The study, conducted by researchers at the University of Nebraska, found that while the average plan document is written on a level for a first-year college student, some of the 40 health plan documents included in the study were written at a college graduate level.
Although the Employee Retirement Income Security Act (ERISA) requires that SPDs be understandable to the average plan participant, the study found that even expert readers had difficulty identifying the relevant information in them.
The researchers asked four experts to review the SPDs and pull out essential information that was then measured by three tests of readability. The expert readers were also instructed to identify information in the text that was relevant to the following six topic areas:
- Medical necessity clauses.
- Claim filing and appeal procedure clauses.
- Mental health and substance abuse benefits clauses.
- Pre-existing condition coverage exclusion clauses.
- Reimbursement or subrogation clauses.
The researchers found that the reading level required to understand the information in the documents ranged from eighth grade to a graduate level.
The finding adds credence to other studies that have found that employees have a difficult time deciphering their health care plans and that the shift toward consumer-driven health plans (CDHPs) makes participants’ ability to understand their health plans even more important, according to the survey authors. One of the authors is a fellow with the Washington-based Employee Benefit Research Institute (EBRI), which funded the study with The Commonwealth Fund in New York.
For a full copy of the study go here .