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Do You Have Health Insurance? Template

NOTE: If the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) applies to you and your intended use of SurveyMonkey, this template is NOT intended for your use without 1) a SurveyMonkey ‘HIPAA-enabled’ account, and 2) a business associate agreement with us, which can be purchased by contacting our sales team. Please see our Acceptable Uses Policy for more information.
1.Do you currently have health insurance, or not?
2.Were you without health insurance for any amount of time in the past 12 months, or not?
3.Who pays for your health insurance? (Check all that apply)
4.Which of the following services are covered, in total or in part, by your health insurance plan(s)? (Check all that apply)
5.Why do you currently not have health insurance? (Check all that apply)
Current Progress,
0 of 5 answered