Association Health Plan Interest Survey Question Title * 1. What year were you born? OK Question Title * 2. Gender Male Female OK Question Title * 3. What is your home zip code? OK Question Title * 4. Select the tax filing status you currently hold Contractor (1099) W2 Employee Managing Broker Sole Proprietorship/Partnership OK Question Title * 5. If you're a managing broker, list the number of each in your agency. Place a '0' in the N/A space if this question doesn't apply to you. 1099 Agents W2 Employees N/A OK Question Title * 6. Select your annual gross income range 0 to 24,999 25,000 to 49,999 50,000 to 74,999 75,000 to 99,999 100,000 to 124,999 125,000 to 149,999 150,000 to 174,999 175,000+ OK Question Title * 7. How do you currently obtain health insurance? Individual policy (federal marketplace, state marketplace, or local agency) Spouse/dependent coverage Your employer Not insured OK Question Title * 8. If you have health insurance, what type of coverage do you have? Individual Individual plus spouse Individual plus children Family N/A OK Question Title * 9. Indicate your level of interest in participating in group purchase of medical, dental, vision, and other benefits for your association assuming the cost is reasonable Extremely interested Very interested Somewhat interested Not at all interested OK Question Title * 10. Check all of the products you'd be interested in purchasing through your association assuming the cost is reasonable Dental/vision insurance Life insurance Long-term disability insurance Long-term care insurance Retirement plans Supplemental insurance (accident, cancer, critical illness, hospital indemnity, etc.) OK DONE