In December, HHS published a list of counties where at least 10% of the
residents are fluent only in a non-English language (the Counties).
This gives us the opportunity to remind you that certain
employer-sponsored plans must provide various types of assistance
to non-English speakers. The more significant requirements
apply to group health plans with enrollees in any one of the
Counties. Somewhat less burdensome requirements apply to employer
plans generally, but only when a certain percentage of the
enrollees are fluent only in the same non-English language.
The non-English language requirements are summarized below:
Document: Summary of Benefits and Coverage
(SBC)
Background: An employer-sponsored group health
plan must provide an SBC to each employee when the employee first
becomes eligible for the plan, at open enrollment, upon a special
enrollment, 60 days before a change in the SBC (unless the change
is coordinated with the effective date of open enrollment), and
upon request. The SBC requirement applies to health plans that
constitute minimum essential coverage (for example, major medical
plans) but does not apply to plans offering only excepted benefits
(for example, stand-alone vision or dental plans).
When are the Non-English Language Requirements
applicable? The requirements apply when an SBC is sent to
an address in one of the Counties.
What are the Non-English Language
Requirements?
- The SBC must include a statement, in the applicable non-English language, explaining how to access the non-English services described below. This statement should be included on the page of the SBC with the "Your Rights to Continue Coverage" and "Your Grievance and Appeals Rights" sections.
- The plan must provide oral language services (for example, a customer assistance call-in line) in the applicable non-English language. The services must include answering general questions about the plan and assisting with the filing of claims, appeals, and requests for external review.
- Upon request, the plan must provide the SBC in the applicable non-English language.
Document: Claims and Appeals Notices
(Notices)
Background: An employer-sponsored benefit plan
must provide a written Notice to any claimant whose claim or appeal
has been denied in whole or in part.
When are the Non-English Language Requirements
applicable? The requirements apply only to certain
employer-sponsored group health plans, namely group health plans
that offer minimum essential coverage and (i) are
non-grandfathered, or (ii) are fully insured and small-group. The
requirements apply when such a plan sends a Notice to an address in
one of the Counties.
What are the Non-English Language
Requirements?
- The Notice must include a statement, prominently displayed in the applicable non-English language, explaining how to access the non-English services described below.
- The plan must provide oral language services (for example, a customer assistance call-in line) in the applicable non-English language. The services must include answering general questions about the plan and assisting with filing claims, appeals, and requests for external review.
- Upon request, the plan must provide the Notice in the applicable non-English language.
Document: Summary Plan Description (SPD),
Summary of Material Modification (SMM), and Summary Annual Report
(SAR).
NOTE: The SPD, SMM, and SAR
requirements are all imposed by ERISA. Plans that are exempt from
ERISA, such as plans sponsored by government employers, may
disregard this section.
Background: An ERISA plan must provide an SPD to
enrollees within 90 days of enrollment. If there is a material
modification to the terms of the plan as described in the SPD, the
plan must provide a new SPD or an SMM. If the material modification
is a reduction of benefits in a health plan, the new SPD or SMM
must be provided within 60 days after the effective date of the
change. ERISA plans generally must provide an SAR annually to all
participants and beneficiaries, though certain plans are exempt
from the SAR requirement.
When are the Non-English Language Requirements
applicable? The requirements apply if the ERISA plan is in
any one of the following categories:
- The plan has fewer than 100 participants at the beginning of the plan year and 25% or more of the participants are literate only in the same non-English language.
- The plan has 100 to 4,999 participants at the beginning of the plan year and 10% or more of the participants are literate only in the same non-English language.
- The plan has 5,000 or more participants at the beginning of the plan year and 500 or more of the participants are literate only in the same non-English language.
What are the Non-English Language Requirements?
- The SPD, SMM, or SAR must include a statement, prominently displayed in the applicable non-English language, explaining how to access the non-English assistance described below.
- The plan must assist the non-English speakers in a manner that provides them with a reasonable opportunity to become informed as to their rights and obligations under the plan. However, the plan is not required to provide anything specific in writing.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.