Explaining Evidence of Coverage

Here is a challenge that Health Research for Action was eager to take on: provide HMO members with information they understand.

HMOs are required to provide "evidence of coverage" documents (EOCs) that explain members' health benefits, costs, and rights. However, we discovered that most people—even people with advanced degrees—have trouble reading and understanding these documents. The result: confusion and higher costs for individuals and health plans.

Along with the California Department of Managed Health Care, we are working to develop a template for group plans throughout California. The template provides simple, clear explanations.

• We conducted readability tests and other research to assess current EOCs.
• We conducted usability tests on the model EOC template.
• We worked with stakeholders to ensure that the new EOC meets the needs of plans and regulatory agencies.