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.
If you have any questions about the non-English requirements applicable to your company's benefit plans, please do not hesitate to contact any member of the Employee Benefits Practice Group.