Wednesday, January 20, 2016

California Expands on PPACA's SBC Translation Requirements for Health Plans in 2016

California's SB 388 adds translation requirements to PPACA's uniform Summary of Benefits and Coverage (SBC) information. As of July 1, 2016, the Department of Managed Health Care (DMHC) and the California Department of Insurance are to make available on their internet sites written translations of the SBC templates in the required language groups and requires plan sponsors to implement them by October 1, 2016.

Existing Law 

California law requires health plans and insurers to translate vital documents into languages other than English for their non-English speaking enrollees. The languages for which written translations are required are based on the populations served. Documents that must be translated include: applications, consent forms and notices pertaining to the denial, reduction, modification or termination of benefits, and the right to file a complaint or appeal.  This law adds SBCs to that list.

Obamacare requires health plans and insurers to provide consumers with an SBC to help them evaluate and compare insurance options. The SBC include features of coverage such as covered benefits, cost-sharing provisions, and coverage limitations as well as a standard glossary of terms.  In practice however, many enrollees and practitioners in the field have found these SBCs to be confusing, and often inaccurate.  PPACA requires this information to be provided in a “culturally and linguistically appropriate manner.”

Federal guidance on what is culturally and linguistically appropriate is inconsistent with California’s language access rules. The federal rule requires the summary of benefits and coverage be translated when 10% of a limited-English proficient (LEP) population resides in the plan's county.

California’s Translation Requirements Go Further

California law requires vital documents to be translated whenever an (LEP) population is a certain percent of the plan’s enrollment, which holds plans directly accountable for the cultural and linguistic access of their members.

Medi-Cal, for example, defines such a threshold language as a language that has been identified as the primary language of 3,000 beneficiaries or five percent of the beneficiary population, whichever is lower, in an identified geographic area. Thirteen distinct languages qualify as threshold languages, according to a May 2014 Medi-Cal statistical brief. Those languages are:

  • Spanish 
  • Vietnamese
  • Cantonese
  • Armenian 
  • Russian
  • Mandarin 
  • Tagalog
  • Korean 
  • Arabic 
  • Hmong 
  • Farsi 
  • Cambodian, and 
  • other Chinese. 
Spanish is the most frequently occurring, threshold language (34.5 percent) and was represented in the greatest number of counties (49). Los Angeles has the greatest number of threshold languages (12) of any county.

The DMHC also makes available, on its website, threshold languages by health plan. For example, Molina Health Care of California has the following threshold languages identified: English, Spanish, Vietnamese, Chinese, Russian, and Hmong.

California residents speak over 100 different languages and more than 40 percent speak a language other than English. Although federal law requires the SBC to be provided in a culturally and linguistically appropriate manner, the federal definition doesn't reach as far as California's.  In San Francisco, the federal standard for California requires translation into two languages, Spanish and Chinese.  But now under this California law there will be ten languages that meet language access thresholds in San Francisco: Spanish, Vietnamese, Chinese, Korean, Tagalog, Russian, Armenian, Khmer, Arabic and Hmong, with Spanish, Chinese, and Vietnamese being the most commonly required language for translations.


By July 1, 2016, the state will develop written translations of the template uniform SBC for all language groups identified by the State Department of Health Care Services in all plan letters as of August 27, 2014, for translation services pursuant to Section 14029.91 of the Welfare and Institutions Code.  Health plans are to adopt these translations by October 1, 2016.