When members
understand their
benefits, they use them.
Redesigning how 3.8 million New Jersey members understand, access, and act on their health benefits — from opaque jargon to a proactive, plain-language digital experience.
Company
Horizon BCBS
Role
Lead Product Designer
Period
2016 – 2018
Domain
Healthcare · Insurance
The Problem
Health insurance is the product people pay the most for
and understand the least.
9 in 10
Americans cannot correctly define deductible, copay, and out-of-pocket maximum — all three together
1.8×
The average number of times a member visits their insurer's portal per year — both times to pay a bill
Lowest
Health insurance portals have the lowest NPS of any financial product — below banks, below utilities
Horizon's member portal had a fundamental engagement problem. Members arrived when something went wrong — an unexpected bill, a denied claim, a coverage question before surgery. Benefits information was buried in PDFs written at a post-graduate reading level.
Preventive care gaps went unaddressed because members had no visibility into them. And cost anxiety was driving people to delay or avoid care entirely — not because of lack of coverage, but because of fear of an unknown number.
The brief: redesign the member experience from reactive to proactive. Make benefits understandable. Make preventive care visible. Make cost transparent before the appointment.
Discovery & Research
Five methods. One through-line:
members were lost in their own benefits.
Heuristic Evaluation
Expert audit of the existing portal against Nielsen's 10 heuristics, layered with healthcare-specific criteria — health literacy standards, WCAG 2.1 compliance, and plain language assessment. 47 WCAG violations found. 11 different navigation paths to benefits information — none completing successfully. Session replay revealed where members dropped off and what they were searching for.
24 Member Interviews
Qualitative sessions with members across age groups, health literacy levels, and plan types — individual, family, employer-sponsored. Participants asked to think aloud while completing 5 core tasks on the existing portal. We expected to learn about navigation preferences. What we found was more fundamental: most members didn't understand the financial mechanics of their own plan.
500+ Member Survey
Structured survey measuring benefits comprehension, portal satisfaction, and health literacy levels across Horizon's member base. Gave the business case statistical weight beyond individual stories. Key finding: 67% of members couldn't correctly explain their deductible. 3 in 5 had at least one overdue preventive care gap they were unaware of.
Journey Mapping Workshops
Cross-functional workshops with Horizon's member services team — the people fielding 4,000 calls per week. Their call logs were a goldmine: real member language, recurring confusion patterns, the exact points where members gave up and picked up the phone. We mapped the current-state journey from policy purchase through first claim, heat-mapping pain points by frequency and severity.
Moderated Usability Testing
Task-based testing on three prototype iterations — paper concepts, mid-fidelity, and hi-fidelity. 8, 12, and 16 participants respectively. Success rates tracked across 5 core tasks: finding copay, understanding deductible, locating a care gap, estimating cost of a procedure, and completing the onboarding flow. Results directly shaped each design iteration.
Competitive Analysis
What the rest of the industry
was — and wasn't — doing.
Methodology
Heuristic evaluation across 4 major US health insurer member portals over 3 weeks. Patterns scored against 8 evaluation criteria spanning benefits clarity, cost transparency, care surfacing, and accessibility.
UnitedHealthcare
The giant
Largest US health insurer — sets the default expectation for what a member portal can do.
Aetna
The acquired
Post-CVS acquisition, blended pharmacy + insurance — a unique cross-domain comparator.
Cigna
The wellness-first
Heavy emphasis on preventive care and member engagement — closest to Horizon's stated goal.
Kaiser Permanente
The integrated
Vertically integrated payer + provider — a fundamentally different member experience model.
Pattern comparison
Key findings
Industry-wide jargon problem
Across all 4 competitors, the member experience defaulted to insurance terminology (deductible, coinsurance, EOB). Most members can't define any of these correctly — but no competitor had committed to a plain-language standard.
→ Design implication
Adopt a Grade 6 reading level as a non-negotiable content standard. Inline definitions, never glossary links.
Cost transparency is the trust gap
Only Kaiser — the integrated payer-provider — surfaced cost before care. The independent payers (UHC, Aetna, Cigna) showed cost after the bill arrived. The pattern reflected the business model, not member need.
→ Design implication
Build a Cost Estimator into the journey — surface estimated out-of-pocket cost during provider search, not after the visit.
Care gaps were buried or absent
Despite every insurer having care-gap data (overdue screenings, missed wellness visits), only Kaiser surfaced them on the home screen. UHC and Cigna hid them in a separate 'Health' tab; Aetna sent them via mail. Visibility was the differentiator.
→ Design implication
Surface preventive care gaps directly on the member dashboard — actionable, dismissable, never alarming.
The pattern was clear: the industry had data members couldn't read, costs members couldn't see, and care gaps members didn't know existed. These three gaps became Horizon's design opportunities.
Key Insights
Five findings.
Each one became a feature.
Members think in moments, not plan terms.
“I don't know what in-network means. I just want to know if my doctor takes my insurance.”
Design impact
Led to situation-based navigation — 'I need to see a doctor' / 'I'm having a procedure' / 'I got a bill' — replacing 14 plan-category menu items.
The deductible is a mystery.
“I thought I already paid my deductible. I paid $200 at the doctor every time.”
Design impact
Led to the Benefits Clarity Card — a plain-language, visual breakdown of how deductibles work, with a real-time progress bar showing exactly where members stood.
Preventive care is invisible until it's urgent.
“Nobody told me I was overdue for a colonoscopy. I found out from the bill.”
Design impact
Led to the Care Gap Module — Horizon had the data. The portal never surfaced it. This made it visible, personalised, and actionable.
Cost anxiety drives avoidance.
“I put off the MRI for six months because I didn't know what it would cost.”
Design impact
Led to the Cost Estimator — pre-care, in-network vs out-of-network, with the member's remaining deductible already applied.
Every piece of jargon erodes trust.
“What's coinsurance? What's an EOB? I just skip anything with words I don't understand.”
Design impact
Led to a plain language content standard — every string targeting Grade 6 reading level, every retained term with an inline plain-language definition.
Design Principles
Five principles specific
to healthcare UX — not generic ones.
Plain language first
Every label, tooltip, and explainer written at Grade 6 reading level. No insurance jargon without a plain-language definition immediately adjacent. Readability scored before shipping — not audited after.
Proactive over reactive
The portal surfaces what members need to do, not just what they've already done. If Horizon has data that would change a member's behaviour, that data is visible — not buried in a report.
Confidence, not anxiety
Healthcare decisions are already stressful. Every design choice reduces friction and ambiguity — never amplifies it. Cost is shown before the appointment, not after. Gaps are framed as actionable, not alarming.
One decision per screen
Progressive disclosure throughout. Don't show everything; show what's needed right now. Secondary information is always available — never hidden, but never in the way.
Accessibility as foundation
WCAG 2.1 AA on every component. Not a post-build audit — designed in from day one. Colour contrast, focus states, touch targets, screen reader labels — all part of the component spec, not a checklist at the end.
Information Architecture
From 14 plan categories
to 4 human moments.
The original portal was organised the way an insurer thinks about products — not the way a member thinks about their life. Card sorting and journey mapping confirmed the fix: navigate by situation, not by policy category.
Task success finding cost info: 23%
I need to see a doctor
Find in-network providers, check referrals, book appointments
I'm having a procedure
Estimate cost, check coverage, get prior auth status
I got a bill
View EOB, understand what you owe, dispute a claim
I need my prescriptions
Check drug coverage, find pharmacy, request refills
Utility rail
My Plan
Benefits · ID Card · Coverage summary
My Account
Claims · Documents · Messages
Settings & Help
Preferences · Contact · FAQs
Task success finding cost info: 71%
Primary navigation items
fewerTask success — finding cost before care
higherClicks to reach benefits information
fewerFeature 01 — Member Dashboard
The portal home, redesigned
from reactive to proactive.
The old homepage was a bill-pay screen with a nav bar. The new dashboard puts the member's health status front and centre — health score, deductible progress, care gaps, and quick actions — all visible in under 30 seconds, no searching required.
Good morning
Alex Martinez
Horizon PPO Select · Employer Plan 2024
Health Score
Good
3 of 5 preventive goals on track
Annual Deductible
$660 left · resets Jan 1, 2025
Preventive Care Gaps
2 overdueAnnual Physical
Last completed 18 months ago
Flu Vaccine
Recommended by October
Mammogram
Completed March 2024 ✓
Health score over raw data
A single number (82/100) built from preventive care completion, deductible status, and claims activity. Members immediately understand where they stand — without reading a report. The score anchors the dashboard and creates a goal worth returning for.
Care gaps on the homepage, not buried
Horizon had the data. The old portal never surfaced it. Moving care gaps to the dashboard home — with one-tap scheduling — drove a 28% improvement in closure rates in the pilot. Visibility was the intervention.
Feature 02 — Benefits Clarity Card
Grade 14 → Grade 6.
Same information. Half the confusion.
The existing benefits summary was a 14-page PDF written at post-graduate reading level. The redesign distilled the three things members actually need to understand — copay, deductible, out-of-pocket max — into a single plain-language card.
Before — PDF benefits summary
* Subject to plan year deductible unless otherwise noted. Coinsurance applies after deductible is met. See Summary of Benefits and Coverage for full details including exclusions and limitations. Non-participating providers may result in balance billing.
After — plain-language benefits card
Your Plan
Horizon PPO Select 2024
What you pay per visit
$30
copay for primary care · $60 for specialists
This is your flat fee. No math required.
Your deductible
$1,500
You pay the first $1,500 of covered care each year
You've met $840 so far this year.
The most you'll ever pay
$4,000
Out-of-pocket maximum per year
After this, Horizon pays 100% for the rest of the year.
Grade 14
Original reading level
Grade 6
Redesigned reading level
Every string reviewed against Flesch-Kincaid before shipping. Retained insurance terms — deductible, copay, coinsurance — each accompanied by a plain-language tooltip. Zero jargon without a definition adjacent.
Feature 03 — Care Gap Module
Horizon had the data.
The portal never surfaced it.
3 in 5 members had at least one overdue preventive care gap — screenings, vaccines, annual physicals they'd missed. The data existed in Horizon's systems. Making it visible, personalised, and actionable was the design decision that drove the biggest measurable outcome.
Annual Physical
Last completed 18 months ago
Recommended yearly by your PCP. Catching issues early means fewer complications — and lower costs — later.
Flu Vaccine
Recommended by October
Fully covered under your plan — $0 at any in-network pharmacy or clinic. Takes 5 minutes.
Mammogram
Completed March 2024
You're up to date. Next recommended screening in 12 months — we'll remind you when it's due.
28%
Care gap closure improvement
Members who saw the module completed overdue screenings at 3× the rate of the control group
3 states
Overdue · Due soon · Complete
Urgency communicated through colour and language — never alarming, always actionable
$0
Cost to members for preventive care
Every card shows cost upfront — removing financial anxiety as a barrier to action
Feature 04 — Cost Estimator
Know the cost
before the appointment.
Cost anxiety was driving members to delay or avoid care. Not because they lacked coverage — because they feared an unknown number. The Cost Estimator shows the real out-of-pocket cost, with the member's remaining deductible already applied, before they book.
Step 1 — Search
Procedure or service
Location
Your plan details applied
Step 2 — Your estimated costs
St. Barnabas Medical Center
after your $660 remaining deductible
$1,840
$340
your cost
Hackensack Meridian Health
after your $660 remaining deductible
$2,100
$420
your cost
NY Presbyterian (out-of-network)
40% coinsurance, deductible applies separately
$3,800
$1,520
your cost
* Estimates based on your current plan year deductible and claims history. Actual cost may vary based on diagnosis codes and provider billing. Not a guarantee of benefits.
Deductible-adjusted cost, not sticker price
Showing $1,840 and calling it an 'estimate' terrified members. Showing $340 — their actual out-of-pocket after their remaining deductible — removed the anxiety. The math is done for them. That was the design decision.
The disclaimer didn't undermine trust
Legal wanted a full disclaimer. We negotiated: one plain-English sentence, not a legal block. 'Estimates based on your current plan year — actual cost may vary.' Members trusted it more because it was honest, not because it was hidden.
Final Screens
What shipped.
Four features across the redesigned member experience — all coded, all in Horizon's brand. Hover to pause. Click any card to open the full page view — keyboard arrows to navigate, Esc to close.
Outcome
When members understand
their benefits, they use them.
34%
Portal engagement increase in 6-month employer-group pilot
28%
Care gap closure improvement — members completed overdue screenings at 3× the rate of the control group
19%
Reduction in member services calls about benefits confusion post-launch
The redesigned member experience launched to Horizon's NJ employer group accounts. The plain language content standard became a governance policy across Horizon's digital products — every string written at Grade 6 reading level, every piece of jargon accompanied by a definition.
“Health insurance is one of the most consequential products in a person's life — and one of the least understood. This project was proof that plain language and thoughtful information architecture aren't nice-to-haves in healthcare. They're the product.”
Some artifacts in this case study represent conceptual recreations of work completed during the engagement. Real customer data, personally identifiable information, and pre-release product details have been anonymized or replaced with representative placeholders to respect client confidentiality.