QUESTION: What should our self-insured group health plan do to meet the requirement that a summary of benefits and coverage be presented in a culturally and linguistically appropriate manner?
ANSWER: The summary of benefits and coverage (SBC) is a disclosure required of most group health plans (both insured and self-insured, but not certain excepted benefits) that is separate from and in addition to ERISA’s summary plan description (SPD) and summary of material modifications (SMM) requirements. As you have noted, the SBC must be presented in a “culturally and linguistically appropriate” manner. (Similar language requirements apply to group health plan claims and appeals notices; see our Checkpoint Question of the Week.) Here is a summary of the non-English language requirements that apply to SBCs:
What Triggers the “Culturally and Linguistically Appropriate” Requirement for SBCs? The requirement is triggered if your plan’s SBC is provided to individuals in any county where at least 10% of the population residing in the county is literate only in the same non-English language (as determined based on U.S. Census data). There are four designated languages for this purpose: Spanish, Chinese, Tagalog, and Navajo. HHS issues a list, updated from time to time, of applicable counties and the language(s) for each county. Note that the rule’s applicability does not depend on whether your plan actually covers any speakers of an applicable non-English language.
What Constitutes Compliance With the Requirement? In general, in the specified counties, plans (and insurers) must provide interpretive services, including answering questions, in the applicable non-English language(s). English-language SBCs provided in the specified counties must include a one-sentence statement—in the applicable language(s)—clearly indicating how to access the plan’s language services. The statement should be included on the page of the SBC with the “Your Rights to Continue Coverage” and “Your Grievance and Appeals Rights” sections. In addition, a written translation of the SBC in the applicable language must be provided upon request. To assist plans with compliance, the agencies (HHS, DOL, and IRS) have made available an SBC template that includes the one-sentence statement in all four languages, and written translations for the SBC template (and the related uniform glossary) in the four languages. Materials are available on the DOL and HHS websites.
Even in counties where no non-English language meets the 10% threshold, a plan may voluntarily include the one-sentence statement in the SBC in any non-English language. In that case, of course, the plan would need to be prepared to provide the relevant language services. Lastly, keep in mind that these rules differ from the ERISA rules on providing language assistance and disclosing its availability in SPDs and SMMs (see our Checkpoint Question of the Week).
For more information, see EBIA’s Health Care Reform manual at Section XVI.G (“Appearance, Language, and Content Requirements for the SBC”). See also EBIA’s Self-Insured Health Plans manual at Section XXVIII.C (“Summary of Benefits and Coverage (SBC)”) and EBIA’s ERISA Compliance manual at Section XXIV.O.7 (“SBC Appearance, Language, and Content Requirements”).
Contributing Editors: EBIA Staff.