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

r 1-2 years r 5-10 years

3. How is your business organized?

r Sole proprietorship r Corporation r LLC

r Partnership r Sub-s corporation r Other (_____________)

4. How many guest rooms?

r 1-3 r 8-10 r 16+

r 4-7 r 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'')

r None r 3-5 r 10+

r 1-2 r 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)?

r None r 3-5 r 10+

r 1-2 r 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?

r Yes (self only) r Yes (self plus ____owners)

r Yes (self + spouse/partner) r No

8. Do you currently have health insurance?

r Yes r No

9. If ``yes'' to #8 above, from whom do you purchase your health insurance?

· Local agent/broker r Local association

· I am covered from other employment r 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?