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Overview and Objectives

Choosing Healthplans All Together (CHAT) is a simulation exercise, which is intended to help participants understand the need for allocation and optimization of health insurance funding. It takes into account the needs and values of different stakeholders regarding health benefits coverage. Researchers and physician ethicists at the University of Michigan Medical School and the National Institutes of Health created CHAT as an exercise for consumers. With permission and licensing from the developers, THCI modified the educational scenario and materials for use in the Mini-Rotation. For this activity, learners worked in breakout groups of 8-9 participants and one facilitator.

THCI Objectives: By the end of this session, participants should be able to recognize:

  • The complex factors underlying health insurance benefit design.
  • Perspectives of different stakeholders – including employers, insurers, patients, providers, and elected officials – in health insurance benefit design.


  • CHAT Board, mounted on a foam core board displaying a range of health benefits and levels of coverage.
  • Fifty (50) pushpins for each small group to indicate benefits and levels they decide to cover.
  • THCI’s planning scenario and roles for the exercise participants (see Materials, below)

Description of the Exercise

The assignment to each small group is to design a health insurance benefit package. There are fifteen health services, or benefits, that could be included, such as Hospitalization, Mental Health, and Vision Care. Each of these fifteen health care services has one, two, or three coverage levels—Basic, Medium, High—for a total of thirty-three service coverage options. Each service and coverage option is valued at a specified number of pushpins (e.g., Home Health / Basic coverage requires 2 pins; Specialty Care / High coverage requires 16 pins).

Coverage of all services at the highest levels requires 83 pushpins. However, the group is allocated only 50 pushpins. Therefore, as a group, participants must negotiate and select what services are most important to include to best serve their community, and at what levels of coverage. In addition, in THCI’s scenario, each participant is assigned a role as a stakeholder, e.g., consumer, practicing physician, health plan manager, hospital director, or corporate benefits manager. As participants express their coverage preferences, they consider their assigned stakeholder’s perspective.

Each breakout group must weigh trade-offs in designing its recommended health insurance plan with finite resources. The groups then reconvene and report to the full group on their discussions and plan design.

Licensing: Learn more about CHAT, including contact information. Sponsors and organizers who wish to use CHAT with their learners should review the licensing information and contact the original developers as instructed. After securing a license to use the “CHAT Board” and “Description of Benefits,” you may use Tufts Health Care Institute’s modification of this educational exercise as you wish.

Additional information and materials for the THCI CHAT Exercise