Navigate Insurance Coverage and Benefits
Market: Family healthcare managers
Scenario: A 42-year-old family healthcare manager needs to understand something about her health insurance. She logs into her health insurance website, searching for specific coverage details and trying to understand policy changes. Frustrated by complex language, she spends time decoding benefits and exploring resources to support her family's health needs.
Average Difficulty: Medium (max difficulty scores are mostly in the 20-30% range or mostly mild with a few intense steps)
33 Outcomes 6% to 31% Difficulty
Research Insights
The research highlights significant challenges in navigating insurance coverage and benefits. Users struggle with complex language, difficulty finding relevant information, and a lack of personalized options. There's a strong desire for clearer communication, more accessible resources, and proactive support throughout the health journey. Simplifying the user experience and increasing transparency are key areas for improvement.
Job Steps
1. Understand coverage details
2. Verify specific benefits
3. Use insurance for healthcare services
4. Manage prescriptions and refills
5. Handle claims and billing
6. Seek support for insurance issues
7. Review and update coverage
Themes Identified
- Clarity and Simplicity: Decreasing the complexity of language, coverage details, and the sign-up process.
- Relevance and Personalization: Increasing the number of relevant options, scenarios, and communications.
- Accessibility and Support: Improving visibility of resources explaining coverage, available help, and support for unique health journeys.
Recommendations
- Implement a plain language initiative to simplify all communications and policy documents.
- Develop a personalized dashboard that highlights relevant coverage options and health journey information.
- Create an interactive decision support tool to help users understand their coverage in various scenarios.
- Integrate a proactive notification system for important updates, reminders, and personalized health tips.
- Implement a chatbot or AI-powered assistant to provide instant, 24/7 support for common questions and issues.
Cautions
- Avoid using industry jargon or complex legal terms without clear explanations.
- Don't overwhelm users with too many options or irrelevant information.
- Refrain from implementing changes without clear communication and guidance.
- Avoid a one-size-fits-all approach to notifications and communications.
- Don't neglect the importance of human support for complex issues or sensitive health matters.
Outcomes
The difficulty percentages below represent the proportion of the market that finds this outcome difficult to achieve.
| Difficulty | Outcome |
|---|---|
| 31% | Increase the number of effective alternatives available if something is not covered |
| 28% | Increase the number of relevant scenarios to give me a clear picture of experience and cost related to my journey |
| 24% | Decrease the complexity of language so it is easier to understand |
| 23% | Increase visibility into what may be required before I go to a health visit or get a new prescription |
| 23% | Increase visibility to resources that explain what is and isn't covered by my plan |
| 22% | Increase specific details around coverage, limits, exceptions |
| 21% | Decrease complexity of the sign-up process |
| 21% | Maximize the amount of relevant information that appears before "jargon" and "junk" |
| 21% | Minimize the complexity of coverage details |
| 21% | Increase trust through clear language |
| 20% | Decrease the time it takes to find and understand the relevant sections of my plan summary |
| 20% | Increase visibility to understand what steps to take next |
| 19% | Increase my level of understanding what step to take next |
| 18% | Decrease the time to get refill requests from doctor |
| 18% | Decrease the time it takes to hear back about an issue or question |
| 18% | Increase number of options that are relevant (to me and my situation, time of year, services used) |
| 18% | Increase my confidence that I know how the visit will be covered by my insurance |
| 18% | Increase visibility into the resources I can use to get help |
| 17% | Increase number of display options that are relevant (eg. by person, plan period, service) |
| 17% | Increase visibility of relevant program details |
| 16% | Increase the ease of changing your communication settings |
| 16% | Increase number of options that are relevant (eg. by person, plan period, service) |
| 15% | Increase the compassion of formulary, network, price, coverage change communications |
| 15% | Increase support of members on unique health journeys |
| 14% | Increase my ability to easily find information |
| 12% | Increase the visibility of relevant communications (coverage, change, program, etc.) |
| 12% | Increase number of communications that are relevant |
| 11% | Increase the number of proactive messages once the experience learns about my interests |
| 10% | Increase the visibility of relevant notifications (status, reminder, attention, etc.) |
| 10% | Increase the number of relevant proactive outreaches to help me in my health journey |
| 9% | Increase the ease of changing your notification settings so I can receive reminders related to my needs |
| 8% | Decrease the time it takes to refill |
| 6% | Increase clarity of knowing when to refill |
