Small Business Health Insurance Rate Increase Mini Survey

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1. Background

Background   Name
Business Name
Business Type
Number of Employees
City
State
Phone
Email

2. Have you received a rate increase in your health insurance premiums in the past six months?

Have you received a rate increase in your health insurance premiums in the past six months?   Yes No

If no, please scroll to the bottom and click "done."

3. If yes, in which of the following ranges did the rate increase fall?

If yes, in which of the following ranges did the rate increase fall?   0-9 percent 10-19 percent 20-29 percent 30-39 percent 40-49 percent 50 percent or more

4. Rate Increase Details

Rate Increase Details   What was the exact percentage increase you were quoted?
When was the increase scheduled to take effect?
What is the name of the health insurer that quoted you this increase?
With the quoted increase, what would your total monthly health insurance premiums be (in dollars)?
With the quoted increase, what would your premiums be as a percentage of your payroll (eg, 5%, 10%, 15%)?

5. How did you respond to the quoted increase (please check any that apply):

How did you respond to the quoted increase (please check any that apply):   Accepted the increase and paid the new premiums Increased deductibles/co-pays or reduced benefits Increased employee cost-sharing Switched insurance carriers Dropped coverage entirely None of the above

Other (please specify)

6. Are you willing to be on a list of small business owners available for interviews with the media about the recent trend in rate increases? (we will contact you before sharing your information with any reporters)

Are you willing to be on a list of small business owners available for interviews with the media about the recent trend in rate increases? (we will contact you before sharing your information with any reporters)   Yes

7. Please share any additional details/comments here:

Please share any additional details/comments here: