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WELCOME TO THE ARxC HEALTH PLAN SURVEY©.

As a non-profit patient advocacy organization, the Advocates for Responsible Care (ARxC), in partnership with Emory University, designed the ARxC Health Plan Survey© to give you a voice in the development of a new health insurance plan that best meets your health care needs. We want to know what you, as a Georgia resident, want from your health insurance plan.

YOU MUST BE AT LEAST 18 YEARS OF AGE AND A LEGAL RESIDENT OF GEORGIA TO TAKE THIS SURVEY.

Risks: We do not expect there to be any significant risks to taking this study.

Benefits: While there are no direct benefits to you for taking this survey, the results of the survey will be used to create a new model for health insurance that will inform community leaders and government officials in Georgia about what you want to see in the new insurance plan to be offered to Georgia residents in 2014.

Confidentiality: Agencies that make the rules about how research is done have the right to review study records. Those with the right to look at your study records include the Emory University Institutional Review Board and the Emory Office for Research Compliance. Records can also be opened by court order. We will keep your records private to the extent allowed by law. Your name and other facts that might identify you will not appear when we present this study or publish its results.

Taking the survey is entirely your choice. You may exit the survey at any time and you may choose to not answer any of the questions.

There is no right or wrong answer to these questions. We only ask that you be honest and accurate with your responses.

Completing the survey may take between 15 minutes to 20 minutes.

If you have any questions or concerns regarding this survey please contact us at 404-633-5843 or email us at arxc.healthrights@gmail.com.

If you have any questions about your rights as a research subject or if you have any questions, concerns or complaints about this study you may contact the Emory Institutional Review Board at 404-712-0720 or 877-503-9797 or irb@emory.edu.

* 1. By checking the box below you agree that you are:
1) At least 18 years of age and a legal resident of the state of Georgia
2) Volunteering to participate in the survey
3) Allowing study researchers to use your responses as stated above

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