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* 1. Booking ID (please fill in the 4 digit code provided by your trainer)

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* 2. Your Gender:

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* 3. Your Race :

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* 4. Your Citizenship:

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* 5. Your Age Range:

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* 6. Your Current Family Status:

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* 7. Your Highest Level of Education:

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* 8. Your Annual Household Income Range (Before Taxes):

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* 9. Please CLICK your response to each the following statements:

  Do Not Know True False
If I want to have additional insurance protection on top of what MediShield Life provides, such as treatment in Class A/B1 wards in restructured hospitals and/or treatment in private hospitals, I should purchase an Integrated Shield Plan.
The coordination of benefits means that I can claim more than 100% of my actual medical expenses from the combination of my health insurance policies.
ElderShield premiums are based on my age of entry, payable annually until age 65.
I can use the money in my Medisave Account to pay for my grandchildren’s healthcare expenses.
Most health insurance policies have a last entry age after which one will not be able to apply for coverage.

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* 10. How CONFIDENT are you to do each of the following?

  Not Confident A Little Confident Confident Very Confident
Buy health insurance, knowing what it is for.
Identify the different types of health insurance products.
Understand my health insurance needs.
Use the various CPF schemes to meet my needs.
Select suitable health insurance products for myself and my dependants.

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