The purpose of this document is to align all stakeholders on what this product will do, who it will serve, and the efforts and resources it will take to build it.
The primary target audience for this health insurance app is existing members across all age demographics. While we anticipate the most utilization among the 18-50 age group, due to their comfort with digital platforms and preference for mobile convenience, the app must cater to the entire membership base. We expect the core user group to skew towards those aged 26 and older. This aligns with the typical transition off of parents’ health insurance — but individuals as young as 18 might be members as well (e.g. receiving coverage from their employers.) Although older demographics (60+) may have overall lower engagement with the app, the platform must remain accessible and user-friendly for all members.
Beyond this broad membership, a significant secondary audience includes individuals with specific healthcare needs, for example — those managing chronic conditions, pregnant individuals, and those recovering from significant health events (e.g. car accident, heart attack, etc.).
Ultimately, the app will aim to provide comprehensive and convenient access to health insurance information and services for a diverse user base with varying levels of digital literacy and healthcare engagement.
Competition
The competitive landscape is broad, as the majority of health insurance providers have started integrating digital solutions to help their members manage their health insurance plans. The most prominent of these direct competitors include industry giants like UnitedHealth Care, Anthem, Cigna, Humana, and Aetna, which combined, encompass a significant market share and possess established member bases.
Beyond these direct competitors, we also face considerable indirect competition from a variety of health and wellness companies. These organizations often focus on specific user needs and specialize in particular aspects of our feature set. Companies such as Doctor On Demand offer dedicated telehealth services, while others like GoodRX concentrate on providing prescription savings and information. This specialization can attract users seeking specific solutions to their unique healthcare needs.
Risk / Opportunity
The healthcare industry is vast, and developing products in this space naturally involves significant risks. One key challenge is the rapid pace of innovation in digital health in areas like AI, medical wearables, and mobile technology. Whether they are direct or indirect competitors, if we are outpaced in innovation, users will perceive our platform as outdated and seek alternative products or health providers.
With that said, many health insurance providers have struggled when launching digital solutions for their members, particularly in terms of usability. Integrating legacy systems is complex, and their improper execution of this has lead to reliability issues in the past. Our competitors' past shortcomings present an opportunity for us to enhance the overall user experience and improve user satisfaction when interacting with digital health insurance systems.
Also, given that our app will serve members directly, negative patient experiences have the potential to impact the overall sentiment towards our company and its systems, including our product.
Market Context and Trends
Surging Digital Adoption
65% of individuals accessed their online medical records in 2024 (up from 25% in 2014), with a heavy shift toward mobile apps (57%).
Health plan apps severely lag behind wealth management and auto finance in satisfaction. They fail to deliver an easy-to-navigate experience 39% of the time.
Primary Target: Existing health plan members across all ages.
Goal: Comprehensive and convenient access for a diverse user base with varying digital literacy and engagement.
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High Anticipated Use
Ages 18-45 (users comfortable with digital products; preference for mobile).
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Accessibility for All
Must be user-friendly for older demographics (60+) despite potentially lower engagement.
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Core Focus
Skews 26+ (post-parental coverage), but potentially includes younger (e.g. 18+ can receive employer coverage).
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Secondary Audience
Individuals with specific healthcare needs (e.g. chronic conditions, pregnancy, accident/trauma recovery).
Business Objectives
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Create an app for members that improves their experience in managing and accessing their health insurance information.
Measured by:
An overall decrease in support inquiries (e.g. phone/email) asking for information that is available on the web app
Maintain a +70 Net Promoter Score
Usability task success rates for specific tasks such as finding a provider, looking up claims statuses, viewing benefits information
Deliverable by: The first quarter of launching the app
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Have 20% of members using the app within the first month it is released
Measured by: number of active users compared to total membership base
Deliverable by: 30 days after product is launched
Scope
The web application
Significant and notable aspects of the product in scope would be
Linking user’s health insurance data to features of the app for specific personalized claims, benefits, prescription, and health records information
Integrating the network into the app for users to search in-network provides according to their plan
Communication plan
Create a comprehensive communication strategy on how to reach existing members on the availability of the app before and after its launch, as well as its primary benefits and capabilities.
Engage members in various channels, including:
direct member communication: emails or physical mailing
employer notification: informing employers and providing them information to encourage their employees to use the app
website: featuring the app on the BCBS MN’s website as CTA
on existing portals: placing promotions on the existing legacy member portals that users engage with online
Onboarding
Onboarding information should be an aspect of the communication plan — that is, providing users clear instruction on how they can get started using the app, where to find certain information, and how to accomplish the main tasks users would seek in the app.
Support resources
Having self-service documentation as well as hands-on support resources to assist users who are having trouble onboarding or interacting with specific features of the app.
Functional Requirements
Login flow and member identification / authentication
Logins should utilize current member ID numbers to validate their identity, then enter an email to associate with the account and make future logins and communication easier.
Home dashboard of most important relevant health insurance information
benefits details and spending progress
claims statuses
active prescriptions
health records information such as vaccinations
Universal search – encompasses global search of in-network providers, services, and medicines
A global search that intelligently processes queries for providers, medical services, and medicines, ensuring relevant results for each search type.
A map interface should be incorporated for healthcare providers, accompanied by essential information including their location, contact details, offered services and specialties, patient ratings, and real-time availability with booking options
Benefits page
Overview and explanation of users' benefits
Includes benefits spending stage
Searchable coverage details
Access to plan documents
Claims page
Claims history, statuses, and relevant information such as Explanation of Benefits
Submit a claim manually
Notifications for claim updates
Prescriptions page
Active prescriptions
Functionality to refill prescription
Information on prescriptions
Digital ID card
An offline member ID card accessible within the app and integrated into the user's mobile device via Apple Wallet or Android Wallet.
View and manage dependents information
Users who have dependents covered under their plan should be able to view and manage their health insurance information.
Support Chat Options
An ability to communicate securely with customer support regarding questions about coverage, claims, or other issues. Push notifications for new messages should be included.
Account management
Ability to update personal information, contact details, and communication preferences
Options to change password and manage security settings
Support for multiple languages
Options to adjust things like font size or color contrast for better accessibility
Billing / Payments
View premium payment details (amount due, due date, payment history)
Save payment information
Set up recurring premium payments
Make one-time premium or claims payments
Access billing statements
Delivery Schedule
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Phase 1
User research, additional competitive analysis, persona development
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Phase 2
Wireframing and prototyping
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Phase 3
User Testing
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Phase 4
Developers build and integrate user data into design elements
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Phase 5
Iteration and further user testing
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Phase 6
Launch MVP and measure feedback for future enhancements
User Stories
Login flow and member identification / authentication
As a health plan member, I want to log in using my current member ID number to validate my identity and then associate an email address with my account, so that I can log in more easily in the future and receive important communications.
Dashboard of most important relevant health insurance information
As a health plan member, I want a dashboard displaying my most important and relevant health insurance information, including benefits spending progress, claims statuses, active prescriptions, and records such as vaccinations, so that I can easily access a comprehensive overview of my health insurance.
As a health plan member, I want to be able to select sections of the dashboard, such as benefits, claims, prescriptions, or health records, and navigate to a more detailed page so that I can access comprehensive information related to that specific area of my health plan.
Universal search – in-network providers, services, and medicines
As a health plan member, I want to have a universal search that allows me to search for in-network providers, services, and medicines in one place, so that I can easily find the healthcare resources I need quickly.
As a health plan member, I want a universal search to intelligently understand whether I'm searching for a provider, service, or medicine and provide relevant results for each type, so that I don't have to perform separate searches in different parts of the app.
As a health plan member, I want to see a map interface when searching for healthcare providers, so that I can easily view where they are located.
As a health plan member, when searching for healthcare providers, I want to view essential information such as their location, contact details, their specialty and the services they offer, patient ratings, and real-time availability with booking options, so that I can make informed decisions on where to find care and easily schedule appointments.
Benefits information page
As a health plan member, I want to see an overview and explanation of my benefits, so that I can easily understand what is covered by my plan.
As a health plan member, I want to see my deductible, co-insurance, and out-of-pocket spending status, including total spent and remaining amounts for each stage, so I can proactively manage my healthcare expenses.
As a health plan member, I want to be able to search my coverage details, so that I can quickly find information about specific services or treatments.
Claims tracking page
As a health plan member, I want to view my claims history, including each claim's status and its relevant information (e.g. Explanation of Benefits), so that I can easily understand the details of my past services and what I paid.
As a health plan member, I want to be able to submit healthcare claims manually, so that I can seek reimbursement when visiting out-of-network providers or when in-network providers don't submit claims on my behalf.
As a health plan member, I want to submit documentation for claims digitally, so that I can avoid the hassle of tracking paper documents and experience an overall quicker processing of my claims.
As a health plan member, I want to receive notifications for claim updates, so that I can stay informed about the progress of my claims.
Active Prescriptions page
As a health plan member, I want to access a dedicated "Prescriptions" page that displays my active prescriptions and has functionality to refill them, so that I can conveniently manage my medications.
View and manage dependents information
As a health plan member, I want to view my dependents' health insurance information, so that I can easily access and understand their benefits within the scope of my health plan.
Support Chat Options
As a health plan member, I want to chat with member support within the app regarding questions about coverage, claims, or other issues and receive push notifications for new messages, so that I can resolve issues and get questions answered without the inconvenience of phone calls.
Account management
As a health plan member, I want to manage my account information and preferences, including personal details, communication methods, security settings, language, and accessibility options, so that my information is correct, I receive communications as desired, and I can interact with the platform easily.
Billing / Payments
As a health plan member, I want to view my billing information, including amounts due, due dates, and payment history, so that I am informed about what I am responsible for paying.
As a health plan member, I want to manage my payments by saving payment details, setting up recurring payments, as well as making one-time payments for premiums or claims, so that I can manage my bills easily.