Audit receipt: your health plan guide

Source: UnitedHealthcare Choice Plus certificate of coverage, 117 pages (Wisconsin) · language: EN

SIMPLE score

Scored 0-4 per dimension by the adversarial auditor. Passing floor: 3 on every dimension.

Original vs simplified

Efficiency

Reading grade: Flesch-Kincaid (English; target 6 or below for health content). Original measured on the full 117-page text; simplified measured on the reader-facing prose. Reading ease rose from 33 to 70 on the same scale. Word count is the visible page; the full coverage and exclusions lists remain, tucked into expanders.

What was done

• Led with the one answer no page of the policy gives: the plan pays most of your bills after a $1,000 deductible, if you stay in-network, up to a $3,500 yearly cap.
• Pulled the cost-sharing numbers out of the buried schedule of benefits into a visible cost split, with a worked example so you never do the math.
• Turned the "responsibilities" prose into four plain actions, each with its real consequence: stay in-network, show your ID card, get prior approval, file claims within 90 days.
• Showed what common visits cost ($0 preventive, $30 primary, $60 specialist, $250 ER, $100 urgent care) and the drug tiers, in scannable tables.
• Split covered vs not-covered into two plain lists, so you can see at a glance what you pay for in full (glasses, LASIK, most dental, cosmetic, IVF).
• Defined deductible, coinsurance, out-of-pocket cap, and medically necessary at the word; removed the 12-page glossary.
• Rewrote the issuer's "we" into "your plan"; moved the full coverage list, all A-to-V exclusions, prior-auth list, benefit limits, and appeals steps into expanders.
• Cut non-actionable legal boilerplate (ERISA framing, reimbursement methodology, coordination-of-benefits mechanics), keeping a one-line pointer for the two-plan case.
• Upgrade 2026-07-30: added a live calculator that estimates your share for the year (first $1,000, then 20%, capped at $3,500), with the math shown in words for print. It was tested against hand-computed cases and matched exactly.
• Upgrade: surfaced the two rules that change every number: care must be medically necessary, and out of network the plan pays a percentage of its own allowed amount, so the provider can bill you the rest.
• Upgrade: attached the exception to the exclusions, so breast reconstruction after a mastectomy and function-restoring surgery are shown as covered, not lumped in with cosmetic.
• Upgrade: added special cases, each pointing back to its section: telling the plan about a new baby or adopted child within 60 days, coverage of children to 26 (27 in Wisconsin), and a subrogation warning if someone else pays you for an injury.
• Upgrade: noted that the amounts come from this specimen's schedule of benefits and that your own plan's schedule controls your costs.