Plain language August 31 2016

Quality health plans & benefits
Healthier living
Financial well-being
Intelligent solutions
Zoe Stetson & Adele Angle
August 31, 2016
Writing plain is
everyone’s gain

Aetna Inc.Writing Plain is Everyone’s Gain
Your presenters
2
Zoë Stetson, Communications Consultant
& quality reviewer
• 4 years with Aetna
• Life before Aetna: Director of marketing and public relations at
two colleges, a long-term care facility and several non-profits;
television producer and talk show host; freelance writer
Jim Dunn, Manager, Writers’ Center for Excellence
• 3 years with Aetna as a copy quality reviewer. Now supervise 10
quality reviewers who look at all materials to be sent externally.
• Life before Aetna: More than 25 years in health care
communications at Anthem, United Health
and HealthNet

Before we start
• Be sure the Flesch-Kincaid
Index is working in Microsoft
Word
• Have class exercises open
on your desktop
• Ask questions throughout
• Keep your phones muted
• Avoid multi-tasking
3

Course objectives
4
• Explain what plain language is and what it isn't
• Describe the value of using plain language for
consumers, Aetna and yourself
• Go over the principles of plain language
• Use the Flesch-Kincaid tool to improve your writing

Aetna Inc.
So here’s the question …

How do we change language like this:
After this review, we determined that the proposed injection penicillin g
benzathine, home infusion/specialty drug administration, home injectable
therapy would not be covered under the member’s benefits plan, assuming all
of the clinical information remains unchanged. Aetna does not consider
intravenous antibiotic therapy medically necessary for Lyme disease when the
medical records do not support that a definitive diagnosis of Lyme disease is
established (positive serologic and/or cerebrospinal fluid (CSF) titer by indirect
immunofluorescence assay (IFA), Prevue Borrelia burgdorferi antibody
detection assay, or enzyme-linked immunosorbent assay (ELISA), which itself is
validated by a positive Western Blot Test), and there is no documentation that
any of the following criteria is met: Lyme arthritis which persists after failing to
respond to a 4-week course of appropriate oral antibiotic therapy, moderate
to severe cardiac involvement, Neurologic involvement of Lyme disease
(neuroborreliosis), or Lyme disease in pregnant women who exhibit symptoms
and signs of Stage II or Stage Ill Lyme disease.
6
READING
GRADE LEVEL 40.6

Into language like this?
We cannot cover the treatment with antibiotics given
through a vein. That’s because the laboratory results do not
confirm that you have Lyme disease. Also, you do not have
symptoms that would need this treatment.
7
READING
GRADE LEVEL 7.1

Aetna Inc.
May we have a volunteer?

Michelle’s Law
9
Under federal law, known as Michelle's Law, dependents who lose
student status due to a disability (that is, serious illness or injury) may
be eligible to continue coverage for up to one year from the first day
of a medically necessary leave of absence or at such time coverage
would otherwise terminate under plan or coverage terms, whichever
occurs first.
Public Law 110–381 110th Congress An Act

Michelle’s Law revised
10
A federal law called Michelle’s Law helps students who must take a
leave of absence for medical reasons. The law lets them continue
health coverage up to one year. To do this, the student must attend
college before the leave starts. The student also needs a letter from
his/her doctor. The letter must say why the leave is needed.

Plain language
11
Communication that your audience understands
the very first time they hear it or read it.
Baby talk, or
“dumbing down”
Imprecise
Stripping out
necessary technical or
legal information
Is … Is NOT…
Familiar words
Short sentences
Pronouns
Bulleted lists
Headlines/subheads
No jargon
Active voice

Why plain language is necessary – 3 trends
12
1. Adults have different levels of reading skill.
2. Our attention span is lower than ever before.
3. People are now expected to make their own health
insurance purchasing decisions.

Trend #1: Adults have different levels of
reading skill
13
Nearly 50 percent of adults in the U.S. read below the
6th grade level.
The average adult in the U.S. reads at the 7th grade
level.
More than 80 percent below the 10th grade level.

Trend #2: Our attention span is shrinking
14
Our attention is pulled in too many different directions
at home … at work … everywhere.
The average American’s attention span is eight
seconds. (Microsoft study, 2013)
And Psychology Today says that only 2 percent of us
are effective multi-taskers ... but almost all of us try to.
multi-task

So here’s the situation we face today
• Your audience reads at a low grade level.
• They have short attention spans.
• We’re asking them to make their own health plan
purchasing decisions.
• We expect them to learn a new vocabulary.
What is precertification? What is a tiered network?
What is coinsurance? What is step therapy?
15

Aetna Inc.
So our communications
needs to be
Plain
Direct
Simple

Why plain language is good for Aetna
17
• Makes dealing with
Aetna easier and less
stressful
• Builds trust
• Allows our audience
to understand what
we’re saying
For our
customers
For
Aetna
For
us (employees)
• Makes for satisfied,
loyal customers
• Helps to keep us
competitive
• Reduces expensive
calls to customer
center
• Saves us from costly
lawsuits
(misinterpreted
language)
• Makes me a more
effective
communicator
• Makes my job easier –
fewer phone calls
from a confused
audience
• Complies with the
Aetna Way

Plain language has been important at
Aetna for a long time
18
“Each letter you write should
be short, direct, courteous and
clear. Whoever receives it will
form his impression of the
Company from what you have
written.”
Morgan Brainard, president and
chairman from 1921 to 1957

Plain language uses
19
• Familiar words
• Short sentences
• Pronouns --“you,” “we”
• Bulleted lists
• Headlines and subheads
• No jargon
• Active voice

Plain language
20
Flesch-Kincaid index

Flesch-Kincaid index
21
Developed in 1975 by J. Peter Kincaid and his team
for the United States Navy
does doesn’t
It can serve as an
early warning
system.
It can tell you if your
writing is too dense.
It doesn’t measure
• Organization, logical order
• Gender, class or cultural
bias
• Poor design

The Flesh-Kincaid formula
22
.39 15.59
total words
total sentences
total syllables
total words+11.8 -

Aetna Inc.
Taking Flesch-Kincaid for a test drive
Go to your exercises in the MS Word
document.

Using the tool—Exercise A
24
1. Highlight what you want to
test
2. Go to Spelling and Grammar
check
3. You’ll get a prompt. “Word
has finished checking the
selected. Do you want to
continue checking the remainder
of the document.”
4. Click “NO”

Testing reading level
25
Your goal is:
• A grade level of 5.0 to 5.9 for employees, members
• A grade level of 9.0 to 9.9 for doctors, brokers, plan sponsors
Exercise A
Under federal law, known as Michelle's Law, dependents who lose student
status due to a disability (that is, serious illness or injury) may be eligible to
continue coverage for up to one year from the first day of a medically necessary
leave of absence or at such time coverage would otherwise terminate under
plan or coverage terms, whichever occurs first.
(Reading Level: )
A federal law called Michelle’s Law helps students who must take a leave of
absence for medical reasons. The law lets them continue health coverage up to
one year. To do this, a student must attend college before the leave starts. The
student also needs a letter from his/her doctor. The letter must say why the
leave is needed.
(Reading Level: )
28.2
5.4

Remember
1. Write a paragraph
2. Check the reading level
3. Revise
4. Test
5. Revise
6. Test again

Aetna Inc.
The seven plain language principles
Now we’ll learn how to apply plain language
to our own writing.

Plain language principles
28
1. Use familiar words

Scrape, cut
Not cancer, harmless
Side effect
Heart attack
High cholesterol
SHORTER WORD
Let’s come up with familiar words for …
Abrasion
Benign
Adverse health effect
Myocardial infarction
Hypercholesterolemia
29
(FROM AETNA’S DIFFICULT WORD LIST)
ORDINARY WORD

More
Use
Give or add
About
Private
SHORTER WORD
Examples of shorter words for
these ordinary words
Additional
Utilize
Contribute
Approximately
Confidential
30
(FROM AETNA’S DIFFICULT WORD LIST)
TIP
A long word
with many
syllables can
raise your
grade level.
ORDINARY WORD

Familiar words—Exercise B
31
First, test the sentence.
Substitute plainer words for the ones in bold.
Now test again by clicking spell check.
Research studies have demonstrated that eating additional whole
grains may contribute to the reduction of cardiac disease, cancer
and diabetes by lowering triglycerides, contributing to insulin
control, assisting with weight management and slowing the gradual
accumulation of plaque.

Exercise B before and after examples
Before: Research studies have demonstrated that eating
additional whole grains may contribute to the reduction of
cardiac disease, cancer and diabetes by lowering triglycerides,
contributing to insulin control, assisting with weight management
and slowing the gradual accumulation of plaque. (Grade 23.7)
After: Research shows that eating more whole grains
may reduce the risk of heart disease, cancer and
diabetes. It lowers triglycerides, helps control insulin,
helps with weight control and slows the build-up of
plaque. (Grade 8.3)
32

33
2. Use short sentences

Short sentences (and paragraphs)
34
sentences
paragraphs
Aim for 15 words or less
No more than five lines.
Four lines is even better.

Short sentences
35
Original Michelle’s Law sentence: 56 words
Revised Michelle’s Law sentence: Average length 10.8 words
• A federal law called Michelle’s Law helps students who must take a
leave of absence for medical reasons. (18)
• The law lets them continue health coverage up to one year. (11)
• To do this, a student must attend college before the leave starts. (12)
• The student also needs a letter from his/her doctor. (10)
• The letter must say why the leave is needed. (9)

How do I make my sentences shorter?
36
delete
diet
divide

Delete ‘THAT’ constructions
37
Instead of this: Try this:
Our records indicate THAT
your June premium is 30 days overdue.
This letter is to inform you THAT
your prescription is covered.
It’s a well-known fact THAT
a yearly physical is a good idea.
Your June premium
is 30 days overdue.
Your prescription
is covered.
A yearly physical
is a good idea.

Put these phrases on a diet
38
Each and every month
Fair and just decision
Clear and simple case
Added bonus
Personal and confidential
Each month
Fair decision
Clear case
Bonus
Private

Divide long sentences into two or more
One sentence:
Because you have enrolled in the Aetna Student Health
Insurance Plan, you are now protected by On Call
International’s worldwide medical information and
assistance services whenever you travel 100 or more
miles away from your primary residence, or whenever
you are traveling in a foreign country.
39
READING
GRADE LEVEL 23.6

Two sentences:
assistance services. It’s there for you when you travel 100
or more miles away from your primary residence, or
whenever you are traveling in a foreign country.
40
READING
GRADE LEVEL 14.2

Three sentences:
assistance services. It’s there for you when you travel 100
or more miles away from your primary residence. You
can also use it when you travel in a foreign country.
41
READING
GRADE LEVEL 10.4

Hint: Look for sentences with and or or
42
You can usually split compound sentences – those with
“and” and “or” into two or more sentences quite easily.
Your premium is 30 days overdue
and we must terminate your
coverage.
You can get more information by
going to www.aetna.com or
calling 1-877-555-1111.
Your premium is 30 days overdue.
We must end your coverage.
You can get information at
www.aetna.com. You can also
call us at 1-877-555-1111.

Short sentences—Exercise C
43
First, test this sentence.
Try breaking this sentence into two or
more sentences.
Can you substitute some shorter words?
Manipulation of your call volume is unacceptable and violates our
departmental procedures for appropriate call handling and providing the
level of service that our customers expect, and, as a result, if at any time
in the future you place callers on hold for more than one minute without
updating them on your efforts, display any other inappropriate behavior
in the normal process of handling a call, or display any other form of
misconduct, it could result in your immediate termination without
further warning.

Exercise C before and after examples
Manipulation of your call volume is unacceptable and violates our departmental
procedures for appropriate call handling and providing the level of service that our
customers expect, and, as a result, if at any time in the future you place callers on
hold for more than one minute without updating them on your efforts, display any
other inappropriate behavior in the normal process of handling a call, or display any
other form of misconduct, it could result in your immediate termination without
further warning.
READING
GRADE LEVEL 37.6, no passive sentences
Please follow our rules when handling a customer’s call. They expect a high level of
service. We may fire you immediately if you manipulate your call volume or handle a
call the wrong away. Don’t put a person on hold for more than one minute without
updating them on your efforts. Don’t show inappropriate behavior when handling a
call or display any other form of misconduct.
READING
GRADE LEVEL 7.7, no passive sentences
44

45
3. Use pronouns – you, we, us

Pronouns are
part of Aetna’s
brand voice
• Warms up the tone
of your writing
• Sounds conversational,
not robotic
Example:
My supervisor asked me
to do a presentation on
the product changes. I
told him I wasn’t familiar
with them but that Mary
can do it. She knows all
about the recent
additions.

Example of using pronouns
47
“A decision on the
above claim cannot be
made at this time
because not all of the
requested information
has been received.”
“We can’t make a
decision on your claim.
We did not receive
the information we
requested. Please
send it to us.”
or

Using pronouns—Exercise D
48
Use pronouns to “warm up” this paragraph.
At the customer’s request, Aetna will send copies of all
documents relating to the claim, free of charge. The
customer can contact the 800 number on the member ID
card, and a customer service representative will supply
instructions on how to request copies of any documents
used in the decision-making process.

Using pronouns—Exercise D
49
At your request, we’ll send copies of all documents relating
to your claim, at no cost. You can call us at the 800 number
on your member ID card. We’ll give you instructions on how
to ask for copies of any documents we used in our decision-
making process.

50
4. Use bulleted lists

Where can we break up this copy by using
bullets?
51
DocFind, our newly redesigned online provider directory at
www.aetna.com, provides information on all our
participating providers including physicians, dentists,
optometrists, hospitals, and pharmacies. DocFind is updated
three times per week: Tuesday, Thursday and Saturday
mornings, including during holiday periods. DocFind receives
provider data updates from our Enterprise Provider Database
(EPDB), our single source for all provider data.
READING
GRADE LEVEL 17

Bullet guidelines
52
• If you find three or more items in a
row, pull them out of the paragraph
and use them in a bulleted or
numbered list
• Keep items short (remove details that
don’t add value for the user)
• Don’t use too many bulleted lists in
one piece – or too many bullets in
one list (aim for no more than five)
Aetna style:
• Primary bullets
─ Secondary

This is much easier to read with bullets
53
DocFind is our online provider directory. You can
find it at www.aetna.com. It lists our
participating providers, including:
• Doctors
• Dentists
• Optometrists
• Hospitals
• Pharmacies
We update this listing three times a week.
READING GRADE LEVEL: 5.3

Use parallel structure
Parallel construction helps readers quickly understand what
they‘re reading. Unparallel construction is confusing. It forces
readers to do a double-take and reread. Or worse, they may stop
reading completely.
This structure uses all verbs and is in parallel construction.
Other ways you can get help with your appeal:
• Call the Employee Benefits Security Administration at 1-866-
444-3272.
• Go to www.aetna.com. Search on the word “ombudsman”
or “consumer assistance.”
• Call us at the number on your member ID card.
54

Use parallel structure
If one bullet starts with a verb, they should all start with a verb. If
the first bullet starts with a noun, the rest should all start with a
noun. This is parallel construction.
It’s NOT this:
Other ways you can get help with your appeal:
• By calling the Employee Benefits Security Administration at 1-866-444-3272
• You can go to www.aetna.com. Search on the word “ombudsman” or
“consumer assistance.”
• Call us at the number on your member ID card.
55

56
5. Use headlines and subheads

How are email subject lines, headlines and
subheads like highway road signs?
Road signs help us find
our way as we speed
down the highway.
Subject lines, headlines and
subheads help us find our
way while we speed
through communications
from Aetna.
57

What do headlines and subheads do?
58
• They summarize your main messages.
• They break up copy and make it easier to read.
• They’re specific and meaningful.
• They’re positive, not alarming.
• They’re brief – typically, fewer than 10 words.
Remember:
• Don’t use punctuation at the end of your headlines and subheads.
• Only capitalize the first word.
• Focus on why it matters to the READER, not to US.
Help us ensure we have accurate information
Help us pay your claims faster – give us up-to-date info
Use our online InTouchCare diabetes resource guide
Here’s help so you can more easily manage your diabetes

Which is easier to follow? Which is easier
to read?
59

60
6. Avoid jargon

Jargon:
the special
language used
by any group
or profession.
It's our common
shorthand.

Example of taking out jargon
62
If you have any questions,
please call me.
Should you have any questions
or concerns regarding the
above, please do not hesitate
to contact the undersigned.
READING
GRADE LEVEL 2.2READING
GRADE LEVEL 9.1
NO JARGONWITH JARGON

63
We may ask you to give
us proof that you live in
the state.
Proof of state residency
may be mandated.
READING
GRADE LEVEL 7.3

64
If you give us false
information on purpose,
we may change or cancel
your policy.
Intentional
misrepresentation may
result in the policy being
modified or terminated.
READING
GRADE LEVEL 17.6

Do customers
know what our
jargon means?
We adjudicate claims.
We terminate members.
We incent good health practices.
We send information that’s
pursuant to a law.

Use
Finish
Send
Call, email
Bring everyone
up to speed
SHORTER WORD
Think of another word for…
Leverage
Finalize
Cascade
Reach out
Level set
66
JARGON

What does this mean?!@@#$%
67
"I leveraged and re-cannibalized a slide deck that
was cascaded to my team because I didn’t have the
bandwidth to recreate the wheel."
READING
GRADE LEVEL 11.6

Translating ?!@@#$%
68
“To save time, I used a slide deck from a coworker to help
me get started.”
READING
GRADE LEVEL 5.1

Use a simple explanation for these terms
69
AD&LM: Aetna Disability & Leave Management
(Say this instead: the area that manages Aetna's disability leaves)
STD: Short-Term Disability
(not to be confused with sexually transmitted diseases)
PTO: Paid time off
ERISA: Employee Retirement Income Security Act
(Say this instead: the law that requires an appeal process for
covered benefits, among other things)
How did using acronyms start?
In the late 1800s, businesses began abbreviating their company names in
writing to fit into places where space was limited ─ on a barrel or crate,
small-print newspapers and railroad cars.
For example, the National Biscuit Company became NABISCO.

Simple initial tips
70
1. Spell out the name, then put initials in parentheses:
EXAMPLE: National Insurance Association (NIA)
2. If you only use the term once, don’t use initials.
3. Always assume your reader will forget what an “initialism”
means two paragraphs later. If your piece is long, spell out
the acronym again, after first mention.

71
7. Use active voice

Active versus passive voice
72
Active voice describes a sentence where the subject performs an
action. It tells what a person or thing does.
I’ll always remember my first promotion at Aetna.
Passive voice describes a sentence in which the subject is acted upon.
It tells what is done to someone or something.
My first promotion at Aetna will always be remembered.
Active voice
Sounds more direct
Reader knows what’s
going on right away
More genuine
Passive voice
Sounds robotic &
business-like
Hides who or what is
doing the action

The three-step active voice recipe
73
1.Find out who or what is doing something
2.Put this who or what in front of the verb
3.Use a verb that describes the action
Example:
PASSIVE: The nonsmoking policy was explained in the letter.
ACTIVE: The letter explained the nonsmoking policy.

Passive sentences
74
Passive sentences hide who is doing the action.
Your claim was denied.
Who denied the claim: My doctor? The hospital? Aetna?

Active sentences
75
Active sentences say who is doing the action.
We denied your claim.
Oh, OK, you denied the claim. What should I do now?

Passive sentences
76
Passive sentences are indirect because they don’t start
with who is doing the action.
The report was written by the manager.

Active sentences
77
Active sentences start with who is doing the
action.
The manager wrote the report.

Put this passive sentence into active voice
78
Your job application will be reviewed by Human
Resources.
(Using our recipe, who is reviewing?)
Human Resources will review your job application.

Aetna Inc.
The Flesch-Kincaid Hotline
How may I help you?

What other resources are there for writers
at Aetna?
1. Aetna Editorial Style Guide (plus, the “Difficult word list”)
2. Writing templates (letterhead, PowerPoint, email)
3. “In Plain Language” newsletter – quarterly
4. Win with plain language – on Aetna Connect
5. Writer certification courses
80

Hotline
81
I am getting a high grade level score. What do I do now?
• Test one paragraph at a time. Is one paragraph way
worse than the others?
• Then work on that paragraph.

Hotline
82
I am stuck with the word “maternity.” I have to say it in
this brochure. How can I get my score down?
Say it just once. Then try to use a pronoun in future
references.
“You can read up on these topics by consulting your
Beginning Right® Maternity Program booklet.
You haven’t received it yet? We can send it to you today!”

Hotline
83
I keep getting a score of zero. What am I doing wrong?
• Simple. Make sure your sentence has punctuation at
the end.
• Your sentence(s) might be too short.
I removed some words. But my score went UP instead of
down. What do I do?
• Keep working.

Hotline
84
I am stuck at a 6.2. I just can’t get this down any
more. What do I do?
• Look at all the sentences that have the word “and” in them.
See if you can split them into two sentences. “Or” works, too.
• Is there a word you MUST use? Test without it. (Just
remember to add back in.)
• Is there phone number or URL? Test without it. (Just
remember to add back in.)
• It’s OK. This might be the best you can do.

Hotline
85
Are we supposed to test with legal disclaimers?
• No – never.
Am I supposed to include websites and phone numbers?
• If your score is too high, take them out and test again.
Should I test other writing?
• Yes. The more you practice and use the tool, the better
you’ll become.

Hotline
86
All this plain language stuff is great.
But frankly, to me, it doesn’t seem
professional. Or business-like.
Thoughts?

Aetna Inc.
The Flesch-Kincaid Hotline
Do you have a question for the hotline?

Plain language August 31 2016

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