Blue Cross and Blue Shield of Illinois

 

October 4, 2013

Legislative Update
Affordable Care Act Question of the Week: Appeals and External Review

The “Question of the Week” answers frequently asked questions regarding the Affordable Care Act (ACA). This week we answer a question regarding the appeals and external review process.

Q. Under ACA, what are the requirements for providing notices about the appeals process in foreign languages?

A. There are certain requirements for adverse benefit determinations associated with non-grandfathered plans and policies. Plans or insurers must provide a notice, upon request, in an applicable non-English language as identified by the Department of Health and Human Services (e.g., Spanish, Tagalog, Navajo or Chinese) if 10 percent or more of the population of a member’s county of residence is literate in the same non-English language.

In the English version of notices, plans and insurers must also include a statement in any applicable non-English language that tells members how to access the plan’s or insurer’s language services. Blue Cross and Blue Shield of Illinois made the business decision to accommodate all requests in the four languages (Spanish, Tagalog, Navajo or Chinese), regardless of county of residence or grandfathered status. Since we do not track requests, it is only a one-time request. Members must make a new request for each notice that they need translated.

This communication is intended for informational purposes only. It is not intended to provide, does not constitute, and cannot be relied upon as legal, tax or compliance advice. The information contained in this communication is subject to change based on future regulation and guidance.

 
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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.