Health Insurance Questionnaire Health Insurance Questionnaire Church Name * What is the size (members/attendees) of your congregation? * Does your church provide Health Insurance coverage for your: Pastor * YES NO Other Full Time Employees * YES NO If your church does not provide health insurance to your Pastor or other employees, how and from where do they obtain their insurance? If your church does provide health insurance to your Pastor or other employees: How many employees (including the pastor) are covered? Type of Health Plan * GROUP PLAN INDIVIDUAL POLICIES Through what entity (group, association, broker, other) do you contract with for the insurance coverage? Is the plan considered a high-deductible plan? YES NO What % of the total insurance premiums are paid by the church? Name and contact information of person that can be contacted with any follow-up information: Name * Phone # * Email * Submit Questionnaire Your information will be kept confidential and used only for the purposes of this survey.
