Beneficiaries Survey

ID Number: CMS-10615
OMB Control Number: 0938-1300

Expires: TBD

Si usted tiene preguntas acerca de esta encuesta o desea recibirla en español, por favor llame al Thoroughbred Research Group al 1-844-859-7862.

[DATE]

ID#

[FIRST NAME] [LAST NAME]

[ADDRESS]

[CITY, STATE AND ZIP]

Dear [HONORIFIC.] [LAST NAME]:

In a few days, you will receive a questionnaire in the mail called the "Healthy Indiana Plan 2.0 Survey." When it arrives, we would greatly appreciate it if you would take the time to fill out this questionnaire. The Centers for Medicare & Medicaid Services (CMS) is the federal agency that administers the Medicare and Medicaid programs and our responsibility is to ensure that you get high quality care. One of the ways we can fulfill this responsibility is to find out directly from you about your care under the HIP 2.0 program.

The questionnaire you will receive asks about your experiences with health care in the HIP 2.0 program. Your name was selected at random from among HIP 2.0 enrollees or disenrollees. The accuracy of the results depends on getting answers from you and others selected for this survey. This is your opportunity to help us serve you better. No one will be able to link your answers to your identity. Your participation is voluntary and will not affect any health care or benefits you receive.

You can participate in this survey now by typing the link below into your Internet browser’s address bar and using your personal login ID and password to access the survey.

https://www.torfasttrack.com/wn434mem <final web survey link inserted later>

Login = ID# Password = ????????

You do not have to participate in this survey. Your help is voluntary, and your decision to participate or not to participate will have no effect on your medical benefits.

We hope that you will take the opportunity to answer the survey. Your knowledge and experiences could help other people enrolled in the HIP 2.0 program to make more informed health care choices. Thoroughbred Research Group, Inc. is a research organization working with CMS to carry out this survey. If you have any questions about the survey, please call Thoroughbred Research Group toll-free at 1-844-859-7862 anytime from 9:00 am to 6:00 pm your local time, Monday through Friday. Thank you for your help with this important survey.

Sincerely,

David A. Bryant

Vice President, Health Policy Research

Thoroughbred Research Group