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CA Department of Insurance

Summary of Benefits and Coverage - Translated Templates

Under California and federal law, issuers of health insurance coverage must provide a written summary of benefits and coverage (SBC) in a uniform format to facilitate consumer understandability and comparison of plans. Issuers must provide SBCs using the authorized SBC template and pursuant to the SBC instructions adopted by the secretary of the U.S. Department of Health and Human Services. California Insurance Code § 10603; 42 U.S.C. § 300gg-15; 45 C.F.R. § 147.200.

Beginning October 1, 2016, SBCs constitute vital documents subject to the translation requirements of the Language Assistance Program under California law. Insurance Code § 10603(a)(3) (added by S.B. 388, Stats. 2015, ch. 655). Requirements of the Language Assistance Program are provided in Insurance Code Sections 10133.8 and 10133.9, and Sections 2538.1-2538.8 of title 10 of the California Code of Regulations.

Translations of the SBC template in the languages identified by the Department of Health Care Services All Plan Letter dated August 27, 2014 (All Plan Letter 14-008) are provided below for both the 2014 SBC template currently in effect, and the 2017 SBC template which takes effect for all plans with open enrollment periods on or after April 1, 2017. However, insurers may use the 2017 SBC Template earlier for group health coverage on or after January 1, 2017 to reduce duplicate SBCs.

For additional SBC materials and information, please visit the Center for Consumer Information & Insurance Oversight (CCIIO) SBC resources page

Please note:

  • Each translated SBC is provided in both Word and PDF formats. Some templates may not display properly on each computer due to compatibility issues with the template format or font. Compare the Word template with the PDF format to confirm the translated text displays correctly on your computer. Please ensure the computer that will be used to generate the finalized SBCs has the necessary fonts installed to display the text correctly in each language.
  • The SBC template and prescribed Why This Matters language for "Yes" and "No" answers have been consolidated into a single document for each translated template, except as noted below.
  • Yellow-highlighted or bracketed text in each template indicates either instructional or placeholder text. Insurers must remove all instructional text and replace any placeholder text with information in accordance with HHS SBC instructions prior to submission. There should be no highlighted or bracketed text in the insurer's final submission.

2014 Templates

Language SBC

Why This Matters

Uniform

Glossary

"Yes"
Answers
"No"
Answers
Arabic 2014 Template
Word
PDF
Included in SBC Template
PDF
Armenian 2014 Template
Word
PDF
Included in SBC Template
PDF
Chinese 2014 Template**
Word
PDF
Included in SBC Template
PDF
Farsi 2014 Template
Word
PDF
Included in SBC Template
PDF
Hmong 2014 Template
Word
PDF
Included in SBC Template
PDF
Khmer/Cambodian 2014 Template
Word
PDF
Included in SBC Template
PDF
Korean 2014 Template
Word
PDF
Included in SBC Template
PDF
Russian 2014 Template
Word
PDF
Included in SBC Template
PDF
Spanish 2014 Template**
Word
PDF
Included in SBC Template
PDF
Tagalog 2014 Template**
Word
PDF
PDF PDF
PDF
Vietnamese 2014 Template
Word
PDF
Included in SBC Template 
PDF

2017 Templates

Language SBC

Why This Matters

Uniform

Glossary

"Yes"
Answers
"No"
Answers
Arabic 2017 Template
Word
PDF
Included in SBC Template
Armenian 2017 Template
Word
PDF
Included in SBC Template
Chinese 2017 Template**
Word
PDF PDF
PDF
PDF
Farsi 2017 Template
Word
PDF
Included in SBC Template
Hmong 2017 Template
Word
PDF
Included in SBC Template
Khmer/Cambodian 2017 Template
Word
PDF
Included in SBC Template
Korean 2017 Template
Word
PDF
Included in SBC Template
Russian 2017 Template Word PDF
Included in SBC Template
Spanish 2017 Template**
Word
PDF PDF
PDF
PDF
Tagalog 2017 Template**
Word
PDF PDF PDF
PDF
Vietnamese 2017 Template
Word
PDF
Included in SBC Template

** Translations provided by CCIIO. Please see CCIIO's SBC resource page.
‡ Translations of the 2017 Uniform Glossary are forthcoming and will be posted at a later date.
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