Q1. 您的職位？（單選題）
Q2. 您的文化程度是：（單選題）
Q3. Your age（填空題）
Q4. Nationality（填空題）
Q5. Which city are you based in?（單選題）
Beijing
Shanghai
Guangzhou
Shenzhen
Other cities
Q6. Scheduled effective date（單選題）
ASAP
Before next birthday, which falls on
A specific day, which is
Q7. Are you currently holding a commercial medical insurance policy?（單選題）
Yes. I'm currently insured by
No
Q8. Do you have a chinese social security account (shè bǎo社保)？（單選題）
Yes
No
Q9. Area of coverage?（多選題）
Mainland China
Greater China
Asia
Worldwide excluding USA
Worldwide
Comments if any
Q10. Who is the insurance for?（單選題）
Yourself
You and your spouse
You, your spouse and your child(ren)
Other
Q11. How old is your spouse?（填空題）
Q12. Your budget per person (You can skip this question)（單選題）
<5k
5-10k
10-15k
15-20k
Other. Please see the table as a reference. Age, type of facilities and benefits selected are taken into account.
Q13. How old is the to-be-insured person?（填空題）
Q14. What benefit(s) would you like to cover, besides inpatient module which is a must?（多選題）
Outpatient
Wellness: physical checkup and vaccine
Dental
Maternity
Optical
None of the above, only inpatient
Q15. What benefit(s) would you like to cover, besides inpatient module which is a must? (Kindly leave your requirement under Comments if plan design is different for each)（多選題）
Outpatient
Wellness: physical checkup and vaccine
Dental
Maternity
Optical
None of the above, only inpatient
Comments
Q16. What types of medial facilities would you like to cover?（多選題）
Government hospitals including international wings
Private clinics and hospitals
High cost private clinics and hospitals (HCP)
Other. Such as facilities you would like to include
Q17. Who will pay the premium?（單選題）
You
Your company
Q18. How old is each member in your family?（多項(xiàng)填空題）
Your spouse
Your child(ren)
Q19. Please state here if you have other requirements.（填空題）
Q20. 您的手機(jī)號(hào)（填空題）
