Go Green. Go Paperless.
Insurance documents made easy
Project
Overview
Working in the digital design department of a major health insurance provider, I was assigned to focus on the Global Paperless Initiative, a large-scale effort to increase member awareness of and commitment to paperless options. The initiative is broken down into several separate (but related) projects, each with its own timeline and goals. I worked as the lead UX Designer on several paperless projects:
Paperless Default: Terms & Conditions
Promotional Contextual Banners
Proxy Enablement
Summary of Cost Share
For the purposes of this case study, I will focus primarily on the first, as it was the initial project and focus. In actuality, I worked on several projects simultaneously, and the work of one informed the work of the others.
Role
Team: myself as Lead UX Designer, plus:
A UX Principal, who oversees several team projects and focuses on higher level strategy
A UX Producer, who helps organize the timelines, resources, and partnerships of all team projects
A UX Writer, who writes and edits all technical copy and contributes with content management strategy
A UX Researcher, who conducted all user testing and data synthesis
As the Lead UX Designer, my responsibilities included:
Annotated Low and High Fidelity Wireframing
Research planning and prototyping in collaboration with our UX researcher
Presenting to stakeholders, including UX Leadership, Product, Legal, Design System, ADA Compliance, Development, and Business Owners
Creating UX artifacts, such as Site Maps and Task Flows, for team reviews, strategizing, and alignment
Using the Design System library to ideate solutions that use current components, patterns, and behaviors
Goal
The Global Paperless Initiative will promote paperless delivery through affirmative consent, clearly identifying the health plan documents to be delivered electronically. The goal is at least 50% of members to opt in for at least one paperless document delivery by the end of 2022, which represents an increase of over a quarter of the total users.
Tools
Sketch - design tool
Figma - design tool
InVision - prototyping tool
Miro - whiteboarding tool
Zeplin - dev handoff tool
Photoshop - design tool
Project
Scope
scope
Initially, as we released the updated Terms & Conditions (T&C), which all users have to agree to in order to have access to their digital accounts, the agreement would include a section about paperless preferences. The underlying premise that all members have to set paperless preferences in order to use their account doesn’t mean that all members have to opt into paperless delivery, but rather that they have to choose to opt-in/out as part of their agreement. Users include all digital customers and fall into two user groups:
Current members: regardless of their paperless delivery settings, all users have to agree to T&C, but fall into three subgroups:
Members who have not opted into any paperless delivery settings (primary target)
Members who have opted into some, but not all, paperless settings (secondary target)
Members who have opted into all possible paperless settings (this experience does not impact their settings)
New members: these members will experience paperless preferences as part of the new member onboarding experience.
I should also note that members have the option of opting into as many or as little as they like. Not all document categories apply to all members, depending upon the kind of plan they have. Documents within scope are divided into these six categories:
Medical bills
Premium bills
Enrollment/Coverage documents
Explanation of Benefits (EOBs)
Tax documentation
Medicare documentation
User flow: Current member w/out paperless settings
I created a User Flow to map out and better understand the various components of the Global Paperless Initiative [GPI], and how they fit together as a whole. This enabled me to track the relationship between different projects, articulate and propose timelines and actions, and present my designs or concepts to others in the context of a larger picture. As the project evolved and the requirements and technical constraints changed, this document became a living, breathing, and ever-evolving source of truth for me.
This is the User Flow in its initial phase, according to the project requirements at the beginning of the initiative.
The Current
Experience
I researched the current paperless settings on the website, Document delivery preferences, which is located within the member’s Profile and Preferences. Not only did I hypothesize that the page title itself is potentially unclear, which was later validated in user testing, I worked with our ADA consultant to identify some existing compliance issues:
Functionality within radio buttons
The placement of document checkboxes to the far right of the screen
This page was designed prior to the updating of our ADA standards, and we saw an opportunity to correct these issues while also improving the paperless opt-in experience for our members.
A view of the current design of the “opt in to all available” flow.
A view of the current design of the “opt out of a single document” flow.
Coupling w/ Terms & Conditions
two-step solution
We grew concerned that including paperless preferences in the T&C might be deceptive and cause members to lose faith in the integrity of the brand. We hypothesized that including both pieces into one single agreement was problematic from both a design standpoint, and with regards to the mental model of our users (later validated in testing). We instead created a two-step process whereby users will see two pages: the first is the mandatory site T&C, and the second contains the optional paperless preferences.
This updated segment of the User Flow demonstrates the two-step format that would guide our initial designs.
content and design
As the paperless terms of use contains different language from the site T&C, if they were combined, the content presented to the user would be conditional based upon if they opt into paperless delivery. This conditional logic, while possible, was costly and time-consuming. Separating the steps would be easier while also providing more transparent UX. I included a Step Indicator, Scroll-box, and a disabled Primary CTA that gets activated upon the user clicking the Attestation Checkbox.
scroll-box versus Show More/less
I discovered that using a scroll-box for a block of content on a mobile device causes a “scroll within a scroll” scenario (shown right). In other words, users could get stuck scrolling within the box on a mobile device due to the size it takes up on the device, which could be a pain point for a user accessing their account on a mobile device (around 70% of our users).
For users with special needs, this could be devastating.
Instead, I used the “Show More/Less” component (shown below) as an opportunity to not only meet our requirements but also fix existing behaviors within the site that were not ADA compliant. This solution was later tested with users, who validated its effectiveness, clarity, and ease of use. It also reinforced the significance of the principle of designing with a mobile-first approach.
Paperless
Preferences
early iterations
The second step, Paperless Preferences, presented its own unique set of challenges. I considered the design currently in production, which has three radio buttons: Yes (to all), Customize, and No. I considered a similar approach but was over-ruled by the legal team, as a “Yes to all” option opens the organization up to potential legal liability due to strict legal requirements around this particular set of categories, and users have to express “explicit consent” by manually clicking any category dealing with paperless delivery of bills.
Some key interactions in this iteration include:
If the user clicked the “Yes”, their options would appear (conditional based upon their existing settings)
If the user clicked the “No thanks,” the CTA changes to “Save” the user proceeds to the authenticated site, as intended
The “I agree” CTA is enabled only after the user has checked the attestation checkbox and at least one document type
If the user deselected an item, or selected an unselected item, from the confirmation screen, the CTA would change to read “Save” or “I agree” (with the attestation checkbox re-appearing), respectively
A view of an early set of iterations for Step Two - Paperless Preferences.
Revisions
Upon review, I discovered an ADA compliance issue: checkboxes that are contained within a radio button must have explanatory copy/labels attached to them. To account for this, we defaulted the prompt to Yes being active, and placed No above it. This enabled me to make all the available options visible, which is favorable from a business standpoint, and to add instructional copy within the radio button to satisfied the ADA requirement. Other modifications included:
Pre-selecting only document categories not related to billing (per legal), and adding the RECOMMENDED labels to account for why some items were pre-selected and others were not
Simplifying the confirmation process by using a modal overlay, which not only loads faster, but removes the de-select/select additional items functionality (not in scope for this prompt)
Removing text links to other pages within the website, as the user is not yet in the authenticated site, and should not navigate out of the flow prior to completing it
A view of a later iteration, which was subsequently prototyped for usability testing.
usability testing
Working with the UX Researcher, I created a prototype of our experience for our first round of usability testing. Key findings include:
Customers were less confused by the two-step version of our experience than a single-step version, as the differentiation between site T&C and paperless terms of use was more apparent
Customers did not notice the NO radio button appearing above the YES, and clicked the empty check-boxes within seconds
Customers felt inclined to opt into all available documents without reading any of the legalese, and did not want to be reminded again in the future of any other paperless settings; a small percentage preferred to receive bills as hard copies
The theme of paperless being a state (“I chose paperless options, therefore I am paperless from now on”) began to emerge
Decoupling From T&C
MFA Complications
At this point, I encountered some unexpected obstacles. The first was that, due to a new system of multi-factor authentication to be implemented, I could no longer couple the T&C with the Paperless Preferences. As such, I needed to remove the first step in the experience, and had to reconsider the context in which users encounter the Paperless Preferences prompt, as it would no longer be associated with updated site T&C.
removing disabled cta’s
An update to our design system required all inactive buttons to be removed. I had to remove the function of showing the “I agree” CTA as disabled until a user has clicked the required attestation checkbox. As a result, I maintained the enabled state of the button and accounted for three possible user error conditions triggered by the user clicking the “I agree” CTA:
If no document type is selected
If the attestation is not selected
Both
All fields required
An additional update, per our ADA liaison, was that all pages with any input field must contain the line “All fields are required unless noted as optional.” This presented a particular challenge in our case: there were optional fields (checkboxes) with a required field (radio buttons). In other words, if a user were to click “I agree” without having selected a checkbox, there would be no preference to update. Rather than use this generic label, I worked with our copywriter to ensure that our instructional language accounted for this nuance.
go paperless later
Given that this experience was now a stand-alone prompt, I had to offer users an “escape,” or null state, in case they are not in a position to make a decision at that time that enables members to move on to the authenticated website. I was responsible for designing how this would appear, as well as the logic of what happens after users enter this flow. After exploring various options, I put a text link at the bottom of the prompt that reads “Go paperless later.”
The placement at the bottom would necessitate the user to read far enough to find the “I agree” CTA, so my hypothesis was that members were more likely to agree after having gotten that far, which I later validated in user testing. Other key findings were:
The choice of the words “go paperless later” over “skip” was chosen to make clear that users would see the reminder again. “Skip” implies that they are skipping the choice altogether, and thus opting out, so I didn’t want this to be a declination.
I included a warning modal to let the user know that if they do proceed, they will see the prompt again upon further sign-on. Users didn’t feel this was particularly necessary but appreciated that it made the experience transparent.
While there was no consensus around how many times a user expected to see the prompt again if they continued to click “go paperless later,” most agreed that there should be a limit, and it should not happen within the same day.
While it seemed unlikely that someone would bypass this prompt more than a single time, the product team wanted it to reappear an infinite number of times before a choice was made, and track the analytics. I pushed back, as this felt like a dark UX pattern, questioned what value we gain with these analytics, and recommended putting limits on the number of times a person can click the link and see the message again.
Contextual Banners
Modal
My other project, Contextual Banners, placed promotional banners on five pages in the website. When clicked, a modal overlay would open and enable the user to opt in any document relevant to that page without leaving it. For instance, from their Premium bill page, the member could click the banner, agree to the terms in the modal, and get confirmation without leaving the billing page.
An example of the Contextual Promotional Banner experience, as shown on the Premium Billing page.
The work on the Default Paperless prompt informed the work on this project. Some key designs and interactions include:
Using the experience fragment from the interrupt in the modal. I used the existing design, and changed some components according the behavior of the modal (i.e. no radio buttons, a cancel button, and no Go Paperless Later link).
Pre-selecting document categories. I won an argument with our legal partners that, within the Contextual Banner experience, members are demonstrating explicit intention to opt in by clicking the banner in the first place, and therefore, we could pre-select document categories (except in the case of My Documents - see below).
Replacing the promo banner with a success message. The modal could not open or re-load to a second confirmation modal, per ADA requirements. Hence, upon opting into the settings within the modal, the banner would get triggered to reload as a confirmation message on the page itself.
Removing the dismissible component from the banners. The requirements had us use a dismissible version of the banners, which would trigger the “No thanks” logic. I hypothesized that closing a banner on a page does not equate, in the mental model of our members, a declination of paperless options. I later tested and validated this theory, and convinced our partners to remove the requirement, as there was little usability or business value to be gained from it.
My Documents
The My Documents page, which is intended to be a centralized hub of all health insurance documents for the member, offered another opportunity for us to improve within the scope of this project by applying our experience fragment. I looked closely at the current experience, and noted potential user pain points:
Previous testing indicated that the leaf icon was unclear, both in meaning and function, to members
The lack of a border around the promotional banner does not indicate it is clickable, supported by low usage metrics
A single click of a leaf opening a modal, in addition to its placement to the far right of the page, were ADA violations
A view of the current paperless opt-in experience on the My Documents page.
checkboxes versus no checkboxes
The requirements had us design a solution that replaced the existing leaf icons with checkboxes. As I explored this approach, we discovered a number of usability problems:
Checkboxes are meant to indicate one of several items are selected FOR an action; not to initiate the action itself. This is an ADA violation, so we included a CTA.
We could not paginate a list of documents with checkboxes, and the only place a CTA could be placed was at the bottom. Given that these lists could include up to 100 items, that is quite a lot of scrolling (particularly on a mobile device) before reaching the CTA.
If members could select documents, it also meant that they should be able to de-select documents, as well. This functionality was not in scope and is potentially confusing in the context of this page, which is meant to simply be a documents hub.
My Doc’s w/ checkboxes
A view of the My Documents page without checkboxes.
I designed an alternative version that contained no checkboxes. The only way for a member to go paperless is via the banner/modal experience, which tested well in the past. Given this page is a hub for all types of documents, all document categories are made available via the modal (although not in a pre-selected state).
To convince our partners of this direction, I tested the two experiences and found that:
Members were confused by the checkboxes, especially given the discrepancy between the individual document they see on the page with the broader document category they opt into on the modal
Members overwhelmingly clicked the promotional banner without even scrolling down the list to the checkboxes
Scrolling through a long, unpaginated list was frustrating
Additional
Scope
new member experience
An additional means of paperless adoption is reaching new members via the on-boarding process. As our work functions as an experience fragment, it could easily be appended to the on-boarding experience. Working in conjunction with the team that owns this experience, we came to a consensus that this experience can exist after account registration, and before the Guided Member Welcome (GMW) hub. As the steps within the GMW can be skipped, or not completed altogether, it was crucial our paperless prompt preceded it.
I saw this as a perfect opportunity to make paperless preferences automatic for on-boarding all new members, and as such, removed the “Go Paperless Later” link. From a technical standpoint, this was viable as this experience was not a full-page interrupt like current members got, and therefore, bypassing the experience was no longer required. Depending upon the user’s paperless status coming out of this experience, subsequent promotional logic would be triggered, just as it would in the current member experience.
document delivery preferences
I considered how our experience fragment could be applied to the existing Document delivery page (see above). Located within a member’s Profile and Preferences, the current design is comprised of three radio buttons which, as we learned, presents usability and ADA compliance issues. Additionally, the new design would include the Proxy Enablement feature, a sister project that enables users to act on behalf of other users within their plan. I supervised the work on this project, which was conducted by a fellow designer on the team.
Conclusion
I’m in a paperless state of mind
One consistent theme that I observed was users think of paperless as being a “state of being,” meaning that once they have “gone paperless,” they expect to be paperless for everything. Customers were surprised by the number of document categories; while these categories are the result of the complex nature of insurance documents, it drove the point home that people want to “go paperless” and be done with it. Most people are inclined to go paperless – love it, in fact – and simply don’t want to be bothered with it afterward.
Although I had to make compromises along the way with our legal and product partners, this “paperless state of mind” theme resonated and prompted me to advocate for our customers:
No infinite cycles of prompts, which I viewed as a potentially dark pattern
Promotional banners that disappear after they are no longer relevant
Accepting that if a member says “No thanks,” they are not interested
future iterations
One battle I did not win, due mainly to legal restrictions, was a feature that allowed users to opt into all in one single click. While I ultimately left the organization prior to launch, I advocated for backlogging this feature, especially given the amount of research I gathered. If we truly listen to our customers, they are telling us that they are happy to go paperless, but doing so should not be intrusive or burdensome. With the paperless prompt, I hoped to achieve the business goals outlined above and increase paperless conversion, which will save the organization millions of dollars, and quite a few trees along the way, but more importantly, to create a design that should help meet this objective in a way that does not harass or mislead customers. While I don’t have access to data to gauge its performance, I was told that within a week, over 100,000 customers opted into paperless delivery, which out-performed expectations.