be made available to participants or beneficiaries upon request to their group health plan”
For every group health plan, whatever its size, the report must include a summary document for the plan holding what the Secretary determines is useful for choosing pharmacy benefit management services, and a second summary document for participants and beneficiaries, available on request, containing only aggregate information and stating that they may request claims level information. It must also give total net spending on drugs, amounts received in rebates and other remuneration, manufacturer copay assistance, payments to brokers and consultants for referring or retaining the business, an explanation of benefit designs steering members to affiliated pharmacies, and total gross spending.
What the document actually says“a summary document for plans and issuers to provide to participants and beneficiaries, which shall be made available to participants or beneficiaries upon request to their group health plan”
There must also be a short document for the people covered by the plan. They can ask their plan for it.
The short one gives totals, not single claims. A member who wants their own claim details can ask for those too. That right is set out below.
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