Template Patient Satisfaction Health Insurance Evaluation Survey Template

Health Insurance Evaluation Survey Template

Health Insurance Evaluation Survey Template

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Health Insurance Evaluation Survey Template

We appreciate your input. Please take a few minutes to complete this short survey about your health insurance plan.
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1.
Using a 1–5 scale, how would you rate your overall satisfaction with your health insurance coverage?
2.
Which company is your health insurance provider?
3.
How would you evaluate the affordability of your health insurance premium?
Very Affordable
Affordable
Neutral
Expensive
Very Expensive
4.
How satisfied are you with your plan's coverage for prescription medications?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
5.
Do you consider the network of healthcare providers included in your plan to be adequate?
Yes
No
6.
How would you rate the customer service provided by your health insurer?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
7.
Please provide any suggestions or feedback to help improve your health insurance coverage.
8.
Would you be likely to recommend your health insurance provider to others?
Yes
No
Not Sure
*
9.
Full Name
10.
Email Address
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Template instructions
Health insurance evaluation survey template is a practical free template for collecting policyholder opinions about coverage, premiums, prescription benefits, provider networks and customer service.

This survey includes rating scales, multiple-choice and open-ended questions to assess overall satisfaction, affordability, prescription coverage, network adequacy and service responsiveness. It asks respondents to name their insurer and rate key areas using 1-5 scales and labeled options. Questions are easy to edit, reorder and brand, and conditional logic can provide targeted follow-ups.

Use scenarios include insurers seeking product feedback, researchers analyzing plans, regulators monitoring consumer experience, or HR teams evaluating benefits. Contact fields allow follow-up, while an open feedback item captures suggestions. Results can be exported and visualized for analysis to prioritize improvements.

Click "Use This Template" to customize, brand and deploy this free template quickly. Start gathering actionable feedback today to improve member satisfaction, retention, and future plan offerings. Get started in minutes now.

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1

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Click "Use This Template" to open it in SurveyMars. You can preview and test it without signing up.

2

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3

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