Form #3 Form #3 Health Plan Information Form

Attachment E: Health Plan Information Form

Health Plan Information Form

Each health plan that administered the CAHPS Health Plan survey and submits data to the Health Plan Survey Database must provide information about the Health Plan which includes such details as the name of the plan, the product type (e.g., HMO, PPO), the population surveyed (e.g., adult Medicaid or child Medicaid), plan State, total enrollment at time sample frame was generated, mode of survey administration (mail, telephone, IVR) and how the sample was selected.