Providing a Summary of Benefits and Coverage to non-English speakers

The Center for Consumer Information & Insurance Oversight (CCIIO) has released a list of all counties in the United States that meet or exceed the 10-percent threshold of people who are literate only in the same non-English language for purposes of providing a Summary of Benefits and Coverage (SBC) in a culturally and linguistically appropriate manner.

SBC requirement. Pursuant to the Patient Protection and Affordable Care Act (ACA), non-grandfathered group health plans and health insurance issuers offering non-grandfathered health insurance coverage must provide an SBC in a culturally and linguistically appropriate manner. Regulations require these plans and issuers to make certain accommodations for notices sent to an address in a county meeting a threshold percentage of people who are literate only in the same non-English language.

Ten-percent threshold. A plan or issuer is considered to provide the SBC in a culturally and linguistically appropriate manner if the thresholds and standards of IRS Temporary Reg. §54.9815–2719T(e) (claims and appeals regulations) are met as applied to the SBC. The threshold is when 10 percent or more of the population residing in the claimant’s county are literate only in the same non-English language, as determined based on American Community Survey (ACS) data published by the U.S. Census Bureau.

Notice requirements. The claims and appeals regulations outline three requirements that must be satisfied for notices sent to an address in a county in which 10 percent or more of the population is literate only in a non-English language. In such cases, the plan or issuer is generally required to:

1. provide oral language services in the non-English language,

2. provide notices upon request in the non-English language, and

3. include in all English versions of the notices, a statement in the non-English language clearly indicating how to access the language services provided by the plan or issuer.

The plan or issuer should include the statement on the availability of language assistance services on the page of the SBC with the "Your Rights to Continue Coverage" and "Your Grievance and Appeals Rights" sections.

The list is based on 2006-2010 ACS data and is applicable for 2012, and it will be updated annually.