Q01
Message
All templates
Insurance Policyholder Experience & Renewal Survey
Measures how policyholders feel about their coverage, premium value, and claims experience, and gauges renewal intent before it turns into churn. An AI follow-up digs into the real story behind a recent claim or renewal decision, surfacing friction points a rating scale alone would miss. Built for insurers and brokers tracking retention and satisfaction.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
14 questions · ~7 min
Q02
Multiple ChoiceRequired
Which type of policy are you thinking of as you answer this survey?
- Auto
- Home or renters
- Life
- Health
- Pet
- Other
Q03
Opinion ScaleRequired
Overall, how satisfied are you with this policy?
Scale: 1 – 7
Min:Very dissatisfiedMax:Very satisfied
Q04
MatrixRequired
How much do you agree with each statement about your policy?
4 rows × 5 columns
- It's easy to understand what is and isn't covered
- The premium I pay is fair for the coverage I get
- Managing my policy online or by app is easy
- Customer service responds quickly when I reach out
Columns: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q05
Multiple ChoiceRequired
In the last 12 months, have you filed a claim on this policy?
- Yes
- No
Q06
Opinion Scale
If you filed a claim in the last 12 months, how satisfied were you with how it was handled?
Scale: 0 – 10
Min:Very dissatisfiedMax:Very satisfied
Q07
RankingRequired
Rank these factors by how much they matter to you when choosing or renewing a policy (most important first).
- Price
- Breadth of coverage
- Customer service quality
- Claims process reputation
- Ease of digital tools
- Trust in the brand
Drag to rank
Q08
Price Sensitivity (Van Westendorp)Required
Thinking about your annual premium for this policy:
- At what price would you feel this coverage is so low-cost that you'd question whether it's adequate?
- At what price would you consider this coverage a bargain — a great deal for the money?
- At what price would you start to feel this coverage is getting expensive, though you might still consider it?
- At what price would this coverage be so expensive you would not consider it at all?
Q09
Opinion ScaleRequired
How likely are you to renew this policy when it comes up for renewal?
Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q10
AI Interview
Reconstruct the real story behind the respondent's renewal likelihood score. If they filed a claim, anchor on that specific claim: what happened, how it was communicated, and any moment of friction or delight. If they gave a low renewal score without a claim, probe what specifically about price, coverage, or service is pushing them to consider leaving, and what would change their mind.
Q11
Multiple Choice
How long have you held a policy with this insurer?
- Less than 1 year
- 1-3 years
- 4-10 years
- More than 10 years
Q12
Multiple Choice
Which age range do you fall into?
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65+
- Prefer not to say
Q13
Multiple Choice
Which best describes your household?
- Living alone
- Couple, no children
- Family with children at home
- Multigenerational household
- Prefer not to say
Q14
Message
Thank you for sharing your experience! Your answers, along with everyone else's, feed directly into how we improve coverage, pricing, and the claims process.
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
- Goes beyond a satisfaction rating with an AI follow-up interview that reconstructs the real story behind a respondent's renewal likelihood score, surfacing friction points a scale alone would miss
- Combines quantitative rigor (opinion scales, matrix agreement, ranking, and a Van Westendorp premium-sensitivity question) with qualitative depth in a single flow
- Segments responses by claim history, policy tenure, age, and household type so insurers can see which groups are most at churn risk
- Transparent prompts and automated per-response quality scoring mean insurers can trust and audit the AI-probed claim/renewal stories, then get an auto-generated report without manual analysis
Jotform
Insurance Policy Information Form TemplateThis is a data-intake form for capturing policy details (holder info, coverage, policy number) rather than a satisfaction or renewal-intent survey. It's easy to customize with Jotform's drag-and-drop builder but isn't built to measure experience or churn risk. Useful only as an admin/onboarding form, not a comparable research instrument.
What it does well
- Simple drag-and-drop form builder for quick deployment
- Good for structured data capture like policy numbers and coverage details
Where it falls short
- Not designed to measure satisfaction, claims experience, or renewal intent at all
- Static fields only — no adaptive follow-up to explore why a policyholder feels a certain way
- No automated scoring or churn-focused reporting
QuestionPro
Insurance policy survey questions + sample questionnaire templateA content-rich guide with a sample questionnaire covering policy satisfaction, claims, and coverage topics, aimed at helping teams write their own survey. It reads more like an educational resource with example questions than a ready-to-field, structured template. Good starting point for question ideas, but requires assembly into an actual instrument.
What it does well
- Broad library of sample insurance survey questions for reference
- Established survey platform with standard question types and reporting dashboards
Where it falls short
- Presented as a guide/sample list rather than a turnkey, fielding-ready survey
- No adaptive AI probing to dig into the story behind a claim or renewal decision
- No published methodology on how question wording or scoring choices were made
SurveyMonkey
Insurance Expenses Survey TemplateFocused on premium and cost-related questions rather than the full renewal/claims experience journey. It's a ready-to-use fielding template on a mature survey platform, but narrower in scope than a full satisfaction-and-retention instrument. Best suited for pricing perception research, not churn diagnosis.
What it does well
- Fielding-ready template on a widely used, reliable survey platform
- Likely includes standard benchmarking and reporting tools for cost/value questions
Where it falls short
- Narrow focus on expenses rather than claims experience, coverage satisfaction, or renewal intent
- Static question set with no adaptive follow-up to surface underlying reasons for dissatisfaction
- No transparent prompt methodology or automated qualitative-response scoring
SurveySparrow
Car Insurance Survey TemplateA conversational-style template scoped specifically to car insurance rather than general policyholder experience across policy types. It offers a chat-like UI for better completion rates, but is limited to auto insurance and standard fixed questions. Not designed to probe deeply into renewal decisions or claims stories.
What it does well
- Conversational chat-style interface that can improve respondent engagement
- Purpose-built for the auto insurance vertical
Where it falls short
- Scoped to car insurance only, not adaptable across policy types like home, life, or health
- No AI-driven follow-up to reconstruct the reasoning behind a satisfaction or renewal score
- No automated per-response quality scoring or transparent prompt disclosure
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.