Why clear communication in medical insurance matters more than ever

Imagine being told you’re covered, only to find out you’re not. Or assuming a benefit is included, only to discover there’s a long list of exceptions in the fine print. For too many people, this is the reality of navigating medical insurance. And it’s not because they’re careless or unwilling to read the documents. It’s because those documents are often confusing, technical, and written in a way that feels like they’re meant to be read by medical professionals, or actuaries, not everyday people trying to make smart decisions about their health and finances.

We see this problem all the time. And we know: it’s not just a “nice to have” to simplify communication. In medical insurance, clear communication can make the difference between someone getting the care they need, or not.

Why is medical insurance so hard to understand?

Medical aid and insurance documents tend to be packed with legal, financial, and clinical jargon. Even when consumers are motivated to understand their plans, they often face hurdles like:

• Unfamiliar terminology: Words like “formulary”, “confinement”, “PMBs”, “chronic benefit”, and “network provider” are rarely explained in plain terms.
• Dense, complex writing: Sentences are long, abstract, and filled with multiple clauses. It’s easy to lose track of the point.
• Assumed knowledge: Many documents assume the reader already understands how insurance works, how claims are submitted, what’s considered out-of-network, or how waiting periods apply.
• Important info buried in fine print: Key exclusions or conditions are often hidden in long policy schedules or in annexures that few people ever read. And let’s not even get started on the double negative formulations.
• Low accessibility: People with lower literacy levels, those who speak English as a second (or third) language, and neurodivergent readers are often unintentionally excluded.

In short, even motivated, educated readers can struggle. And for those new to insurance, under financial stress, or managing chronic conditions, these documents can feel like an impenetrable wall.

What happens when communication is unclear?

Poor communication in medical insurance isn’t just frustrating, it has real-world consequences:

• People make poor choices: If benefits aren’t clearly explained, people might choose a plan that doesn’t meet their needs.
• They miss out on benefits: Members might not know they qualify for chronic medication support, counselling, or screening benefits.
• They get surprised by out-of-pocket costs: When exclusions, limits, or network restrictions aren’t clear, members can be hit with unexpected bills.
• They lose trust: When people feel confused or misled, they start to believe insurers are intentionally hiding information, and they disengage.

The benefits of clear, plain language communication

When medical aid providers invest in plain language, everyone wins. Clear communication:

• Empowers members to make better decisions about their health and money
• Reduces call centre volumes because people can self-serve more easily
• Improves compliance with regulatory requirements for transparency and fairness
• Builds trust and loyalty by showing members that the provider values honesty and clarity
• Supports vulnerable groups by making vital information accessible to those with lower literacy or language barriers

What does clear communication look like?

• Use everyday words instead of jargon (say “specialist” instead of “provider”)
• Break down complex processes step by step
• Highlight key information using headings, bullets, and bold text
• Be upfront about costs, exclusions, and limits
• Test materials with real users, especially those who struggle most
• Provide information in multiple languages and formats
• Clear communication is more than editing, it’s about empathy. When we write as if someone’s well-being depends on it, we create insurance documents that do what they’re meant to do: protect people.

Is your medical aid communication working for your members? If not, it’s time to rewrite the story—clearly.