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2016 List Addresses Counties Requiring Benefits Notices in Non-English Languages
Practical Law Legal Update w-001-3943 (Approx. 4 pages)
2016 List Addresses Counties Requiring Benefits Notices in Non-English Languages
by Practical Law Employee Benefits & Executive Compensation
| Published on 28 Jan 2016 • USA (National/Federal) |
The Department of Health and Human Services (HHS) has issued its 2016 list of counties in which benefits notices must be provided in certain non-English languages. The list reflects an Affordable Care Act (ACA) requirement under which group health plans and insurers must provide notices in a culturally and linguistically appropriate manner.
HHS has issued its 2016 list of counties for which group health plan benefit notices must be provided in non-English languages. The list, which is based on data published by the US Census Bureau:
- Reflects an Affordable Care Act (ACA) requirement that nongrandfathered group health plans and insurers provide notices in a "culturally and linguistically appropriate manner" (see Practice Note, Internal Claims and Appeals Under the ACA and Affordable Care Act Toolkit).
- Updates the December 2014 version of this list.
To satisfy the "culturally and linguistically appropriate" standard, plans and insurers must provide claims and appeals notices, on request (as opposed to doing so automatically), in a non-English language if 10% or more of the residents in a US county are literate only in the same non-English language. Other requirements involving language services also apply if the 10% threshold is met or exceeded (see Additional Requirements Apply; 29 C.F.R. § 2590.715-2719(e) and 80 Fed. Reg. 72208). (The "culturally and linguistically appropriate" standard also applies in the context of summaries and benefits and coverage (SBCs) under the ACA, see Practice Note, Summaries of Benefits and Coverage Under the ACA).
As with earlier editions of this list, the 2016 version of counties that meet or exceed the 10% threshold includes:
- The county name and state in which the county is located.
- The percentage of individuals in the county who are literate only in Spanish, Chinese, Tagalog, or Navajo.
Additional Requirements Apply
In addition to providing notices in a language that satisfies the non-English language threshold, plans and insurers must provide:
- Oral language services (for example, a telephone customer assistance hotline) where customer service representatives will answer questions in a non-English language that meets the 10%-or-more threshold.
- Assistance with filing claims and appeals, including external review, in an applicable non-English language (see Practice Note, External Review Under the ACA).
One-Sentence Statement in Non-English Language Must Be Included in Notices
Each English-version notice sent by a plan or insurer to an address in a county that meets the 10%-or-more threshold also must include a one-sentence statement in the relevant non-English language. This one-sentence statement must:
- Be prominently displayed in the applicable non-English language.
- Clearly indicate how to access the language services provided by the plan or insurer.
Practical Impact
Consistent with a cautionary statement from HHS in the 2016 list, some counties have been added or removed compared to previous years, based on changes in the Census Bureau data. Texas, for example, had both several newly added counties, and counties that dropped off the list, relative to the December 2014 version. In Colorado, as another example, one county was added to the list, while two others dropped off.
To ease the compliance burden of having to monitor changes affecting particular counties in each state, plans and insurers might consider using the one-sentence statement described above:
- For all notices within an entire state or particular service area.
- That reflects the threshold language(s) in any county within the state.
For a discussion of the "culturally and linguistically appropriate" rules, updated to address final regulations issued in November 2015 (see Legal Update, ACA Final Rules Expand Claims Procedure Rules and More), see Practice Note, Internal Claims and Appeals Under the ACA.