**SUBJECT:** Plain language for your 2001 brochure

The 2001 brochure frame for your plan type with the new language and
format is enclosed. If you have two options we will send you a benefits
frame for two options separately.

**Your brochure submission**

Your 2001 FEHB brochure must be in the new format and use plain language
throughout, including Plan-specific text. The language in the brochure
frame is plainly written and laid out the way we want to see all
brochures for 2001.

Your brochure language is due to your contract specialist **July 1,
2000**. Please note, however, that the brochure language that
accompanies and describes your benefit proposals must be in plain
language and we must receive it by **May 31**, 2000.

Work with your OPM contract specialist to add your benefits and
procedures \-- including your changes and clarifications for 2001 \-- to
this new frame. Follow the frame and other guidance we send concerning
mandatory language. Periodically during benefit negotiations, we will
exchange text and discuss your proposals electronically. See our carrier
letter on Open Season material for more information. If you have not
received that letter recently, call your contract specialist for another
copy.

**Background**

Through carrier letters and the 1998 and 1999 Fall carrier conferences,
we have emphasized our strong commitment to plain language. Together we
re-wrote the administrative portions of your brochures for contract year
2000. Representatives from several fee-for-service and HMO plans,
together with Office of Insurance Programs staff, have developed clear
and customer-focused benefit descriptions that facilitate plan-to-plan
comparison. They developed a brochure frame for both types of FEHB plans
\-- fee-for-service and HMO.

.

We had focus groups look at the draft frame. We wanted feedback from
actual users on our efforts to simplify and rewrite the health benefits
brochures in plain language. The result of the three different focus
groups were \"Outstanding\" from the standpoint of validating the work
of the health plan/OIP work group. It also caused us to rethink other
language.

The focus groups particularly liked:

-   The format and order of sections \-- for instance, the plan-specific
    information in the front and general FEHB information in back;

-   Benefits in chart form with the description on the left and the
    member\'s costs on the right;

-   The more detailed table of contents, the new overview at the
    beginning of the benefits section, and \-- for some plans \-- the
    new index; and

-   The easier to follow language, such as the step-by-step disputed
    claims process and the Medicare primary payer chart.

**Things you need to know to prepare your 2001 brochure**

Although the frame is straightforward, we have enclosed guidelines for
writing the text and completing the benefit portions of the frame.

**Conclusion**

We are pleased to present this brochure frame to you. Please work with
your contract specialist to develop your brochure. If you have questions
about the frame that do not relate to your Plan\'s benefits or
procedures, please feel free to call Agnes Kalland (<amkallan@opm.gov>)
at 202/606-0745.

Sincerely,

(signed)

Frank D. Titus

Assistant Director

for Insurance Programs

Enclosures

**Enclosure**

**Guidelines for 2001 brochures**

**Rules for writing your text portions (All sections except Section 5)**

The fee-for-service frame and the HMO frame are laid out in the same
order so that it will be easier for members to find their way around the
brochure. And it will also be easier for them to compare plans.
Therefore, the Section names and the headings are standard. Follow the
standard headers. Use the suggested text unless it conflicts with your
procedures or benefits, because it is already in plain language. Do not
edit text that applies to all plans. Work with your contract specialist
where you need to.

**Rules for filling in Section 5 Benefits**

We folded a fee-for-service plan\'s benefits into Section 5 to
illustrate to you how the blocks could be used. We are not requiring you
to provide, exclude, or change any benefit from last year. Replace the
sample benefits with your benefits \-- however, you must word them
plainly, following the edit rules in this letter. Use the sample
language wherever you can.

Some parts of Section 5 are standard:

-   Present benefits in chart form, with the chart open on the sides.
    Even though the sides are open, use white space around text as if
    the chart lines were filled in;

-   Do not change the Section headings;

-   Do not change the Important information blocks, except to conform
    them to your procedures or benefits where we have noted that the
    text is Plan-specific;

-   Follow the standard headers in the gray bands, such as Diagnostic
    and treatment services. Do not re-order the headers or remove any of
    them. If you do not have a given benefit, say \"No Benefit;\"

-   If you split the chart before the next gray band, use the suggested
    way of explaining that the benefit is continued on the next page.
    For instance, when the Diagnostic and treatment services block is
    split between two pages, we state at the bottom right corner of the
    page: Diagnostic and treatment services - *Continued on next page*.
    And, then, in the gray band on the next page we say in the left
    block: Diagnostic and treatment services *(continued)*, and in the
    right block: You pay;

-   Show \"You pay\" in the gray band that appears at the top of each
    page; and

-   Use suggested text if it applies because it is already in plain
    language. We marked some text as standard; if you must edit that
    text, work with your contract specialist.

> **Left column, Description:**

-   List your benefits; do not use sentences and paragraphs to describe
    when a simple list is all that\'s needed. Do NOT put cost
    information in the Description column.

-   Start a new description block when you think the information needs
    to be broken up. For instance, always start a new block when the
    costs change. You may block benefits however you wish, such as
    according to the member\'s costs for them. (Note, however, that you
    cannot re-order the headers in the gray bands.)

-   When you have exclusions specific to a given benefit, start a new
    block. In the left column, say \"*Not covered:*\" and show
    exclusions. In the right column, show only that the member will pay
    *\"All charges.\"* Not covered entries in both sides should be
    *italized*.

-   If you have information that doesn\'t fit as a benefit description
    or cost introduce it with \"Note:\" then explain it. Sparingly,
    cross reference a benefit to another section. Again, put notes about
    benefits in the left column and notes about costs in the right
    column.

-   Handling lists of covered services and exclusions:

> •• In some cases a wide variety of services will be covered with a
> limited number of exceptions and you won\'t want to list all the
> things that are covered. But you will want to specify those that are
> not covered. Use \"such as\" to indicate the listing isn\'t inclusive
> and \"not covered\" to identify exclusions. See the Maternity care
> example in Section 5(a).
>
> •• You can use \"such as\" in the *Not covered* blocks too, as a way
> of illustrating that other excluded items exist \-- for example, items
> that are excluded as a matter of definition. See \"Personal comfort
> items, such as\" in the *Not covered* section of the Inpatient
> hospital benefits in Section 5(c).
>
> •• If the list of covered services is short, use \"limited to\" to
> indicate an inclusive list. Generally, the use of \"limited to\" will
> avoid the need for a \"not covered\" entry. See the Educational
> classes and programs example in Section 5(a).
>
> •• There may be cases where you use \"limited to\" but feel a \"not
> covered\" entry is desirable because a closely related service isn\'t
> covered. See the Organ tissue transplants example in Section 5(b).

-   Whenever you can, define terms in the benefit section instead of the
    Definitions section. For instance, durable medical equipment.
    However, when a term is widely used \-- e.g., medically necessary
    \-- put the term in the Definitions section.

**Right column, You pay:**

-   Show the MEMBER\'s costs. Keep explanations simple (as in our
    examples). Do NOT describe benefits in the You pay column. For
    fee-for-service plans, there is a change in focus \-- from telling
    the member what the Plan pays to telling them what they will pay.

-   When describing your reasonable and customary allowance, or other
    allowances, use the term \"Plan allowance\" or \"our allowance\".
    The term will be defined in the text portion of the brochure.

-   *{DO NOT TYPESET INSTRUCTIONS. Generally, our instructions to you
    are in brackets and italics.}*

**Formatting, typesize, margins, etc.**

Footer: Front page: none

2^nd^ page to end: 10 pt italic

Left text: *2001 {insert Plan name}*

Center: page number

Right text: *{name of section}*

Typesize: Section heads: 14pt bold

Headers in text: 12 pt bold

Sub-headers: 10 pt bold and indent 5 spaces and add bullet

Text: 10 pt regular (same as last year)

Text in *\"Not covered\"* blocks: 10 pt *italic*

Margins: Not less than: 0.6 top

0.5 bottom

1.0 inside

0.8 outside

Shading: Section 5: Benefit Description/You Pay and Note blocks:

Offset (Shade gray-40%; white type.)

Section 5: Benefit headers (such as \"Diagnostic and treatment
services\":

Shade gray-10%; regular (black) type.

Lines: Above and below Section heads; 6pt spacing before and after
heading.

Benefits Chart: Lines above, below, and middle of each block. (All
except inside and outside edges)

6pt spacing top and bottom of text; left/right indent 2pt.

Bullets: hanging by 2pt.

Space so that there is a lot of white space \-- easier read.

Headers: Text sections: Start of each section.

Benefits section: Each page either:

-   Section header, or

-   Gray header with benefit/You pay. (Do not repeat You pay on page),
    or

-   As instructed in frame.