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Questionnaire on health insurance

Name

: ..

Address

: ..

Phone number : ..
Email id

: ...

1) Do you have a health insurance?


Yes
No
2) How much do you care about having a health insurance policy?
Very much
Not much
3) What

is your income per annum?


2.5 lakhs and below
2.5-5 lakhs
5-10 lakhs
10 lakhs and above

4) Are you able to smoothly pay your current health insurance policy with
your current annual income?
Yes
Know
5) Type of family structure?
Joint
Nuclear

6) Have you encountered with any type of health problems in the past?
Yes
No

7) What

8) Who

type of health insurance policy do you have?


Individual health insurance policy
Health insurance for the whole family
Health insurance for spouse
Health insurance for father/mother

persuaded you to purchase policy?


Insurance officials
Relatives
Friends
Others

9) Do you renew your health insurance regularly when it expires?


Yes
No
Maybe
10)

Which insurance company do you prefer?


Public company
Private company
Any other (specify)

11)
Which of the following factors do you consider while choosing
health insurance?
Name and reputation of insurance company
Availability of tax benefits
Flexibility of policy offered
Reliability of service offered

12)

How you would like to pay health insurance premium amount?


Monthly
Half yearly
Quarterly
Yearly

13)
Sources from which you have come to known about health
insurance?
Tv

Family
Friends
Newspaper
Agents

How much satisfied are you with your health insurance?


Very much satisfied
Somewhat satisfied
Not at all satisfied

What type of amount are you willing to pay for health insurance?
Upto 10000
10000-15000
15000-20000
20000 and above

Have you ever claimed health insurance in past 12 months?


Yes
No

14)

15)

16)

17)
Overall, how would you rate the quality of health care you have
received in the last 12 months?
Excellent
Very good
Good
Fair
Poor
18)
Are you satisfied with the time that health insurance take to
provide you with reimbursement?
Very much satisfied
Somewhat satisfied
Not at all satisfied
19)
How confident are you that if you become seriously ill you will
get high quality and safe medical care?
Very confident
Somewhat confident
Not to confident

20)

How long have you been without insurance?


3 months or less
4-11 months
One or two years
Never

21)
During the last 12 months did you have health insurance ALL the
time, or was there a time during the year when you did not have any
health coverage?
Yes
No
22)

Do you like to purchase or renew health insurance policy online?


Yes
No
Sometimes

23)
Which websites do you use to purchase or renew health
insurance online?
Policybazzar
Coverfox
Others
24)

Would you like to compare health insurance policies?


Yes
No
Sometimes
Always

How likely is that you change your health insurance plans?


always
Frequently
Sometimes
never

25)

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