Student Insurance Survey

Contact Information

Please provide your contact information so that you may be entered into our quarterly drawing for an Visa Gift Card. We appreciate your time.

* Required Fields

Name of Insured* Student ID Number*
Address*
City* State* Zip*
Email* Phone*
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General Information

1. Which College or University do you attend?

2. How long have you been insured under the Student Insurance Plan?
this school year this school year and prior school years.

3. Are you an International Student? Yes No

4. Are you a Graduate Student? Yes No


Regarding the benefits of the insurance program available through your College or University:

1. Are you satisfied with the Student Insurance Plan at your school? Yes No

2. If you answered "No", what benefits would you like to see improved or added under your plan?

3. Are you satisfied with the premium payment terms under your Student Insurance Program (annual, semi-annual, etc.) Yes No

4. If you answered "No", what term would you like to see available?

5. When you enroll in the Student Insurance Plan, what method do you prefer?
US Mail Student Insurance Website by Telephone


Regarding the Student Insurance Website:

1. How often have you visited the Student Insurance Website?

2. Have you used the website to view the insurance benefits outlined in the brochure? Yes No

3. Have you downloaded your Identification Card through the Student Insurance Website? Yes No

4. Did you find the ID Card print process easy to navigate? Yes No

5. Are you aware that you may find a Preferred Provider (results in a higher reimbursement) through the Student Insurance Website? Yes No

6. Have you found your service provider through the Internet Site? Yes No

7. If you answered "No" how did you find your service provider?

8. Do you realize that instructions for claim procedure and claim forms are available through the Student Insurance Website? Yes No

9. Have you checked the status of a claim you have filed through the Student Insurance Website? Yes No

10. Was having the ability to check your claim status online helpful to you? Yes No

11. If you answered "No" why not?


Regarding Customer Service provided by Associated Insurance Plans International, Inc. (AIP International):

1. Have you had a situation where you contacted AIP International regarding the Student Insurance Plan? Yes No

2. Was contact made by mail, telephone or internet?

3. Name of CSR who assisted you:

4. Please rate your experience on a scale of one to ten, with ten being the best possible experience.

5. Please describe your experience in more detail.

6. Were your issues resolved to your satisfaction? Yes No

7. Do you have suggestions that we would benefit from and which we could improve upon?

8. Are you aware that our office hours have been extended to 7:00 am to 7:00 pm Central Time? Yes No

9. Do the extended office hours help with your ability to contact a Representative regarding your health insurance? Yes No


Regarding Claim Service:

1. Have you contacted the claims department regarding a claim you have filed, or intended to file? Yes No

2. Was contact made by mail, telephone or internet?

3. Name of CSR who assisted you:

4. If by telephone, were you transferred to the claim office by AIP International? Yes No N/A

5. Please rate your experience on a scale of one to ten, with ten being the best possible experience.

6. Please describe your experience in more detail.

7. Were your issues resolved to your satisfaction? Yes No

8. Do you have suggestions that we would benefit from and which we could improve upon?



The information you have provided us with will help us to improve your service experience when dealing with our company. Thank you for taking the time to complete the survey. Your name will be entered into our quarterly drawing for an iPod. Please do not hesitate to call us at 800-452-5772 when we can provide you with assistance.