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Old 03-02-2008, 02:36 AM
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Default $75 Health Insurance Study - San Francisco, CA area

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We are looking for participants for a health insurance study.

Thursday March 6th
Friday March 7th

Downtown San Francisco, near Embarcadero BART station

Approximately 45 min

You will receive $75 mailed by check for your participation.

To participate in this study, you MUST be currently insured by a health insurance company other than Kaiser.

If you’re interested in participating, please fill in your info below and answer ALL of the following questions and return by e-mail.


INSTRUCTIONS: Type an "X" next to your answer.

1. When are you available to meet with us? (Check all that apply.)

THURSDAY March 6th
___ 9:00 AM
___ 11:00 AM
___ 12:00 noon
___ 1:30 PM
___ 2:30 PM
___ 4:00 PM
___ 5:00 PM

FRIDAY March 7th
___ 9:00 AM
___ 10:00 AM
___ 11:00 AM
___ 12:30 PM
___ 1:30 PM
___ 2:30 PM

2. What healthcare company are you currently insured by?
___ Healthnet
___ Blue Shield of CA
___ Blue Cross of CA
___ Pacificare
___ Other:

3. Have you used your health insurance benefits within the last 6 months?
___ Yes
___ No

4. What kind of health plan do you have?
___ HMO
___ PPO
___ Other (Please Specify):

5. Who is on your health plan with you?
___ You only
___ You and spouse
___ You and spouse, dependents
___ You and dependents
___ Other:

6. Have you participated in a Focus Group or Usability Study in the last six months?
___ Yes
___ No

7. What is your level of education?
___ High school
___ Some College
___ College Graduate
___ Graduate Degree
___ Other

8. Do you work for Blue Shield of California, Blue
Cross, Kaiser, Pacific Care, Healthnet, or a Health
Insurance Broker?
___ Yes
___ No

9. May I call to ask you a few questions to see if
you have the characteristics we’re looking for?

___ Yes, my telephone number is: _______________
___ No

(I will not disclose your telephone number to anyone, ever. And the information you share with us will be kept strictly confidential).

Thank you!
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