D R A F T

Health Insurance Questionnaire for PAII inn and vendor (?) members

  1. I don't need health insurance r (Check and return so we get an idea of % of members not interested.)

  2. How long have you been in business?

    Less than 1 year 2-5 years
    10+ years 1-2 years
    5-10 years

  3. How is your business organized?
    Sole proprietorship Corporation
    LLC Partnership
    Sub-s corporation Other:
  4. How many guest rooms?
    1-3 8-10 16+
    4-7 11-15
  5. Do you have full-time employees to whom you would like to offer health insurance? (Include owners if it's a ``corporation'')
    None 3-5 10+
    1-2 6-10
    AGES: (List number of)
    __18-25 __40-50 __51-60
    __26-40 __41-50 __61+
  6. How many part-time-time employees (regularly working fewer than 30 hours/week)?
    None 3-5 10+
    1-2 6-10
  7. If you legal entity is a sole proprietorship or a partnership, do you need health insurance for yourself and/or other owner of your business?
    Yes Self Only Yes (self plus ____owners)
    Yes (self + spouse/partner) No
  8. Do you currently have health insurance?
    YES NO

  9. If ``yes'' to #8 above, from whom do you purchase your health insurance?
    Local agent/broker Local association
    I am covered from other employment CVB OTHER
  10. Which items below are most important to you in choosing a health insurance plan?

    Please rank all in order of importance. Place a ``1'' next to the MOST important item, ``2'' next to the second most important item, etc. Use each number only once

    __ Broadest possible choice of physicians/hospitals
    __ Coverage for specific medical conditions
    __ Good customer service from the insurer
    __ Low deductibles/co-payments
    __ Low employee share of premium
    __ Low employer share of premium
    __ Simple administration/forms

  11. What other factors do you consider important when choosing whether to offer a health insurance plan?