> **FEHB Program Carrier Letter U.S. Office of Personnel Management**

### All Carriers Office of Insurance Programs

> **Letter No. 2000-03 Date: January 19, 2000**
>
> Fee-for-service \[03\] Experience-rated HMO \[03\] Community-rated
> \[03\]
>
> **SUBJECT:** **Consumer Assessment of Health Plans Survey**

This letter provides instructions for conducting Consumer Assessments of
Health Plans Surveys (CAHPS®) in 2000. All Federal Employees Health
Benefits (FEHB) plans with at least 500 FEHB subscribers (contracts) as
of March 31, 1999, must conduct the CAHPS® 2.0H Adult Commercial Survey.
Also, we require you to add two supplemental questions to the Adult
Survey (Enclosure 1 contains the Adult Survey and supplemental questions
we want you to add to the questionnaire). If you have fewer than 500
FEHB Subscribers and are conducting the Adult Survey or the Child Survey
for other lines-of- business or for National Committee for Quality
Assurance (NCQA) accreditation you must report your survey results to
OPM.

This year we do not require you to report the smoking cession measures
included in the Adult Survey. We do not require you to conduct the Child
Survey or the new Management of Menopause (MoM) Survey in 2000. However,
if you administer the Child Survey you must send us a copy of the survey
results.

## Reporting Deadlines

Please note the following reporting deadlines for reporting CAHPS® 2.0H
data and other information to OPM:

-   Vendor Selection Form - January 31, 2000

-   Interim Reports - March 20, 2000

-   Final Reports -- Member Level Data Files -- June 9, 2000

-   Final Reports -- Summary Level Data Files (NCQA validated) -- July
    10, 2000

## Public Burden Statement

Please include the following statement on questionnaires you mail to
respondents: "This information collection has been approved by the U.S.
Office of Management and Budget (Control Number 3206-0236) and is in
compliance with the Paperwork Reduction Act of 1995. We estimate that it
will take an average of 20 minutes to complete, including the time to
read instructions and to gather necessary information. Send comments
regarding our estimate and any suggestions for minimizing respondent
burden, reducing completion time or any other aspect of this information
collection to the U.S. Office of Personnel Management (OPM), Reports and
Forms Manager, (OMB Number 3206-0236), Washington, DC 20415-7900. Your
participation in this information collection is voluntary. The OMB
Number, 3206-0236, is currently valid. OPM may not collect this
information, and you are not required to respond, unless this number is
displayed." Also, include the following statement in the upper right
corner of each questionnaire: "Form approved: OMB No. 3206-0236."

# [Data Collection Vendor]{.underline}

FEHB plans must use a NCQA certified vendor to administer their CAHPS®
2.0H Surveys. You may contract with any NCQA certified vendor. A list of
approved vendors is available online at
<http://www.ncqa.org/pages/policy/hedis/surveys.htm>.

Please complete and return the enclosed Vendor Selection Form (Enclosure
2) to let us know the name of the vendor you will be using to collect
and report CAHPS® 2.0H data. If you offer more than one FEHB plan,
complete a separate Vendor Selection Form for each plan you will be
surveying. The deadline for returning your completed Vendor Selection
Form is January 31, 2000. You may send us the forms by facsimile to
(202) 606-0036, or by overnight mail to:

> U.S. Office of Personnel Management
>
> Retirement and Insurance Service
>
> Office of Insurance Programs
>
> Attention: Ralph Pierce
>
> 1900 E Street, NW., Room 3415
>
> Washington, DC 20415

# 

# [Pre-Administration Audit Requirement]{.underline}

FEHB plans seeking NCQA Accreditation must arrange for their NCQA
certified auditor to verify the integrity of the sample frame before the
vendor draws the sample and administers the CAHPS® survey. Please
contact NCQA's Technical Inquiry Line at (202) 955-5697, or via e-mail
at <hedis@ncqa.org> with any questions about this requirement. If you
are an FEHB plan that is not seeking NCQA Accreditation you do not have
to meet this requirement.

## 

## Survey Instruments & Protocols

Your vendor must use the CAHPS® 2.0H questionnaire (see Enclosure 1 for
a copy of the instrument). Vendors must administer the survey and report
survey results according to the protocols in Volume 3 of NCQA's HEDIS®
2000. All NCQA vendors have received copies of HEDIS® - Volume 3, which
includes the survey instrument and protocols. NCQA's Publication
Department has additional copies available for purchase at (800)
839-7487.

## 

## Membership Data & Sample Frame

We advise you to work closely with your vendor to draw sample frames for
your survey. You must draw the sample according to NCQA protocols,
except that you must draw the sample frame from all currently enrolled
commercial members, including all FEHB members, [regardless of their
Medicare status]{.underline}. The sample frame should only include
members continuously enrolled in the plan for at least 12 months for the
period ending December 31, 1999. The sample size is 850 for the Adult
Survey. Over-sampling, is permissible according to NCQA protocols.

Your membership file and or sample frame must include the required data
file elements contained in Table S-1 of HEDIS 2000, Volume 3 (See
Enclosure 3). In addition, the data files must include your FEHB plan
name and your FEHB Sub-Code (See Enclosure 4 for a list of Plan names
and Sub-Codes). You must add these elements at the end of each header
record.

[Reporting Survey Data to OPM]{.underline}

Your vendor must report member level CAHPS® 2.0H data according to
NCQA's Adult Survey File Specifications and Layouts (see Enclosure 5).
In addition to NCQA's data file elements, the member level file must
include your FEHB plan name and your FEHB Sub-Code. You must add these
elements at the end of each header record. Have your vendor add survey
response data for the two supplemental questions at the end of the
member level file in field positions 125 and 126-127.

Beginning in 2000, to ensure consistency and comparability of survey
results NCQA will create and validate summary level data files on behalf
of vendors. We require plans submitting data to NCQA to provide OPM with
a copy of the validated summary level data files received from NCQA. OPM
or its contractor will compute summary level data for FEHB plans that do
not submit survey data to NCQA.

## Reporting Format

We will accept your Adult Survey and or other CAHPS® Surveys (conducted
for other lines-of-business) Member Level Data files and Summary Level
Data files (computed and validated by NCQA) on diskette or compact disc
(CD). You may include results for multiple plans on a single diskette or
CD. All disks/discs must have a content label to include the Plan(s)
name and FEHB Sub-Code(s). If you want OPM to apply one plan's survey
data to another plan, include clear instructions with your submission
\-- include the name of the primary plan (the plan listed in the header
record) and the plan's FEHB Sub-Code. Then, list the name(s) and FEHB
Sub-Code(s) of the plan that will be using the primary plan's data.
[Please send all data files to Ralph Pierce, at the address listed
above]{.underline}.

## 

## 

## 

## Interim Report

All plans must submit preliminary member level data files to us for our
review. Submit this report in the file format described above. Include
all surveys received and processed through March 3, 2000. This interim
report will test your vendor's understanding and ability to meet our
reporting requirements. In addition, it will give us time to work with
your vendor to correct reporting related problems.

## Final Report

The format for the Final Report will be the same as the Interim Report.
The Adult Member Level Data File will contain your complete survey
results, including results for the two supplemental questions. FEHB
Plans with NCQA computed Summary Level Data will include an electronic
copy of their validated Summary Level Data File with their Final Report.
In addition, this report will include final data for any other CAHPS®
2.0H Survey conducted for other lines of business.

[Processing Fee]{.underline}

Each plan participating in the survey will be responsible for a pro rata
share of the total cost of compiling, processing and reporting CAHPS®
2.0H Survey data to OPM. OPM will negotiate a fixed fee with a
contractor who will be responsible for these functions. The fee will
apply to each FEHB Sub-Code. We will provide you with the amount of the
fee later.

Our contractor will send you an invoice for the data processing fee. The
fees are payable directly to OPM's contractor and will be due on June 9,
2000. We will provide you with the contractor's name and address later.

We appreciate your cooperation and look forward to working with you.
Please contact Ralph Pierce (<rpierce@opm.gov>) or Tanya Morrow
(<tmmorrow@opm.gov>) with any questions you may have. You may reach them
by telephone at (202) 606-0745.

Sincerely,

(signed)

Frank D. Titus

Assistant Director

for Insurance Programs

Enclosures

**SUPPLEMENTAL QUESTIONS**

Please add the following two questions to the Adult questionnaire:

60\. Do you have a child covered under your current health plan?

\_\_\_\_ No [Please return the survey in the postage paid
envelope]{.underline}

\_\_\_\_ Yes [Go to Question 61]{.underline}

61\. We want to know your rating of all your experience with [your
child's health plan]{.underline}.

Use [any number from 0 to 10]{.underline} where 0 is the worst health
plan possible, and 10 is the best health plan possible.

How would you rate your child's health plan [now]{.underline}?

0 Worst health plan possible

1

2

3

4

5

6

7

8

9

10 Best health plan possible

  --------------------------------------------------- ------------ ----- ---- -----
  **PLAN NAME**                                       **FEHB                  
                                                      SUB-CODE**              

  Advantage Care, Inc.                                XW           HMO   KY   000

  Aetna U.S. Healthcare                               2U           HMO   GA   000

  Aetna U.S. Healthcare                               2X           HMO   CA   000

  Aetna U.S. Healthcare                               3G           HMO   NC   000

  Aetna U.S. Healthcare                               3G           HMO   SC   000

  Aetna U.S. Healthcare                               5B           HMO   TX   000

  Aetna U.S. Healthcare                               5U           HMO   RI   000

  Aetna U.S. Healthcare                               6F           HMO   CO   000

  Aetna U.S. Healthcare                               6J           HMO   TN   000

  Aetna U.S. Healthcare                               6T           HMO   IL   000

  Aetna U.S. Healthcare                               6T           HMO   MO   000

  Aetna U.S. Healthcare                               7K           HMO   KS   000

  Aetna U.S. Healthcare                               8A           HMO   FL   000

  Aetna U.S. Healthcare                               8J           HMO   WA   000

  Aetna U.S. Healthcare                               8L           HMO   NV   000

  Aetna U.S. Healthcare                               8V           HMO   OK   000

  Aetna U.S. Healthcare                               8X           HMO   TX   000

  Aetna U.S. Healthcare                               8Z           HMO   MI   000

  Aetna U.S. Healthcare                               9M           HMO   ME   000

  Aetna U.S. Healthcare                               BU           HMO   CA   000

  Aetna U.S. Healthcare                               H1           HMO   CT   000

  Aetna U.S. Healthcare                               JC           HMO   NY   000

  Aetna U.S. Healthcare                               JN           HMO   DC   000

  Aetna U.S. Healthcare                               JN           HMO   MD   000

  Aetna U.S. Healthcare                               JN           HMO   VA   000

  Aetna U.S. Healthcare                               KL           HMO   PA   000

  Aetna U.S. Healthcare                               NE           HMO   MA   000

  Aetna U.S. Healthcare                               NG           HMO   LA   000

  Aetna U.S. Healthcare                               NK           HMO   DE   000

  Aetna U.S. Healthcare                               P3           HMO   NJ   000

  Aetna U.S. Healthcare                               RD           HMO   IN   000

  Aetna U.S. Healthcare                               RD           HMO   KY   000

  Aetna U.S. Healthcare                               RD           HMO   OH   000

  Aetna U.S. Healthcare                               SU           HMO   PA   000

  Aetna U.S. Healthcare                               TK           HMO   LA   000

  Aetna U.S. Healthcare                               TS           HMO   TX   000

  Aetna U.S. Healthcare                               UJ           HMO   NH   000

  Aetna U.S. Healthcare                               V8           HMO   DC   000

  Aetna U.S. Healthcare                               V8           HMO   MD   000

  Aetna U.S. Healthcare                               V8           HMO   VA   000

  Aetna U.S. Healthcare                               WQ           HMO   AZ   000

  Aetna U.S. Healthcare                               XC           HMO   IL   000

  Aetna U.S. Healthcare                               XC           HMO   IN   000

  Aetna U.S. Healthcare                               Z1           HMO   VA   000

  Alliance Health Plan                                1R           FFS   AA   000

  Altius Health Plans                                 9K           HMO   UT   000

  Altru Health Plan                                   2R           HMO   MN   000

  Altru Health Plan                                   2R           HMO   ND   000

  American Healthcare Trust, Inc                      4U           HMO   TN   000

  American HMO                                        AC           HMO   IL   001

  American HMO                                        AC           HMO   IN   001

  AmeriHealth HMO                                     FK           HMO   NJ   000

  AmeriHealth HMO                                     SP           HMO   DE   000

  Antero HealthPlans                                  9X           HMO   CO   000

  APWU Health Plan                                    47           FFS   AA   000

  APWU Health Plan                                    47           FFS   MN   001

  APWU Health Plan                                    47           FFS   TX   001

  Arnett HMO                                          G2           HMO   IN   000

  Association Benefit Plan                            42           FFS   AA   000

  Athens Area Health Plan Select                      8Y           HMO   GA   000

  AultCare HMO                                        3A           HMO   OH   000

  Av-Med Health Plan                                  EM           HMO   FL   000

  Av-Med Health Plan                                  GP           HMO   FL   000

  Av-Med Health Plan                                  H5           HMO   FL   000

  Av-Med Health Plan                                  HW           HMO   FL   000

  Av-Med Health Plan                                  JF           HMO   FL   000

  BCI HMO, Inc.                                       3B           HMO   IL   000

  BCI HMO, Inc.                                       3B           HMO   IN   000

  Beacon Health Plans                                 4K           HMO   FL   000

  Blue Care Network West MI                           G7           HMO   MI   000

  Blue Care Network West MI                           K5           HMO   MI   000

  Blue Care Network West MI                           KF           HMO   MI   000

  Blue Care Network West MI                           KN           HMO   MI   000

  Blue Care Network West MI                           KR           HMO   MI   000

  Blue Care Network West MI                           LN           HMO   MI   000

  Blue Care Network West MI                           LX           HMO   MI   000

  Blue Chip, Coord Hlth Partners                      DA           HMO   MA   001

  Blue Chip, Coord Hlth Partners                      DA           HMO   RI   001

  Blue Choice                                         MK           HMO   NY   000

  Blue Cross and Blue Shield                          10           FFS   AA   000

  Blue Cross and Blue Shield                          10           POS   CT   001

  Blue Cross and Blue Shield                          10           POS   GA   001

  Blue Cross and Blue Shield                          10           POS   KS   001

  Blue Cross and Blue Shield                          10           POS   LA   001

  Blue Cross and Blue Shield                          10           POS   MA   001

  Blue Cross and Blue Shield                          10           POS   MN   001

  Blue Cross and Blue Shield                          10           POS   ND   001

  Blue Cross and Blue Shield                          10           POS   NJ   001

  Blue Cross and Blue Shield                          10           POS   NY   001

  Blue Cross and Blue Shield                          10           POS   OH   001

  Blue Cross and Blue Shield                          10           POS   OK   001

  Blue Cross CaliforniaCare                           M5           HMO   CA   000

  Blue Shield of CA Access+                           SJ           HMO   CA   000

  BlueCHOICE                                          9G           HMO   MO   000

  BlueChoice HMO                                      5K           HMO   NY   000

  BlueChoice HMO                                      5L           HMO   NY   000

  BlueChoice HMO                                      S7           HMO   NY   000

  Bluegrass Family Health                             2B           POS   KY   000

  BlueLincs HMO                                       N5           HMO   OK   000

  C.D.P.H.P.                                          SG           HMO   NY   000

  Capital Health Plan                                 EA           HMO   FL   000

  CapitalCare                                         2G           HMO   DC   000

  CapitalCare                                         2G           HMO   MD   000

  CapitalCare                                         2G           HMO   VA   000

  Care Choices                                        FA           HMO   IA   000

  Care Choices                                        FA           HMO   NE   000

  Care Choices                                        FA           HMO   SD   000

  Carelink Health Plans                               4C           HMO   WV   000

  Certus HealthCare                                   3Y           HMO   TX   000

  CHP of Ohio                                         MG           HMO   OH   000

  CIGNA CoMED HealthCare                              P4           HMO   NJ   000

  CIGNA HC of AZ-Phoenix                              16           HMO   AZ   000

  CIGNA HealthCare of California                      9T           HMO   CA   000

  CIGNA HealthCare of CO                              1C           HMO   CO   000

  CIGNA HealthCare of NY                              HU           HMO   NY   000

  CIGNA HealthCare of VA                              W2           HMO   VA   000

  CIGNA HealthCare of VA                              W3           HMO   VA   000

  CommunityCare HMO                                   7C           HMO   OK   000

  Compcare Health Services                            69           HMO   WI   000

  Compcare Health Services                            6X           HMO   WI   000

  ConnectiCare                                        TE           HMO   CT   000

  Dean Health Plan                                    WD           HMO   WI   000

  Doctors Health Plan, Inc.                           6D           HMO   NC   000

  Doctors Health Plan, Inc.                           6D           HMO   SC   000

  Exclusive Healthcare                                9Y           HMO   IA   000

  Exclusive Healthcare                                9Y           HMO   NE   000

  Fallon Community Health Plan                        JV           HMO   MA   000

  Family Health Plan                                  WH           HMO   WI   000

  First Choice Health Plan                            5G           HMO   WA   000

  First Priority Hlth                                 C8           HMO   PA   000

  FIRSTCARE                                           6U           HMO   TX   000

  FIRSTCARE                                           CK           HMO   TX   000

  FIRSTCOMMUNITY HEALTH PLAN, INC.                    2V           HMO   AL   000

  Foreign Service                                     40           FFS   AA   000

  Foundation Health                                   5C           HMO   FL   000

  Foundation Health                                   5D           HMO   FL   000

  Foundation Health                                   5E           HMO   FL   000

  Free State Health Plan                              LD           HMO   DC   001

  Free State Health Plan                              LD           HMO   MD   001

  Free State Health Plan                              LD           HMO   PA   001

  Free State Health Plan                              LD           HMO   WV   001

  GEHA Benefit Plan                                   31           FFS   AA   000

  GEHA Benefit Plan                                   31           POS   NE   001

  Generations Family Health Plan                      8B           HMO   NC   000

  George Washington Univ HP                           E5           HMO   DC   000

  George Washington Univ HP                           E5           HMO   MD   000

  George Washington Univ HP                           E5           HMO   VA   000

  GHI Health Plan                                     80           HMO   NJ   001

  GHI Health Plan                                     80           HMO   NY   001

  GHI HMO Select                                      6V           HMO   NY   000

  GHI HMO Select                                      X4           HMO   NY   000

  Grand Valley Health Plan                            RL           HMO   MI   000

  Group Health Coop                                   WJ           HMO   WI   000

  Group Health Cooperative                            54           HMO   WA   000

  Group Health Cooperative                            VR           HMO   ID   000

  Group Health Cooperative                            VR           HMO   WA   000

  Group Health Plan                                   MM           HMO   IL   000

  Group Health Plan                                   MM           HMO   MO   000

  Group Hlth Coop/Eau Claire                          WT           HMO   WI   000

  Guam Memorial Health Plan                           ZA           HMO   GU   000

  Gulf South Health Plan, Inc.                        LY           HMO   LA   000

  Harvard Pilgrim Health Care                         68           HMO   CT   000

  Harvard Pilgrim Health Care                         68           HMO   MA   000

  Harvard Pilgrim Health Care                         68           HMO   ME   000

  Harvard Pilgrim Health Care                         68           HMO   NH   000

  Harvard Pilgrim Health Care                         68           HMO   NY   000

  Harvard Pilgrim Health Care                         68           HMO   VT   000

  Harvard Pilgrim Hlth Care-NE                        70           HMO   MA   000

  Harvard Pilgrim Hlth Care-NE                        70           HMO   RI   000

  Health Alliance                                     52           HMO   MI   000

  Health Alliance HMO                                 7X           HMO   IA   000

  Health Alliance HMO                                 FX           HMO   IL   000

  Health Alliance HMO                                 FX           HMO   IN   000

  Health Maintenance Life                             28           HMO   GU   000

  Health Maintenance Plan(HMP)                        R5           HMO   OH   000

  Health Net                                          LB           HMO   CA   000

  Health New England                                  DJ           HMO   CT   000

  Health New England                                  DJ           HMO   MA   000

  Health Options                                      D7           HMO   FL   000

  Health Options                                      FN           HMO   FL   000

  Health Options                                      FR           HMO   FL   000

  Health Partners of Alabama                          DF           HMO   AL   000

  Health Partners of the Midwest                      RN           HMO   IL   000

  Health Partners of the Midwest                      RN           HMO   MO   000

  Health Plan of Nevada                               NM           HMO   AZ   001

  Health Plan of Nevada                               NM           HMO   NV   001

  Health Plan Upper OH Valley                         U4           HMO   OH   000

  Health Plan Upper OH Valley                         U4           HMO   WV   000

  HealthAmerica Pennsylvania                          26           HMO   PA   000

  HealthAmerica Pennsylvania                          2J           HMO   PA   000

  HealthAmerica Pennsylvania                          SW           HMO   PA   000

  HealthAssurance HMO                                 5X           HMO   OH   000

  HealthAssurance HMO                                 6L           HMO   WV   000

  Healthcare Oklahoma                                 6W           HMO   OK   000

  HealthCarePlan                                      Q8           HMO   NY   000

  HealthFirst HMO                                     8E           HMO   TX   000

  HealthFirst, Inc.                                   RF           HMO   OH   001

  HealthGuard                                         NQ           HMO   PA   000

  Healthkeepers                                       X8           HMO   VA   000

  HealthPartners Classic                              53           HMO   MN   000

  HealthPartners Classic                              53           HMO   WI   000

  HealthPartners Health Plan                          HQ           HMO   MN   000

  HealthPartners Health Plan                          HQ           HMO   ND   000

  HealthPartners Health Plan                          HQ           HMO   WI   000

  HealthPlus MI                                       X5           HMO   MI   000

  Healthsource HMO of NY                              XL           HMO   NY   000

  Heart of America HMO                                RU           HMO   ND   000

  Heritage National Healthplan                        4T           HMO   TN   000

  Heritage National Healthplan                        4T           HMO   VA   000

  HIP Health Plan of FL                               3N           HMO   FL   000

  HIP Health Plan of FL                               K7           HMO   FL   000

  HIP of Greater New York                             51           HMO   NY   000

  HMO Blue                                            5Q           HMO   TX   000

  HMO Blue                                            5R           HMO   TX   000

  HMO Blue                                            AH           HMO   NY   000

  HMO Blue/Rio Grande                                 4Y           HMO   TX   000

  HMO Blue/Rio Grande                                 4Z           HMO   TX   000

  HMO Colorado/Nevada                                 L2           HMO   CO   001

  HMO Colorado/Nevada                                 VS           HMO   NV   001

  HMO Health Ohio                                     L4           HMO   OH   000

  HMO New Mexico                                      5H           HMO   NM   000

  HMO-CNY                                             EB           HMO   NY   000

  HMSA                                                87           HMO   HI   001

  Hometown Health Plan                                4H           HMO   NV   000

  Humana Care Plan                                    18           HMO   IN   000

  Humana Care Plan                                    18           HMO   KY   000

  Humana Care Plan                                    HR           HMO   KY   000

  Humana Health Plan                                  D2           HMO   IN   000

  Humana Health Plan                                  D2           HMO   KY   000

  Humana Health Plan Inc.                             75           HMO   IL   000

  Humana Health Plan Inc.                             75           HMO   IN   000

  Humana Health Plan of AZ                            DY           HMO   AZ   000

  Humana Health Plan of Texas                         TW           HMO   TX   000

  Humana Health Plan of Texas                         TX           HMO   TX   000

  Humana Health Plan of Texas                         UE           HMO   TX   000

  Humana Health Plan of Texas                         UR           HMO   TX   000

  Humana Health Plan, Inc.                            TL           HMO   NV   000

  Humana Kansas City, Inc.                            MS           HMO   KS   000

  Humana Kansas City, Inc.                            MS           HMO   MO   000

  Humana Medical Plan                                 7F           HMO   FL   000

  Humana Medical Plan                                 9D           HMO   FL   000

  Humana Medical Plan                                 EE           HMO   FL   000

  Humana Medical Plan                                 JH           HMO   FL   000

  Humana Medical Plan                                 P5           HMO   FL   000

  Humana Medical Plan                                 P7           HMO   FL   000

  Humana Wisconsin Hlth Org.                          X1           HMO   WI   000

  Independent Health Assoc                            C1           HMO   NY   000

  Independent Health Assoc                            QA           HMO   NY   000

  Intergroup of Arizona, Inc.                         A7           HMO   AZ   000

  John Deere Family Healthplan                        1J           HMO   IA   000

  John Deere Family Healthplan                        1J           HMO   IL   000

  John Deere Health Plan                              3J           HMO   IA   000

  John Deere Health Plan                              3J           HMO   IL   000

  John Deere Health Plan                              3J           HMO   TN   000

  John Deere Health Plan                              3J           HMO   VA   000

  Kaiser Permanente                                   57           HMO   OR   000

  Kaiser Permanente                                   57           HMO   WA   000

  Kaiser Permanente                                   59           HMO   CA   000

  Kaiser Permanente                                   62           HMO   CA   000

  Kaiser Permanente                                   63           HMO   HI   000

  Kaiser Permanente                                   64           HMO   OH   000

  Kaiser Permanente                                   65           HMO   CO   000

  Kaiser Permanente                                   8M           HMO   VT   000

  Kaiser Permanente                                   9H           HMO   ZZ   999

  Kaiser Permanente                                   DM           HMO   CT   000

  Kaiser Permanente                                   E3           HMO   DC   000

  Kaiser Permanente                                   E3           HMO   MD   000

  Kaiser Permanente                                   E3           HMO   VA   000

  Kaiser Permanente                                   F8           HMO   GA   000

  Kaiser Permanente                                   HA           HMO   KS   000

  Kaiser Permanente                                   HA           HMO   MO   000

  Kaiser Permanente                                   K1           HMO   MA   000

  Kaiser Permanente                                   K1           HMO   NH   000

  Kaiser Permanente                                   PW           HMO   NY   000

  Kaiser Permanente                                   QB           HMO   NY   000

  Kaiser Permanente                                   QH           HMO   NY   000

  Kaiser Permanente                                   QT           HMO   NC   000

  Kaiser Permanente                                   QT           HMO   SC   000

  Keystone Health Plan Central                        S4           HMO   PA   000

  Keystone Health Plan East                           ED           HMO   PA   000

  KeystoneBlue                                        EF           HMO   PA   000

  Kitsap Physicians Service                           VT           HMO   WA   000

  Lovelace Health Plan                                Q1           HMO   NM   000

  M\*Plan                                             IN           HMO   IN   000

  Mail Handlers                                       45           FFS   AA   000

  Maxicare Indiana                                    GK           HMO   IN   000

  Maxicare Louisiana                                  JA           HMO   LA   001

  Maxicare Southern California                        CM           HMO   CA   000

  M-Care                                              EG           HMO   MI   000

  MD-IPA                                              JP           HMO   DC   000

  MD-IPA                                              JP           HMO   MD   000

  MD-IPA                                              JP           HMO   VA   000

  MDNY Healthcare, Inc.                               5Y           HMO   NY   000

  MDNY Healthcare, Inc.                               8U           HMO   NY   000

  Medical Value Plan                                  EV           HMO   MI   000

  Medical Value Plan                                  EV           HMO   OH   000

  Mercy Health Plans/Premier                          7M           HMO   IL   000

  Mercy Health Plans/Premier                          7M           HMO   MO   000

  MVP Health Plan                                     GA           HMO   NY   000

  MVP Health Plan                                     M9           HMO   NY   000

  MVP Health Plan                                     MX           HMO   NY   000

  MVP Health Plan                                     VW           HMO   VT   000

  NALC                                                32           FFS   AA   000

  National HMO Health Plan                            MN           HMO   CA   000

  NYLCare Health Plans SW                             V2           HMO   TX   000

  NYLCare HP of the Gulf Coast                        UM           HMO   TX   000

  NYLCare HP of the Gulf Coast                        ZE           HMO   TX   000

  NYLCare HP of the Gulf Coast                        ZF           HMO   TX   000

  NYLCare Northwest                                   8N           HMO   WA   000

  Omni Healthcare                                     HN           HMO   CA   000

  OmniCare                                            KA           HMO   MI   000

  OPTIMA Health Plan                                  9R           HMO   VA   000

  OSF HealthPlans                                     9F           HMO   IL   000

  PacifiCare Asia Pacific                             JK           HMO   GU   000

  PacifiCare of Arizona                               7R           HMO   AZ   000

  PacifiCare of Arizona                               A3           HMO   AZ   000

  PacifiCare of California                            CY           HMO   CA   000

  PacifiCare of Colorado                              D6           HMO   CO   000

  PacifiCare of Nevada                                K9           HMO   NV   000

  PacifiCare of Ohio, Inc.                            R8           HMO   KY   000

  PacifiCare of Ohio, Inc.                            R8           HMO   OH   000

  PacifiCare of Oregon                                7Z           HMO   OR   000

  PacifiCare of Oregon                                7Z           HMO   WA   000

  PacifiCare of Oregon                                SS           HMO   OR   000

  PacifiCare of Oregon                                SS           HMO   WA   000

  PacifiCare of Texas                                 GF           HMO   TX   000

  PacifiCare of Washington                            WB           HMO   WA   000

  PacifiCare OK                                       2N           HMO   OK   000

  Panama Canal Area                                   43           FFS   AA   000

  Paramount Health Care                               U2           HMO   OH   000

  Partners Health Plans                               7Y           HMO   NY   000

  PARTNERS Nat\'l HPs of IN                           MC           HMO   IN   000

  PARTNERS NHP of NC                                  EQ           HMO   NC   000

  PARTNERS NHP of NC                                  EQ           HMO   SC   000

  PARTNERS NHP of NC                                  EQ           HMO   VA   000

  PCA Family Health Plan of FL                        FQ           HMO   FL   000

  PCA Health Plans of Florida                         PJ           HMO   FL   000

  PCA Health Plans/Puerto Rico                        5P           HMO   PR   001

  Penn State Geisinger HlthPlan                       N9           HMO   PA   001

  Personal Care Plan of NC                            4X           HMO   NC   000

  PersonalCare\'s HMO                                 GE           HMO   IL   000

  PHP/Mohawk Valley Region                            SH           HMO   NY   000

  Physicians Health Plan                              U5           HMO   MI   000

  Physicians Health Plan                              U6           HMO   MI   000

  Physicians Health Plan                              U7           HMO   MI   000

  Physicians Health Plan                              U8           HMO   MI   000

  Physicians Health Services of NJ                    2F           HMO   NJ   000

  Physicians Health Services/CT                       DP           HMO   CT   001

  Physicians Health Srvs of NY                        PD           HMO   NY   001

  Physicians HP of N. Indiana                         DQ           HMO   IN   000

  Physicians Plus HMO                                 7P           HMO   WI   000

  Piedmont Community Healthcare                       2C           POS   VA   000

  Postmasters                                         36           FFS   AA   000

  Postmasters                                         36           FFS   ZZ   000

  Preferred Care                                      GV           HMO   NY   000

  Preferred Plus of Kansas                            VA           HMO   KS   000

  Premera HealthPlus                                  8F           HMO   ID   000

  Premera HealthPlus                                  8F           HMO   WA   000

  Premier HealthCare of Arizona                       9A           HMO   AZ   000

  Premier HealthCare of Arizona                       9B           HMO   AZ   000

  Prepaid Health Plan                                 QE           HMO   NY   000

  Presbyterian Health Plan                            P2           HMO   NM   000

  PrimeHealth of Alabama, Inc.                        AA           HMO   AL   000

  PrimeHealth of Alabama, Inc.                        AA           HMO   MS   000

  PrimeONE                                            9W           HMO   WV   000

  Principal Health Care of Iowa                       SV           HMO   IA   000

  Principal Health Care of KC                         7W           HMO   KS   000

  Principal St.Louis                                  12           HMO   IL   000

  Principal St.Louis                                  12           HMO   MO   000

  Priority Health                                     BQ           HMO   MI   000

  Priority Health Care, Inc.                          W7           HMO   VA   000

  Providence Health Plan                              SD           HMO   OR   000

  Providence Health Plan                              SD           HMO   WA   000

  Prudential HealthCare HMO                           1K           HMO   KS   000

  Prudential HealthCare HMO                           1K           HMO   MO   000

  Prudential HealthCare HMO                           6P           HMO   TX   000

  Prudential HealthCare HMO                           8C           HMO   CT   000

  Prudential HealthCare HMO                           8P           HMO   NJ   000

  Prudential HealthCare HMO                           9P           HMO   NY   000

  Prudential HealthCare HMO                           EC           HMO   FL   000

  Prudential HealthCare HMO                           EH           HMO   FL   000

  Prudential HealthCare HMO                           EZ           HMO   GA   000

  Prudential HealthCare HMO                           HE           HMO   FL   000

  Prudential HealthCare HMO                           JB           HMO   DC   001

  Prudential HealthCare HMO                           JB           HMO   MD   001

  Prudential HealthCare HMO                           JB           HMO   VA   001

  Prudential HealthCare HMO                           Q4           HMO   NC   000

  Prudential HealthCare HMO                           Q4           HMO   SC   000

  Prudential HealthCare HMO                           RR           HMO   OK   000

  Prudential HealthCare HMO                           RS           HMO   OK   000

  Prudential HealthCare HMO                           UA           HMO   TN   000

  Prudential HealthCare HMO                           UB           HMO   MS   000

  Prudential HealthCare HMO                           UB           HMO   TN   000

  Prudential HealthCare HMO                           UN           HMO   TX   000

  Prudential HealthCare HMO                           UP           HMO   TX   000

  Prudential HealthCare HMO                           V6           HMO   VA   000

  Prudential HealthCare HMO                           VV           HMO   PA   000

  Prudential HealthCare HMO                           VX           HMO   TX   000

  Prudential HealthCare HMO                           VY           HMO   AR   000

  Prudential HealthCare HMO                           VZ           HMO   IL   000

  Prudential HealthCare HMO                           VZ           HMO   MO   000

  Prudential HealthCare HMO Midwest                   Q9           HMO   OH   000

  Prudential HealthCare HMO Midwest                   S3           HMO   IN   000

  Prudential HealthCare HMO Midwest                   S3           HMO   KY   000

  Prudential HealthCare HMO Midwest                   S3           HMO   OH   000

  Prudential HealthCare Midwest                       AY           HMO   OH   000

  QCA Health Plan                                     8Q           HMO   AR   001

  QualChoice of North Carolina                        7Q           HMO   NC   001

  QualMed of Colorado                                 2D           HMO   CO   000

  QualMed Plans for Health                            27           HMO   NJ   000

  QualMed Plans for Health                            27           HMO   PA   000

  QualMed Plans for Health                            2K           HMO   PA   000

  QualMed Plans for Health                            PX           HMO   NM   000

  QualMed Plans for Health OH/WV                      QJ           HMO   OH   000

  QualMed Plans for Health OH/WV                      QJ           HMO   WV   000

  QualMed Plans for Health -Pa.                       24           HMO   PA   000

  QualMed WA Health Plan                              TM           HMO   WA   000

  Rocky Mountain HMO                                  88           HMO   CO   000

  Rural Carrier Benefit Plan                          38           FFS   AA   000

  Rush Prudential HMO                                 17           HMO   IL   000

  Rush Prudential HMO                                 17           HMO   IN   000

  SAMBA                                               44           FFS   AA   000

  Scott and White                                     UF           HMO   TX   000

  Secret Service                                      Y7           FFS   AA   000

  SecureCare of Iowa                                  3Q           HMO   IA   000

  SelectCare HMO                                      K6           HMO   MI   000

  SmartPlan                                           8D           HMO   LA   000

  SummaCare Health Plan                               5W           HMO   OH   000

  SuperBlue HMO                                       8T           HMO   WV   000

  SuperMed HMO                                        5M           HMO   OH   000

  Texas Health Choice, L. C.                          2T           HMO   TX   001

  Texas Health Choice, L. C.                          UK           HMO   TX   000

  The Wellness Plan                                   K3           HMO   MI   000

  Total Health Choice                                 4A           HMO   FL   000

  Total Health Care                                   N2           HMO   MI   000

  Triple-S                                            89           HMO   PR   001

  UHC of North Carolina                               XM           HMO   NC   000

  Union Health Service                                76           HMO   IL   000

  United Health Care of Ohio                          3U           HMO   KY   000

  United Health Care of Ohio                          3U           HMO   OH   000

  United Health Care of Ohio                          VC           HMO   OH   000

  United Health Plan                                  C4           HMO   CA   000

  United HealthCare Mid-Atlantic                      BL           HMO   DC   001

  United HealthCare Mid-Atlantic                      BL           HMO   MD   001

  United HealthCare MidWest                           4M           HMO   KS   000

  United HealthCare MidWest                           4M           HMO   MO   000

  United HealthCare New England                       VF           HMO   MA   001

  United HealthCare New England                       VF           HMO   RI   001

  United Healthcare of Arizona                        2S           HMO   AZ   000

  United Healthcare of Arizona                        TD           HMO   AZ   000

  United HealthCare of Florida                        QK           HMO   FL   000

  United HealthCare of Kentucky                       DU           HMO   IN   000

  United HealthCare of Kentucky                       DU           HMO   KY   000

  United HealthCare Puerto Rico                       7U           HMO   PR   001

  United HealthCare Select                            H8           HMO   IL   000

  United HealthCare Select                            H8           HMO   MO   000

  United HealthCare/Midlands                          NF           HMO   IA   000

  United HealthCare/Midlands                          NF           HMO   NE   000

  Unity Health Plans                                  W4           HMO   WI   000

  Universal Care                                      6Q           HMO   CA   000

  UPMC Health Plan                                    8W           HMO   PA   000

  Valley Health Plan                                  VH           HMO   WI   000

  Vantage Health Plan                                 6A           HMO   OH   000

  Vantage Health Plan                                 7V           HMO   LA   000

  VIVA Health Plan                                    4B           HMO   AL   000

  Vytra Health Plans                                  J6           HMO   NY   000

  Welborn HMO                                         H3           HMO   IN   000

  WellPath Select                                     2E           HMO   NC   000

  WellPath Select                                     2E           HMO   SC   000

  Western Health Advantage                            5Z           HMO   CA   000

  Yellowstone Community Health                        2Y           HMO   MT   000
  --------------------------------------------------- ------------ ----- ---- -----

Vendor Selection Form

[Plan Name:]{.underline} [FEHB Sub-Code]{.underline}:

(Use a separate sheet for each plan or Sub-Code -- make copies of this
form if necessary)

Please mark all boxes below that apply:

-   Health Plan will conduct the CAHPS® 2.0H Adult Survey

-   Health Plan will conduct the CAHPS® 2.0H Child Commercial Survey

-   Health Plan has fewer than 500 FEHB Subscribers/Contracts and will
    not be conducting CAHPS® Surveys in 2000

NCQA Certified Vendor's Name who will be conducting the survey
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Vendor Contact, Address, E-Mail and Telephone Number:

Health Plan Contact, Address, E-Mail and Telephone Number:

Plan Contact & Address for Invoice (if different from above):

Please send the form by overnight mail or fax it to:

U.S. Office of Personnel Management

Retirement and Insurance Service

> Office of Insurance Programs Fax #: (202) 606-0633 or 606-0036

Attention: Ralph Pierce

1900 E Street, NW. Room 3415

> Washington, DC 20415
>
> **(Please complete and return to OPM by January 31, 2000)**