Name
: ..
Address
: ..
Phone number : ..
Email id
: ...
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
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)
13)
Sources from which you have come to known about health
insurance?
Tv
Family
Friends
Newspaper
Agents
What type of amount are you willing to pay for health insurance?
Upto 10000
10000-15000
15000-20000
20000 and above
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)
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)
23)
Which websites do you use to purchase or renew health
insurance online?
Policybazzar
Coverfox
Others
24)
25)