Questionnaire

Customers perception towards health insurance Empirical study in Ahmedabad city

General information

1. Name: ____________

2. Gender: a. Male b. Female

3. Age: a. Less than 30years b. 30-40 years

c. 40-50 years d. Above 50 years

4. Marital status:

a. Single b. Married

5. Type of family: a. Joint b. Nuclear

6. Education:

a. Illiterate b. Primary c. Middle

d. Matrix e. higher secondary f. Graduation g. Post graduation h. Vocational i. Other (specify) ___

7. Occupation

a. Employed b. Self employed c. Labour d. Housewife e. Unemployed f. Professional g. Family owned business h. Retired

8. Income per annum (in Rs.):

a. Less than 50000 b. 50000-100000

d. 150000-200000 e. Above 200000

9. Do you have health insurance policy?

a. Yes b. No

10. Who is your insurer?

a. Public Company b. Private Company

c. Any other (specify) ___________

c. 100000-150000

11. What type of Health Insurance Policy you have?

a. Individual Health Insurance b. Group Health Insurance c. Family Floater Health insurance d. Other (specify) __________

12. What are the reasons for going in for health insurance policy? a. Tax planning measure

c. Employer s contribution e. Availgood quality medicaltreatment f. Risk coverage against future illness

13. Who persuaded you to purchase the policy?

a. Insurance Officials b. Relative

b. Travelling abroad

d. Existing illness

c. Friends

d. Advertisement e. Income Tax Advocate f. Colleagues g. yourself h. Other (specify) ___

14. What approach was adopted in seeking health insurance coverage?

a. Insurance agent seeked you out b. You seeked out insurance agent

15. Do you agree that the services provided by the insurance companies are delivered

effectively? a. Yes b. No c. Indifferent

16. What is the chance of renewing the service after the expiry of present insurance policy?

a.100% b. 50% c. 25% d. 0%

17. Are you willing to pay more for additionalservices, which can be included in your

health insurance package? a. Yes b. No

18. Do you think the promotional efforts being taken by insurance company are sufficient? a. Yes b. No

19. Which of the following factors did you consider being the most important while

Choosing your insurance policy? Please give the response for following statements on five

point Likert s Scale ranging from Strongly Agree to Strongly Disagree:

Note: - SA Strongly Agree,A Agree, I Indifferent, D Disagree, SD StronglyDisagree.

statement SA A i d SD

a. Name and Reputation of the insurance company b. Maximum customers satisfaction c. Minimum co-payment involved

u.Flexibility of policy offered e.Easy accessibility of linked hospitals f Easy availability of services in hospitals