EmblemHealth: Diversity Survey

Thank you for taking the time to fill out this survey. EmblemHealth is interested in finding out about your experience with us, your health plan, and your doctors. Your feedback will help us improve the quality and types of services you receive. Let's begin.

Required Fields are indicated with an asterisk (*).

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1. When talking with your doctor, do you prefer to use a language other than English?
2. Thinking about your most recent office visit, did your doctor speak to you in the language you prefer?
3. The following are questions about your race and ethnicity. This information helps us to better meet your needs and the needs of the communities we serve. Your answers will be kept private and will not affect your health care coverage.
Please tell us your ethnicity (select one):






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4. Are you Hispanic or Latino?
5. On a scale of 1 to 5, where 1 is not well at all and 5 is very well, how well do you understand English? (choose one)
6. On a scale of 1 to 5, where 1 is not at all satisfied and 5 is very satisfied, how satisfied are you with the way you and your doctor communicate (in other words, are you comfortable speaking with your doctor about your concerns and/or do you feel your doctor explains things to you clearly regarding your health, a diagnosis, treatment, medications, etc.)?
7. On a scale of 1 to 5, where 1 is very dissatisfied and 5 is very satisfied, how satisfied are you with the overall number of primary care doctors, specialists, and behavioral or mental health doctors in your plan who speak your language and meet your cultural, gender, racial, and ethnic needs?
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8. On that same 1 to 5 scale, where 1 is not at all satisfied and 5 is very satisfied, how satisfied are you that your primary care doctor understands your cultural, gender, racial, ethnic, and language needs?
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9. On that same 1 to 5 scale, where 1 is not at all satisfied and 5 is very satisfied, how satisfied are you that any specialists you see understand your cultural, gender, racial, ethnic, and language needs?
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10. Do you feel your health plan offers enough primary care and specialist doctors to choose from, who meet your cultural, gender, racial, ethnic, and language needs?
11. Do you prefer to see only doctors or specialists from your culture and/or ethnicity?
12. Do you feel your plan offers enough mental health professionals who meet your cultural, gender, racial, ethnic, and language needs?
13. Do you prefer to see only mental health professionals from your culture and/or ethnicity?
14. On that same 1 to 5 scale, where 1 is not at all satisfied and 5 is very satisfied, how satisfied are you that your mental health professional understands your cultural, gender, racial, ethnic, and language needs?
15. On a scale of 1 to 5 where 1 is not well at all and 5 is very well, how well do you understand your health plan’s policies and procedures regarding:
15a. Privacy?
15b. Covered and non-covered benefits?
15c. Doctor/health care professional availability?
15d. Access to services and medications?
15e. Do you know where to find this information?
16. Now it’s your turn. Please tell us what you like most about your health plan, or what you think we could do better. If you don’t have any feedback, just skip this question.
17. Please tell us what kind of doctors, specialists, or mental or behavioral health specialists you’d like to see EmblemHealth offer. Please include information regarding their language, race, culture, ethnicity, and location.
18. Would you like EmblemHealth to call you about your answers to this survey?
** I understand that the phone numbers I gave on this survey may be used by EmblemHealth or any of its contracted parties to call me about my account, my health benefit plan, related programs, or services provided to me.

HIP Health Plan of New York (HIP) is an HMO plan and Group Health Incorporated (GHI) is a PPO plan with a Medicare contract. Enrollment in HIP and GHI depends on contract renewal. HIP and GHI are EmblemHealth companies.

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