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Accessibility and Health Insurers: What Section 508 and ADA Legislation Mean For Health, Medicaid and Medicare Insurance Organizations

Ensuring compliance for both Section 508 and the ADA means not only creating accessible core content, but making sure that all online PDF documents are also accessible.First published on

More than ever, health insurance organizations – including Medicare and Medicaid programs – are tackling the issue of online accessibility, including accessible online PDFs. They have to: they face financial penalties and the risk of losing government contracts if they don’t.

Two separate concerns have created this emerging demand:
1. Like federal government agencies, private health insurers are looking for ways to comply with Section 508 of the Rehabilitation Act. Since these private organizations have contracted with the federal government (Centers for Medicare and Medicaid Services) to offer the Medicare and Medicaid programs, access to the program must meet this federal regulation. The regulation requires they ensure access to and use of their websites and digital documentation to people with disabilities, including the blind or visually impaired who use screen reader software to visit the web and read their electronic documents. Non-compliance could lead to the loss of lucrative contracts for insurers.

2. The Americans with Disabilities Act (ADA) legislates accessibility in the United States, and currently this legislation doesn’t mention web and web content accessibility specifically, although that may be about to change. Since the 1990s, disabled plaintiffs have triumphed in many structured negotiations, agreements and lawsuits against large private organizations that did not make their website and web content accessible to them. The rulings have generally fallen under the ADA’s Title III which defines “places of public accommodations”. Judges have agreed in these lawsuits that websites and its content are indeed an extension of a brick and mortar business, a public accommodation, for those organizations otherwise required to comply with the ADA. That risk of litigation is likely to increase if a proposal by the Civil Rights Division of the Department of Justice (DOJ) goes through, asking for an amendment to Title III to update the definition of “places of public accommodation” to definitively include websites and online information. To avoid the potential threat of large settlements, health insurers need to begin implementing measures to make their digital information and communications accessible.

Ensuring compliance for both Section 508 and the ADA means not only creating accessible core content, but making sure that all online PDF documents are also accessible. That includes the thousands of informational PDF documents and collaterals typically associated with Medicare and Medicaid programs on an insurers’ websites, but also includes a more onerous category of PDFs; the e-delivered communications like statements and notices such as billing statements, EOBs (Explanation of Benefits) SBs (Summary of Benefits), etc. Why are these documents such an onerous challenge to make accessible? Traditionally, making PDFs accessible requires a manual tagging approach. Even when a document is created with accessibility in mind and converted to a tagged PDF, those tags still often need to be manually adjusted in order to give a screen reader user full navigation and usability of the document. This is a labor intensive process that can be time and cost prohibitive at high volumes. Since insurers are generating these statements and notices for thousands or even millions of members every month, the page counts can be in the millions, hundreds of millions or even billions, making a manual process simply not scalable.

That’s all changed now, though. New technology exists that can convert these high-volume e-delivered PDF communications on the fly, meeting the Web Content Accessibility Guideline standards (WCAG 2.0 Level AA) and making them accessible to visually impaired customers on demand. By negating the need for manual PDF remediation, this makes creating accessible statements and notices obtainable. Plus it’s more cost effective and far less time consuming, converting a single statement in milliseconds. Now the insurer’s visually impaired customers no longer have to wait for their accessible version, a traditional frustration for those customers who were given less time to make critical health and financial decisions based on information in the documents.

The issue of website and online document accessibility isn’t going to go away for health insurers. To keep contracts and avoid risks of penalties, fines, lawsuits, and brand damage – while ensuring comparable access and opportunity for their blind and visually impaired customers – they’ll need to comply. The right plan of action, with accessibility technology in place, can help them do so.

Are you a health, Medicare or Medicaid insurer? How could new PDF accessibility technology help you strategize your compliance plan moving forward? Offer your thoughts in the comments section below.

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