A Guide to Offering Accessible Health Spending Benefits

Applying accessibility guidelines to FSAs, HRAs, HSAs, and more.

Digital tools promise a more convenient world. Instead of waiting on hold or traveling across town, a member can understand their FSA balance, buy healthcare essentials, and file a claim — when and where they want to. But that promise is not a guarantee.

For organizations that want to offer accessible health spending benefits, building a website or an app is just the first step. Teams must also carefully apply accessibility guidelines to ensure that all program members can fully understand their benefits. In this guide, we'll break down the World Wide Web Consortium's accessibility guidelines through the lens of organizations that offer pre-tax accounts, lifestyle benefits, supplemental benefits, and rewards programs.

Designing for accessibility will help you design a better product for everyone. Accessibility guidelines are best practices for product design.

Camri Hinkie
VP of Design

What’s the WCAG?

The World Wide Web Consortium (W3C) publishes the Web Content Accessibility Guidelines (WCAG) to build a more inclusive internet. By following these guidelines, organizations can create digital content that reaches members who leverage assistive technologies for blindness and low vision, deafness and hearing loss, and more when consuming content on the internet. 

What are assistive technologies? Examples of assistive technologies include:

  • Screen readers 
  • Braille displays
  • Screen magnification software
  • Voice recognition software
  • Switch devices and
  • Alternative input devices like sip-and-puff controllers
A member accessing the internet via assistive technology.
Your members may use assistive technology to access your platform.

What are the four principles?

The WCAG organizes its guidelines around four principles: perceivable, operable, understandable, and robust. In the coming sections, we'll review each principle through the lens of offering health spending benefits. 

To fully understand all of WCAG's standards, you should read through its scoring criteria. The purpose of this guide is not to share every rule but to highlight fundamental principles and good practices for organizations that want to offer accessible health spending benefits. 

The four principles of WCAG principles: perceivable, operable, understandable, and robust. Perceivable is defined as "Information and user interface component must be presentable to users in ways they can perceive" and operable defined as "User interface components and navigation must be operable," understandable as "Information and the operation of user interface must be understandable" and robust as "Content must be robust enough that it can be interpreted reliably by assistive technologies."
This is how First Dollar applies the WCAG's four core principles.

Perceivable accessibility

Information and user interface components must be presentable to users in ways they can perceive.

WCAG 2.1

Provide text alternatives.

Images, videos, and audio are helpful ways of conveying important information to members, and that's why it's essential that everyone can access this content. All organizations should provide text alternatives for non-text content. This can look like the following:

  • Alt-text for images
  • Closed captioning for videos
  • Transcripts for audio

Ensure you have proper color contrast.

Organizations should ensure that their primary colors used for UI elements (like buttons)  have an acceptable color contrast ratio with text. By carefully selecting their colors, the content will be easily distinguishable from its background, so the text is readable for all. First Dollar recently discovered one of our primary UI colors wasn't meeting this standard, so we made an update.

An example of First Dollar's updated primary colors for accessibility.
We updated our primary UI color because it failed to meet color contrast requirements.

Operable accessibility

Operable - User interface components and navigation must be operable. This means that users must be able to operate the interface (the interface cannot require interaction that a user cannot perform).

WCAG 2.1

Ensure your benefits are accessible by keyboard.

Some members may not use a mouse when accessing your website or platform. For that reason, ensure all members can operate all functionality and interactive elements with just a keyboard. 

Avoid “fat finger” issues.

Tapping on screens can be harder if you only have one hand, are holding a baby, experience tremors, or have bigger fingers.

Language Note: "Select" is mobile-friendly and assistive technology-friendly, while "click" is closely tied to the use of a mouse. By adopting "select," you'll create better instructions throughout your platform for all users.

First Dollars touch target sizes demonstrated for checkboxes and radios.
First Dollar’s touch target size goals to ensure our Health Wallet is operable for all.

Understandable accessibility

Understandable - Information and the operation of the user interface must be understandable.

WCAG 2.1

Creating understandable content can feel like a tall task in a world filled with jargon, but it's a responsibility for organizations looking to educate their members. At First Dollar, we aim to create understandable content through plain, consistent language across the entire experience that's localized for a user's native language. 

Use plain language.

Plain language is a concept that's hard to define but easy to recognize. Plain Language.gov, an official website of the United States government, shares the following guidance.

Language that is plain to one set of readers may not be plain to others. Material is in plain language if your audience can:

  • Find what they need
  • Understand what they find the first time they read or hear it
  • Use what they find to meet their need
  • PlainLanguage.Gov

At First Dollar, we built a taxonomy to document all the health spending benefits we power. This task wasn't straightforward as the industry often has a lack of alignment for account names. When we had to make a choice, we chose to simplify the terms to language that would most be familiar to members, like "Fertility Reimbursement" instead of "Health Reimbursement Account." Yes, a fertility reimbursement is a form of an HRA, but most members will know their HRA as their fertility benefit.  This is how the account names show up in our Health Wallet for individuals and our Health Wallet Manager for administrators.

A table highlighting First Dollar's taxonomy for health spending benefits with limited purpose flexible spending account, health reimbursement arrangement, and fertility HRA as an example.
For alignment, First Dollar built a taxonomy for the names of our health spending benefits.

Localization ensures plain language is accessible for everyone.

Simple words spoken in an unfamiliar language aren't very plain. Organizations must localize their entire experience to their members' languages to provide understandable content. 

True localization is better than translation.

There needs to be more than copying and pasting from Google. Localizing content means:

  • Ensuring voice and tone are similar in each experience
  • Content captures the intent and meaning of the original source
  • Differing audience goals and needs are accounted for
  • All content is dynamic and adaptable, so multiple languages can be displayed without altering the source code.

Offering content and support in a member's first language empowers them and their families to understand and utilize their healthcare funds.

"- Natalie Molina
Customer Success Associate
An example of a wellness and commuter account in English and Spanish.
Define accounts by how individuals use them and provide them in their first language.

Robust accessibility

Robust - Content must be robust enough that it can be interpreted by a wide variety of user agents, including assistive technologies.

WCAG 2.1

Members of your population may use different tools to access content on your platform or app. Some members may depend on user agents like a Chrome browser, while others may use assistive technologies like a screen reader or magnification software. When creating your content and technology, ensure maximum compatibility with every way that your population may access your content.

From a technical perspective, this means ensuring elements have start and end tags or are correctly nested. If headers are not in a sequentially descending order, assistive technology may read the content out of the intended order, confusing the member.

From a content perspective, content creators should seek to convey meaning and status through multiple sensory characteristics. Don't rely solely on color to convey meaning, especially regarding statuses. Instead, use a combination of color, shape, symbol, and text.

An example of using multiple characteristics to convey status. A checkmark and green highlight of the phrase, "All items are HSA eligible." An x symbol and red highlight of the copy "This amount exceeds your available funds to spend" and an exclamation mark and yellow highlight for the phrase, "The market has closed. Buying and selling will resume at market open."
Health Wallet statuses convey meaning through color, symbol, and text.

If Health Wallet statuses were only conveyed with a color, a member using a screen reader would miss out on that helpful context. By using color, symbol, and text to convey statuses, more members can understand this important context. Applying the robust principle also creates a more well-designed product for all; accessibility principles are good design principles.

Stop signs are a good way to remember.

Here's a non-Internet example to help remember this concept. Stop signs are:

  • The color red.
  • Say "STOP" in all caps, and 
  • In the shape of an octagon.

Traffic engineers give drivers three ways to recognize this vital traffic signal; we should do the same for health spending benefits.

Testing for accessibility

For developers looking to test their organization’s platform for accessibility, there are many options. Here are some of our favorites:

  • Axe, an accessibility testing library for React applications, can be used to test local development (not production).
  • Google Lighthouse is an open-source, automated tool with an accessibility audit that can be run against any web page. It will give you a score out of 100 and include various things that might need improvement.

How does First Dollar test for accessibility?

First Dollar uses axe-core to audit client applications for critical accessibility issues automatically. This tool runs in our local development environment to surface any new issues early before they’re released in other environments. On an annual basis, we also run manual reports on a subset of our application pages using Google Lighthouse.

For identifying and resolving accessibility issues discovered between bi-annual tests, we ask customers to email support@firstdollar.com. Upon receiving the information, our team will create a ticket for the issue and send it to the appropriate product manager for prioritization to resolve said issue.

What's First Dollar’s accessibility score?

Our most recent accessibility audit was performed on February 7, 2023, through Google Lighthouse. In that audit, the First Dollar Health Wallet (desktop) received an accessibility score of 97 out of a possible score of 100.

Josh Hostetler

Josh leads content for First Dollar, a fintech company that builds infrastructure for health spending benefits. Before First Dollar, Josh led course creation at Aceable, taught First Grade, waited tables at Olive Garden, and wore many other hats. He misses the breadsticks.