by admin | Aug 23, 2024 | Blog
Health plans must communicate effectively with all members, regardless of their language. The Affordable Care Act (ACA) mandates that claims and appeals notices be provided in a culturally and linguistically appropriate manner. Here’s how health plans can meet these requirements.
Key Requirements
1. Population Threshold: If 10% or more of a county’s population speaks a non-English language, notices must include a statement in that language explaining how to get help. This is based on U.S. Census data and updated on government websites.
2. Oral Language Services: Health plans must offer phone assistance in the non-English language to answer questions and help with claims and appeals.
3. Written Notices: All English notices must have a clear statement in the non-English language about how to access language services.
4. Translation Upon Request: Full notices must be provided in the non-English language if requested.
Implementation Tips
- Stay Updated: Regularly check the Department of Labor (DOL) and Health and Human Services (HHS) websites for the latest information.
- Use Provided Language: Utilize the sample statements provided by the agencies to ensure compliance.
- Train Staff: Ensure customer service representatives are trained to assist in multiple languages.
Conclusion
Providing notices in different languages is crucial for fair access to healthcare information. By following these guidelines, health plans can better serve their diverse members and comply with the ACA.
Source: Thomson Reuters
by Lexi Garcia | Jul 18, 2024 | Blog
In the complex world of healthcare benefits, understanding the requirements for Medicare Part D disclosure notices can be a challenge, especially for start-ups venturing into offering health plans. This article aims to shed light on the requirements for Health Reimbursement Arrangements (HRAs) and Health Flexible Spending Accounts (Health FSAs).
Medicare Part D and Creditable Coverage
Medicare Part D is a federal program that provides prescription drug coverage to individuals who are eligible for Medicare. Plan sponsors that offer prescription drug coverage must disclose to covered Part D-eligible individuals and to the Centers for Medicare & Medicaid Services (CMS) whether their drug coverage is “creditable.” Coverage is considered creditable if its actuarial value equals or exceeds that of defined standard Part D coverage.
HRAs and Medicare Part D Disclosure Notices
The term “group health plan” for disclosure purposes includes “account-based medical plans” such as HRAs. Therefore, sponsors of HRAs that offer prescription drug coverage must provide disclosure notices to Part D-eligible individuals, advising whether the HRA’s prescription drug coverage is creditable. CMS officials have informally stated that a single, combined disclosure notice covering both an HRA and another group health plan offered by the same employer is permitted. Thus, if all of the HRA participants are also participants in your company’s major medical plan, you could avoid separate notices for your HRA entirely.
Health FSAs and Medicare Part D Disclosure Notices
On the other hand, sponsors of health FSAs are not required to provide disclosure notices to Part D-eligible individuals. This is due to a specific exception in CMS guidance, which states that health FSAs are not taken into account when determining whether employer-provided prescription drug coverage is creditable.
Conclusion
Understanding the requirements for Medicare Part D disclosure notices is crucial for companies planning to offer health benefits. While HRAs generally require these notices, health FSAs do not. As always, it’s essential to stay informed and consult with a benefits advisor to ensure compliance with all regulations.
Source: Thomson Reuters
