California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 12.1 - Health Care Language Assistance Program › Section 2538.2 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
For the purposes of these regulations, the following
					 definitions apply:
(a) "Demographic
				  profile" means, at a minimum, primary/preferred spoken and written language of
				  insureds, race and ethnicity.
(b)
				  "Indicated/threshold language(s)" means the language(s) identified by a health
				  insurer pursuant to California Insurance Code section
				  10133.8 and
				  these regulations into which vital documents shall be translated.
(c) "Individual access to interpretation
				  services" means an insured's ability to receive oral interpretation services in
				  their primary/preferred language in the provision of their health
				  care.
(d) "Interpreting" or
				  "interpretation" means the process of listening, understanding and analyzing
				  something spoken or reading something written in one language (source language)
				  and orally re-expressing that message faithfully, accurately and objectively in
				  another spoken language (target language), taking the cultural and social
				  context into account.
(e) "Language
				  assistance services" means oral interpreting and written translation services
				  provided free of charge to insureds.
(f) "Language preferences and linguistic
				  needs assessment" means assessing and determining the spoken and written
				  language preferences of the insured population.
(g) "Limited English Proficiency (LEP)" means
				  a limited ability or inability to speak, read, write, or understand the English
				  language at a level that permits the insured to interact effectively with his
				  or her health care providers or health insurer.
(h) "Point(s) of Contact" means an instance
				  in which an insured accesses the services covered under a health insurer's
				  policy or certificate, including administrative and clinical services,
				  telephonic and in-person contacts.
(i) "Remote interpreting" means interpreting
				  provided by an interpreter who is not in the presence of the speaker, e.g.,
				  interpreting via telephone or videoconferencing.
(j) "Translating" or "translation" means the
				  conversion of a written text in one language into a written text in a second
				  language corresponding to and equivalent in meaning to the text in the first
				  language.
(k) "Vital Documents"
				  includes but is not limited to the following documents when produced by the
				  health insurer including when the production or distribution is delegated by
				  the health insurer to a third party:
(1)
				  Applications;
(2) Consent forms,
				  including health insurer authorization forms;
(3) Letters containing important information
				  regarding eligibility and participation criteria;
(4) Notices pertaining to the denial,
				  reduction, modification, or termination of services and benefits, and the right
				  to file a complaint or appeal;
(5)
				  Notices advising LEP persons of the availability of free language assistance
				  and other outreach materials that are provided to insureds;
(6) An insurer's explanation of benefits or
				  claims processing information that is sent to an insured if the document
				  requires a response from the insured;
(7) A matrix of the categories of health
				  insurance benefits outlined in the insurance contract including co-payments and
				  coinsurance, exclusions and limitations in the following sequence: deductibles;
				  lifetime maximums; professional services; outpatient services; hospitalization
				  services; diagnostic and therapeutic radiological services; preventive health
				  services; emergency health care coverage including ambulance services;
				  prescription drug coverage; durable medical equipment; mental health services;
				  chemical dependency services; home health services; other
				  services.