QUESTIONNAIRE

NO: DATE:

NAME:

ADDRESS:

SOCIAL ECONOMIC FACTORS

1. Gender of the respondents

Male Female
2. Age of the respondents

Below 25 Years 25-34 Years 35-44 Years

45-54 Years 55-64 Years Above 65 Years

3. Educational Status of the respondents

Primary School High School High Secondary Diploma

Degree Professional Others illiterate

4. Marital Status of the respondents

Married Unmarried Divorced

5. Family Size / Members

Adults Children Sr Citizens

6. Occupation Information of the respondents

Salaried Professionals Self Employed Business Retired

7. Gross Income of the respondents per annum

Below 50000 50000-1 Lakh 1 Lakh-3 Lakhs 3 Lakhs-5 Lakhs

5 Lakhs-10 Lakhs Above 10 Lakhs

8. Gross Income of the respondents per annum

Below 50000 50000-1 Lakh 1 Lakh-3 Lakhs 3 Lakhs-5 Lakhs

5 Lakhs-10 Lakhs Above 10 Lakhs

9. Do you aware of Health Insurance Plans
Yes
No

10. Do you have Health Insurance Plan

Yes
No

11. How do you know about Health Insurance

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

12. 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

13. Particular reason behind choosing Health Insurance Plan

Brand Name
Safety
Good Customer Service
Good Claim Processing

14. Purpose of taking Health Insurance Plan

Covering Medical Expenses
Tax Purpose
Others
Compulsion

15. 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

16. Benefits of taking Health Insurance Policy

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

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

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

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