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Let's Build NEW Affordable Health Plan We Can All Use.

EVOKE Foundation is a Non Profit organization dedicated to social change through Art & Media. In these challenging times we began to realize that we, the creatives, need our own support. One change we all need right now is affordable health insurance. With the power of numbers we can build a group plan and share the cost, we are in this together. The more we grow our collective buying power increases and reduces the cost of your plan.

This Information will help us develop a group health plan that will be very affordable for everyone in our industry that can not normally be obtained without large buying power.

NONE of this information will be shared in any way outside of our small team at EVOKE.

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* 1. Occupation

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* 2. Age

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 3. Employment status

Independent Contractor

Freelancer

Gig worker

Employed by a company Full Time

Employed by a company Part Time

Other (please specify)

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* 4. Do you belong to an Association / Professional Group or club ? Please name it.

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* 5. Does it worry you to not have health insurance ?

Yes

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* 6. Do you currently have health insurance ?

Yes

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* 7. If you are not insured what is the reason ?

Cost too high

Lost Job /Changed Employers

Lost Medicaid

Employer does not offer insurance or ineligible for coverage

Do not feel I need health coverage / pay out of pocket for any medical needs

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* 8. What is the most important health coverage for you ?

Emergency

Preventative care

Surgery

Pre-existing condition care

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* 9. What is important to you about health insurance ?

Low out of pocket costs ( deductible,office co-pay, prescription co-pay)

Network of doctors/ hospitals

Easy claims process

Telemedicine

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* 10. What worries you the most about health insurance ?

Difficulty paying medical bills overtime/medical bills that can not be paid

Monthly premiums

Not being able to insure your whole family

Not being covered in an emergency

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* 11. What is the most you can afford to pay for health insurance per month for individual ?

Under $100

$100-$300

$300-$500

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* 12. What is the most you can afford to pay for health insurance for your family ?

Under $100

$100-$300

$300-$500

$500-$750

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* 13. Would you pay a membership fee of $10.00 per month to join an association with other benefits get access to considerably reduced insurance premiums ?

Yes

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* 14. Would you like to tell us what you'd like to see in a health plan ?

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* 15. Would you like to be notified when EVOKE Insurance becomes available ?

Yes

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* 16. Your details - Only for the purpose of this survey. It's important but we made this optional for you. By not filling this out we have no way to contact you again.

Name

State/Province

Email Address

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* 17. Would you like to refer a friend or colleague ?
The more we grow our collective buying power increases and reduces the cost of your plan. We are in this together.

Email Address

Let's Build NEW Affordable Health Plan We Can All Use.

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* 1. Occupation

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* 2. Age

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* 3. Employment status

Question Title

* 4. Do you belong to an Association / Professional Group or club ? Please name it.

Question Title

* 5. Does it worry you to not have health insurance ?

Question Title

* 6. Do you currently have health insurance ?

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* 7. If you are not insured what is the reason ?

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* 8. What is the most important health coverage for you ?

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* 9. What is important to you about health insurance ?

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* 10. What worries you the most about health insurance ?

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* 11. What is the most you can afford to pay for health insurance per month for individual ?

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* 12. What is the most you can afford to pay for health insurance for your family ?

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* 13. Would you pay a membership fee of $10.00 per month to join an association with other benefits get access to considerably reduced insurance premiums ?

Question Title

* 14. Would you like to tell us what you'd like to see in a health plan ?

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* 15. Would you like to be notified when EVOKE Insurance becomes available ?

Question Title

* 16. Your details - Only for the purpose of this survey. It's important but we made this optional for you. By not filling this out we have no way to contact you again.

Question Title

* 17. Would you like to refer a friend or colleague ? The more we grow our collective buying power increases and reduces the cost of your plan. We are in this together.

* 17. Would you like to refer a friend or colleague ?
The more we grow our collective buying power increases and reduces the cost of your plan. We are in this together.