Q01
Message
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Health Insurance Plan Evaluation Survey
Evaluates how members experience their current health insurance — cost, coverage, network access, claims handling, and customer service — for health plans, employer benefits teams, or brokers assessing plan performance. An AI follow-up interview reconstructs a real recent claim or service interaction to surface exactly where the experience broke down or exceeded expectations.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
Multiple ChoiceRequired
Which best describes your current health insurance?
- Employer-sponsored plan
- Government marketplace/exchange plan
- Medicare
- Medicaid
- Individual plan purchased directly
- I don't currently have health insurance
Q03
Opinion ScaleRequired
Overall, how satisfied are you with your current health insurance plan?
Scale: 0 – 10
Min:Not at all satisfiedMax:Extremely satisfied
Q04
MatrixRequired
How satisfied are you with each of the following aspects of your plan?
7 rows × 5 columns
- Monthly premium cost
- Deductible and out-of-pocket costs
- Size of the provider network
- Ease of finding in-network doctors
- Prescription drug coverage
- +2 more
Columns: Very dissatisfied · Dissatisfied · Neutral · Satisfied · Very satisfied
Q05
Multiple Choice
In the last 12 months, how often did you file or use a claim through your insurance?
- Never
- Once
- 2-3 times
- 4-6 times
- More than 6 times
Q06
Multiple Choice
In the last 12 months, has a claim of yours been denied, delayed, or paid for less than you expected?
- Yes
- No
- Not sure / don't recall
Q07
Rating ScaleRequired
How easy is it to understand what your plan covers and what you'll owe out of pocket before receiving care?
Range: 1 – 5
Min:Very difficultMax:Very easy
Q08
Best–Worst Trade-off (MaxDiff)
When you think about what matters most in a health insurance plan, which of these matters most and which matters least to you?
- Low monthly premium
- Low deductible
- Large provider network
- Prescription drug coverage
- Mental health/behavioral health coverage
- Telehealth or virtual care access
- Customer service quality
- Digital tools for claims and coverage
Pick best & worst per setBest:Matters mostWorst:Matters least
Q09
Point Allocation
Think about the last $100 you spent out of pocket on healthcare. Roughly how was it split across these categories? (It's fine to estimate.)
- Doctor visit copays
- Prescription drugs
- Deductible payments toward a procedure or hospital visit
- Dental or vision care not covered by the plan
- Other out-of-pocket costs
Allocate 100 points
Q10
AI Interview
Reconstruct the respondent's most recent significant interaction with their health insurance — a claim, doctor visit, prescription fill, or customer service call. Ask what happened step by step, whether the cost or coverage matched what they expected going in, and what specifically went well or caused friction. If their overall satisfaction was low, probe whether the root cause was cost, network access, claims processing, or communication; if satisfaction was high, ask what specifically earns that loyalty and whether it would survive a premium increase.
Q11
Multiple Choice
Which age range do you fall into?
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65+
- Prefer not to say
Q12
Multiple Choice
How many people, including yourself, are covered under your current health insurance plan?
- Just me
- 2
- 3
- 4
- 5 or more
- Prefer not to say
Q13
Message
That's everything — thank you for the honest feedback! Your responses will be combined with others to identify where health plans should improve coverage clarity, cost transparency, and claims service.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Includes a dedicated AI follow-up interview that reconstructs the respondent's most recent claim or service interaction to pinpoint exactly where the experience broke down or exceeded expectations, not just a satisfaction score.
- Pairs a satisfaction matrix (cost, coverage, network, claims, customer service) with targeted follow-ups on claim frequency and denial/delay/underpayment history, so quantitative ratings are backed by specifics.
- Uses a MaxDiff exercise to force real prioritization of what matters most in a plan, plus a constant-sum question to quantify how out-of-pocket spend actually breaks down — richer than single Likert items.
- Automated per-response quality scoring and auto-generated reports mean plan teams and brokers get analysis-ready output without manually reading open-ends.
Jotform
Health Insurance Evaluation Survey Form TemplateA fielding-ready static form template covering health insurance evaluation, built on Jotform's drag-and-drop form builder. It's easy to customize and embed but relies on fixed question sets with no adaptive questioning. Good for quick deployment, less suited to probing individual claim experiences in depth.
What it does well
- Simple drag-and-drop customization and fast deployment
- Broad integration ecosystem typical of Jotform (payments, storage, notifications)
- Familiar, easy-to-fill form format for respondents
Where it falls short
- Static question set with no adaptive AI follow-up to dig into a specific recent claim or service interaction
- No automated per-response quality scoring or AI-generated analysis of open-ended feedback
- No voice AI interview option or guided screen-share tasks
SurveyMonkey
Health Insurance Evaluation Survey TemplateSurveyMonkey's template offers a standard, fielding-ready health insurance evaluation survey with the platform's established analytics and benchmarking features. It's built around fixed multiple-choice and rating questions rather than conversational probing. Strong for broad quantitative tracking, weaker for capturing the 'why' behind a specific bad or good claim experience.
What it does well
- Established survey analytics dashboard and reporting tools
- Large-scale distribution and panel options
- Recognizable, trusted respondent experience
Where it falls short
- No adaptive AI interview to reconstruct a respondent's actual recent claim or service interaction
- Fixed-question format only — no voice AI interview or guided task with screen share
- No transparent, published prompt methodology or automated per-response quality scoring
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.