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Survey Name Health Insurance Survey
Description Sample Survey
Category    (Browse All Categories)

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Welcome:

Health Care is important to all of us. As a resident of Bedford County and a Post Graduate Student at the University of Liverpool England I am conducting a survey on Health Care Provision in Bedford County Virginia as part of my sudies for an MBA. I would appreciate your particpation. All respones are confidential and only summary inforation will be published in the final report. I am looking for Employers of Bedford County to particalte in the Employer part of this survey and for any resident of Bedford county to particpate in the other part of this survey. Confidentlaity is guaranteed. At the end of the survey you will be invited to give your email address. If you do I will send you a copy of the tabulated results and a copy of my final thesis when submitted to Liverpool University in November / December 2005. The Questionaire will take about fifteen minuits to complete.


Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.


Your survey responses will be stricly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Rick Maciorowski at 540 890 0478 or by email at the email address specified below.


Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.


 
   
 
Are you... *
 
   

How Many Employees do you have ?
 
   

All of these answers relate to the cost of FPS ( Fee Per Service Coverage) What is the total Annual Premium For Family Coverage In Dollars *
 
How much does the company pay as a pecentage for Family Coverage *
 
What is the Annual Deductable in Dollars? *
 
What is the Co Payment for Family coverage? *
 
What is the Total Annual Total Premium for Individual Coverage in Dollars? *
 
How Much Does the company pay as a percentage for Individual coverage *
 
What is the Annual Deductable in Dollars for Individual Coverage? *
 
What is the Co Payment Percentage for Indicvidual Coverage? *
 
 
   

Universal Risk Pool for the population of a State.

· All children are in one pool 0
· 18 to 27 Pool 1
· 28 to 37 Pool 2
· 38 to 47 Pool 3
· 48 to 57 Pool 4
· 59 to Retirement Age Pool 5

 
   

Do You Offer Medical Insurance to Employees?
Yes    
 
   

What types Of Medical Insurance do you currently offer? Please Check all that apply
 
   
 
Additional Comments/Suggestions for improvement
 
 
   
 
What kind of medical insurance coverage do you have?
 
   
 
What was your total household income (from all sources) before taxes for the year [Year]?
 
   


 
   

All of these answers relate to HMO ( Health Maintainence Coverage) What is the total Annual Premium For Family Coverage In Dollars *
 
How much does the company pay as a pecentage for Family Coverage *
 
What is the Annual Deductable in Dollars? *
 
What is the Co Payment for Family coverage? *
 
What is the Total Annual Total Premium for Individual Coverage in Dollars? *
 
How Much Does the company pay as a percentage for Individual coverage *
 
What is the Annual Deductable in Dollars for Individual Coverage? *
 
What is the Co Payment Percentage for Indicvidual Coverage? *
 
 
   

These Questions Relate to HSA Insurnace What is the total Annual Premium For Family Coverage In Dollars *
 
How much does the company pay as a pecentage for Family Coverage *
 
What is the Annual Deductable in Dollars? *
 
What is the Co Payment for Family coverage? *
 
What is the Total Annual Total Premium for Individual Coverage in Dollars? *
 
How Much Does the company pay as a percentage for Individual coverage *
 
What is the Annual Deductable in Dollars for Individual Coverage? *
 
What is the Co Payment Percentage for Indicvidual Coverage? *
 
 
   

All of these answers relate to PPO ( Prefered Provider Coverage) What is the total Annual Premium For Family Coverage In Dollars *
 
How much does the company pay as a pecentage for Family Coverage *
 
What is the Annual Deductable in Dollars? *
 
What is the Co Payment for Family coverage? *
 
What is the Total Annual Total Premium for Individual Coverage in Dollars? *
 
How Much Does the company pay as a percentage for Individual coverage *
 
What is the Annual Deductable in Dollars for Individual Coverage? *
 
What is the Co Payment Percentage for Indicvidual Coverage? *
 
 


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