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Do we need to provide our Summary of Benefits and Coverage in another language?

Updated: 3 hours ago

Ensuring Compliance with Summary of Benefits and Coverage Rules

In today's blog, we cover a recent update/clarification from CMS on how employers who operate in predominantly non-English speaking counties should handle their Summary of Benefits and Coverage document. Are you required to provide it in another language? To provide translation services? What counties apply? Read on to learn more!

What is a Summary of Benefits and Coverage (SBC)? The SBC is not the Wrap document or the POP document. An SBC is a short, easy-to-read summary of what a health plan covers. It helps people understand their health insurance better. The government requires health plans to give this summary to their members.

SBC Rules for Language Help In most cases, employers don't usually have to give the whole SBC in languages other than English. But, they need to check a special list from CMS (Centers for Medicare & Medicaid Services). This list shows counties in each state where 10% or more of people speak a language other than English. In these places, employers must add a note in that language to the SBC. This note tells people they can get help understanding the SBC in their language.

Example of Language Requirements

Here in Texas, in Bexar County, 10% of people speak Spanish. Employers there must add a Spanish note to their SBC. This note says people can ask for help in Spanish.

Providing Language Help Here's what employers need to do:

  • Check if they're in a county on the CMS list.

  • If yes, they must offer language help, even if no one at the company speaks that language.

  • They don't need to translate the whole SBC, just add the note about language help.

The CMS has a sample note employers can use the county list. Employers just need to make sure the note is in the right language and has the right contact info.

Steps for Employers to Follow the Rules

  1. Look at the CMS list to see if your county is on it.

  2. If it is, add the right language note to your SBC.

  3. Make sure you can provide language help if someone asks for it.

  4. Use the sample note from the government, but change the contact info.

  5. Keep checking the list because it can change.

Additional SBC Considerations SBCs must be distributed to employees upon health plan enrollment, when substantial plan changes occur, or upon request. The document encompasses critical information such as plan coverage details, associated costs, and illustrative scenarios demonstrating plan functionality in common medical situations..

Conclusion Following these SBC rules is important for employers. It helps employees understand their health benefits, no matter what language they speak. By checking the CMS list and offering language help when needed, employers can make sure they're doing the right thing and following the law.

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