1. Instructions

    1. Instructions

  2. Basic Information

    1. *Please indicate your age range.

    2. *Please indicate your gender.

    3. *Please indicate your annual income range.

  3. Insurance Information

    1. *How long have you been with your current insurance provider?

    2. *How do you receive your insurance?

  4. Evaluation

    1. Evaluation

    2. *I have easy access to the information on my plan.

    3. *I can easily find doctors in my area.

    4. *I can easily find doctors I work well with.

    5. *I can find specialists that work with the doctors and my plan.

    6. *I am happy with the plan I have.

    7. *My co-pay is affordable.

    8. *My co-pay is easy for me or a healthcare provider to figure out from my card.

  5. Other Information

    1. *Have you switched from another insurance recently?

    2. *Have you filed a claim recently?

    3. *How satisfied were you with the process?

    4. *Would you/have you recommended your insurance to friends/family?

Health Insurance Evaluation Questionnaire


Health Insurance Evaluation Questionnaire

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Instructions

This is an evaluation questionnaire to get a better idea of your level of satisfaction when it comes to your health insurance.



What do you need to know?


  1. Provide all required information here using this form.
  2. Click ✓ Ok to submit and check off each request.
  3. Drafts are saved automatically and your progress restored (so you don't have to complete the checklist in one go


Need help?


Click the message icon in the top left corner to leave a message or comment for the question or section you're stuck in or need help with.


Getting started


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*Please indicate your age range.

  • 18-25

  • 26-34

  • 35-44

  • 45-44

  • 45-54

  • 55-65

*Please indicate your gender.

  • Male

  • Female

*Please indicate your annual income range.

 Please note that this is in US Dollars.  

  • <$20,000

  • $20-49,999

  • $50-74,999

  • $75-99,999

  • $100-149,999

  • $150,000+

*How long have you been with your current insurance provider?

  • Less than one year

  • One to nearly two years

  • Two to nearly five years

  • Five to nearly ten years

  • Ten years or more

*How do you receive your insurance?

  • Work

  • Personal

  • Family Plan

Evaluation

On a scale of 1 (Strongly Disagree) to 5 (Strongly Agree), please indicate your level of agreement with the following statements. 

*I have easy access to the information on my plan.

  • Strongly Disagree

  • Disagree

  • Neutral

  • Agree

  • Strongly Agree

*I can easily find doctors in my area.

  • Strongly Disagree

  • Disagree

  • Neutral

  • Agree

  • Strongly Agree

*I can easily find doctors I work well with.

  • Strongly Disagree

  • Disagree

  • Neutral

  • Agree

  • Strongly Agree

*I can find specialists that work with the doctors and my plan.

  • Strongly Disagree

  • Disagree

  • Neutral

  • Agree

  • Strongly Agree

*I am happy with the plan I have.

  • Strongly Disagree

  • Disagree

  • Disagree

  • Agree

  • Strongly Agree

*My co-pay is affordable.

  • Strongly Disagree

  • Disagree

  • Neutral

  • Neutral

  • Strongly Agree

*My co-pay is easy for me or a healthcare provider to figure out from my card.

  • Strongly Disagree

  • Disagree

  • Neutral

  • Agree

  • Strongly Agree

*Have you switched from another insurance recently?

  • Yes

  • No

*Have you filed a claim recently?

  • Yes

  • No

*How satisfied were you with the process?

  • Extremely Dissatisfied

  • Somewhat Dissatisfied

  • Neutralv

  • Somewhat Satisfied

  • Extremely Satisfied

*Would you/have you recommended your insurance to friends/family?

  • Yes

  • No