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QUESTIONNAIRE

NO: DATE:

NAME:

ADDRESS:

SOCIAL ECONOMIC FACTORS

1. Gender of the respondents

Male
Female

2. Age of the respondents


Below 25
25-34
35-44
45-54
55-64
Above 65

3. Educational Status of the respondents


Primary School
High School
High secondary
Degree
Professional
Others
Illiterate

4. Marital Status of the respondents


Married
Unmarried

5. Occupation Information of the respondents


Salaried
Professional
Self Employed
Business
Retired
6. Gross Income of the respondents
Below 50000
50000 – 100000
100000 – 200000
200000 - 300000
300000 – 400000
400000 - 500000
500000 – 1000000
Above 1000000

7. Do you aware of Health Insurance Plans


Yes
No

8. Do you have Health Insurance Plan


Yes
No

9. How do you know about Health Insurance


Insurance Agents
Marketing Sales Managers
News Paper
Television / Radio Advertisement
Family / Friends
Hospitals

10. In which company you would like to purchase Health Insurance Plan
Government Health Insurance
Public Ltd Health Insurance company
Private Health Insurance Company
Foreign based / MNC Health Insurance

11. Particular reason behind choosing Health Insurance Plan


Brand Name
Safety
Good Customer Service
Good Claim Processing

12. Purpose of taking Health Insurance Plan


Covering Medical Expenses
Tax Purpose
Others
Compulsion
13. What would you like more in Health Insurance policy
Better Utilization of health care facility
Easy reimbursement process
Emergency Health care
Reduce cost of drugs expenditure

14. Benefits of taking Health Insurance Policy


Compensation
Accident & Permanent Disability
Benefits
Provides free of cost – Major surgeries
Critical illness benefits
Others
No idea

15. Do you think your Health Insurance premium rates are reasonable
YES
NO

16. How happy are you with the choice of Health care providers in your current plan
Highly Satisfied
Satisfied
Not Satisfied

17. How satisfied are you with the outcome of your claims
Highly Satisfied
Satisfied
Not Satisfied

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