Have you selected a qualifying primary care practitioner for yourself?
Yes No

Have you selected a qualifying primary care practitioner for your dependents?
Yes No

Do you understand when a pre-service authorization is required?
Yes No

Do you know how to obtain a pre-service authorization?
Yes No

Do you have any cultural, ethnic or language needs/preferences for health care providers?
Yes No

If so, please explain:

Did you receive your medical and prescription cards in a timely manner?
Yes No

Do you understand your prescription drug benefit?
Yes No

If you have contacted a member service representative, were you satisfied with the level of service you received?
Yes No Not Applicable

Please give us any comments you have regarding the previous questions as well as your overall comments of Arise Health Plan:

If you have further questions or need additional information regarding the above items, please provide your name, phone number and email address so an Arise Health Plan representative can respond to your request: