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Questionnaire on Health insurance

Are you aware of Health Insurance and its benefits?

1) Yes
2) No

Do you have Health Insurance?

1) Yes I do
2) No, I do not

Were you without medical claim Policy for any amount of time in the past 12 months, or not?

1) Yes, I was
2) No, I was not

If you do not have a health insurance coverage, why are you not insured?

1) I don’t need insurance


2) I can’t afford insurance
3) Employer does not offer insurance coverage payments
4) Dissatisfied with previous coverage
5) I do not believe in health insurance
6) Other

What is your marital status?

1) Married
2) Unmarried

Do you have kids?

1) Yes
2) No

How important do you consider health insurance to be?

1) Extremely Important
2) Somewhat Important
3) Neutral
4) Somewhat unimportant
5) Extremely Unimportant

Are you a service person?

1) Yes
2) No

Please mark to the age group you belongs to?

1) 0-20
2) 20-35
3) 35-60
4) Above 60

Who pay for your health insurance?

1) Former Employer
2) Current Employer
3) Local Government
4) State Government
5) National Government
6) Self-Funded

What is your monthly salary?

1) 10k -20k
2) 20k-40k
3) 40k-60k
4) Above 60k

How much is your monthly premium?

1) Under 1000
2) 1001- 5000
3) 5000- 10000
4) Above 10000

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

1) Less than a year


2) 1 -3 Years
3) 3 -5 Years
4) 5 -10 Years
5) 10 Years and more

How easily can you access the network hospitals included in your coverage?

1) Extremely easy
2) Somewhat easy
3) Neutral
4) Somewhat Difficult
5) Extremely Difficult

Does the coverage of your insurance stretch far enough to cover a range of medical services?

1) Broad Coverage
2) Sufficient Coverage
3) Average Coverage
4) Subnormal Coverage
5) Very Little Coverage
6) Activity specific coverage
7) Other (please specify)

Where would you most likely go for information on health insurance?

1) High Street health insurance branch


2) Over the phone
3) A Health insurance website
4) A price comparison website
5) Other(please specify)

With your current coverage, how easy is it to file a claim?

1) Extremely easy
2) Somewhat easy
3) Neutral
4) Somewhat Difficult
5) Extremely Difficult

Are you satisfied with your current health insurance plan?

1) Very Satisfied
2) Satisfied
3) Adequate
4) Dissatisfied
5) Very Dissatisfied