Appendix

APPENDIX A1

SURVEYS

SURVEY FOR CONVERTERS

Form No. [survey id]

Barcode

Department of Veterans Affairs

Veterans Group Life Insurance Survey

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number of this information collection is xxxx-xxxx. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. Your participation is voluntary. Your answers will be used only for the purpose of this study. This study is being conducted for the Department of Veterans Affairs to assess future program and benefit needs. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: VA Clearance Officer (005R1B), U.S .Department of Veterans Affairs, Washington DC 20420. If you have comments or concerns regarding the status of your individual submission of this form, write directly to (name) (Org) (Address).

Please take the time to complete this survey. Participating is easy and it only takes 10 minutes to complete. Your answers are very important to us. This brief survey asks for your input on Group Life Insurance offered through the Veterans Benefits Administration. Answer each question thinking about yourself.

Please return your completed survey in the enclosed postage-paid envelope.

• Answer all the questions by putting an X in the box corresponding to your answer, like this:

 Yes

• Be sure to read all the answer choices given before marking your answer.

• You are sometimes told to skip questions depending on the answer you give. When this happens you will see an instruction that tells you what question to answer next, like this: [Skip to Question 13].

See the examples below:

Example

11. Did you receive a telephone call about the VGLI program?

? Yes

? No [Skip to Question 13]

? Don’t remember [Skip to Question 13]

12. Did the telephone call provide useful information about the value of the VGLI program?

? Yes

? No

? Don’t remember

13. Did you visit the VA insurance website, www.insurance.va.gov, for more information on VGLI?

? Yes

? No [Skip to Question 15]

? Don’t remember [Skip to Question 15]

Thank you for your assistance.

Questions about your Military Service

1. When you joined the military, you were automatically enrolled in term life insurance coverage through the Servicemembers’ Group Life Insurance (SGLI) Program. Were you aware of the SGLI program?

 Yes

 No  [Skip to Q3]

2. Thinking about your experiences with the SGLI program, including products, services, and personnel, how would you rate your overall satisfaction with the SGLI program?

 Excellent

 Very good

 Good

 Fair

 Poor

⁶  Don’t know

3. While you were in the military, did you have any life insurance coverage other than your coverage through SGLI?

 Yes

 No

 Don’t know

4. As you were preparing to separate from the military, you may have participated in a separation briefing. How would you rate your overall satisfaction with the separation briefing?

 Excellent

 Very good

 Good

 Fair

 Poor

⁶  Did not attend a separation briefing  [Skip to Q7]

5. During your separation briefing, do you recall being briefed about the Veterans’ Group Life Insurance (VGLI)?

 Yes

 No  [Skip to Q7]

 Don’t remember  [Skip to Q7]

6. How satisfied were you with the information you received about the VGLI program at your separation briefing?

 Very satisfied

 Somewhat satisfied

 Neither satisfied nor dissatisfied

 Somewhat dissatisfied

 Very dissatisfied

Questions about the Veterans Group Life Insurance (VGLI) program

7. Do you recall receiving information about the VGLI program through the mail?

 Yes

 No

 Don’t remember

8. You may have received more than one package of information about VGLI. How many VGLI information packages do you recall receiving?

⁰  None  [Skip to Q11]

 One

 Two

 Three or more

 Don’t remember

9. How carefully did you read the information on the VGLI program?

 Read information

 Skimmed information

 Did not read information  [Skip to Q11]

 Never received VGLI information  [Skip to Q11]

10. Please rate the VGLI information package on the following features. (Please check one box in each row.)

	Excellent	Very good	Good	Fair	Poor	Don’t remember
a. Information was organized in a way that made sense to me						
b. It was easy to under-stand the features and benefits						
c. It showed me how to choose a coverage amount						
d. It provided me with the premium for coverage						
e. It clearly explained the steps to enroll						
f. It contained information for people my age						
g. It contained information for people whose health is like mine						

11. Did you receive a telephone call about the VGLI program?

 Yes

 No  [Skip to Q13]

 Don’t remember  [Skip to Q13]

12. Did the telephone call provide useful information about the value of the VGLI program?

 Yes

 No

 Don’t remember

13. Did you visit the VA insurance website, www.insurance.va.gov, for more information on VGLI?

 Yes

 No  [Skip to Q15]

 Don’t remember  [Skip to Q15]

14. How satisfied were you with the VGLI information from the VA insurance website?

 Very satisfied

 Somewhat satisfied

 Neither satisfied nor dissatisfied

 Somewhat dissatisfied

 Very dissatisfied

 Don’t remember

15. Were you aware of the following features and benefits of VGLI? (Please check yes, no or don’t know for each item.)

	Yes	No	Don’t know
a. If you submit your application within 120 days of separation, you do not need evidence of good health to get VGLI coverage			
b. You can apply for VGLI coverage up to 1 year and 120 days after separation			
c. You can renew VGLI coverage regardless of your health			
d. You can keep VGLI coverage for your entire life			
e. VGLI offers an option for the terminally ill to get 50% of their coverage in a lump sum before death to help pay for medical and other expenses during the last months of life			
f. VGLI provides free financial counseling to survivors			

Questions about your decision to convert to VGLI

16. Our records indicate you chose to convert your SGLI to a VGLI policy. Below is a list of possible reasons that may have affected your decision. Please rate how important each reason was to you. (Please check one box in each row.)
	Very important	Somewhat important	Not very important	Not at all important
a. Insurance plan features (coverage levels, accelerated benefits option, settlement options)				
b. Cost				
c. Ability to purchase regardless of health				
d. Sponsorship by the VA				
e. It was easy to enroll				
f. Didn't want to lose the benefit..................				

17. Other than VGLI, how easy do you think it would be for someone your age to get life insurance coverage?

 Very easy

 Somewhat easy

 Neither easy nor difficult

 Somewhat difficult

 Very difficult

18. Other than VGLI, how easy do you think it would be for someone in your health to get life insurance coverage?

 Very easy

 Somewhat easy

 Neither easy nor difficult

 Somewhat difficult

 Very difficult

19. Please indicate if you have life insurance coverage through any of the following sources (other than VGLI)? (Please check yes or no for each item.)

	Yes	No
a. An employer?		
b. A spouse’s employer?		
c. A life insurance plan that you purchased on your own?		
d. A military benefits association (e.g., Navy Mutual Aid, etc.)?		
e. Some other source of life insurance (please specify) _______________		

20. What is the total coverage amount of all of your non-VGLI life insurance coverage?

 No additional life insurance coverage

 Up to $24,999

 $25,000 to $99,999

 $100,000 to $199,999

 $200,000 to $499,999

⁶ $500,000 to $999,999

 $1,000,000 or more

21. Which of the following reasons prompted you to select the life insurance company you chose to purchase coverage from? (Please check yes or no for each item.)

	Yes	No
a. The coverage is provided through my employer		
b. The premiums for the coverage I obtained were less than I would have paid for VGLI		
c. Needed more coverage than VGLI offered		
d. Needed different coverage than VGLI offered (e.g., I wanted whole life or permanent life insurance, not term life insurance)		
e. Insurance company’s reputation		
f. Other (please specify)__________ ____________________________		

22. How important do you feel it is for you personally to have life insurance coverage at this time?

 Very important

 Somewhat important

 Not very important

 Not at all important  [Skip to Q24]

23. When thinking about life insurance coverage, how important are each of the following factors to you at this time? (Please check one box in each row.)

	Very important	Somewhat important	Not very important	Not at all important	N/A at this time
a. Insurance coverage to provide for dependent children					
b. Insurance coverage to provide for a spouse					
c. Insurance coverage to provide for burial costs					
d. Insurance coverage to provide for final medical costs					

Background questions about you

24. At the time of separation, were you a Reserve Component or National Guard member?

 Yes

 No

25. At the time of separation, what was your rank?

 O4 or above

 O1 - O3

 WO1 - CW4

 E8 - E9

 E5 - E7

⁶  E1 - E4

26. Are you male or female?

 Male

 Female

27. What is your age?

 Under 25

 25-29

 30-34

 35-44

 45-54

⁶  55-64

 65 or over

28. What is your marital status

 Married

 Widowed

 Divorced

 Separated

 Never married

29. What is the highest grade or degree you have completed in school?

 High school diploma/grade 12/GED/equavalent

 Vocational/technical/trade school

 Associate degree

 Bachelor’s degree

 Master’s or doctoral degree

30. Which of the following were you doing last week? (Please check all that apply.)

 Working

 Temporarily absent from a job or business

 Looking for work

 Going to school/student full-time

 Caring for children/keeping house

⁶  Retired

 On disability

⁹⁵  Other (please specify) ____________________

31. Please indicate if you have any of the following dependents of any age. (Please check yes or no for each item.)

	Yes	No
a. Dependent children (of any age)		
b. Other dependents		

32. Do you have a service-connected disability rating?

 Yes

 No  [Skip to Q34]

33. What is the percent rating of your service-connected disability rating?

___________

34. Which of the following categories best describes your total individual income for 2007 before taxes? This should include wages and salaries, net income from business or farm, pensions, dividends, interest, rent, disability payments, and any other money you receive.

 Less than $25,000

 $25,000-$49,999

 $50,000-$74,999

 $75,000-$99,999

 $100,000 or more

Thank you for completing this important survey. Please return your completed survey in the self-addressed, postage-paid envelope included in your survey packet.

35. Which of the following categories best describes your total household income for 2007 before taxes? This should include wages and salaries, net income from business or farm, pensions, dividends, interest, rent, disability payments, and any other money income received by all members of the household.

 Less than $25,000

 $25,000-$49,999

 $50,000-$74,999

 $75,000-$99,999

 $100,000 or more

36. Including yourself, how many people does this income support?

___________ [number of people]

SURVEY FOR

NON-CONVERTERS

Form No. [survey id]

Barcode

Department of Veterans Affairs

Veterans Group Life Insurance Survey

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number of this information collection is xxxx-xxxx. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. Your participation is voluntary. Your answers will be used only for the purpose of this study. This study is being conducted for the Department of Veterans Affairs to assess future program and benefit needs. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: VA Clearance Officer (005R1B), U.S .Department of Veterans Affairs, Washington DC 20420. If you have comments or concerns regarding the status of your individual submission of this form, write directly to (name) (Org) (Address).

Please take the time to complete this survey. Participating is easy and it only takes 10 minutes to complete. Your answers are very important to us. This brief survey asks for your input on Group Life Insurance offered through the Veterans Benefits Administration. Answer each question thinking about yourself.

Please return your completed survey in the enclosed postage-paid envelope.

• Answer all the questions by putting an X in the box corresponding to your answer, like this:

 Yes

• Be sure to read all the answer choices given before marking your answer.

• You are sometimes told to skip questions depending on the answer you give. When this happens you will see an instruction that tells you what question to answer next, like this: [Skip to Question 13].

See the examples below:

Example

11. Did you receive a telephone call about the VGLI program?

? Yes

? No [Skip to Question 13]

? Don’t remember [Skip to Question 13]

12. Did the telephone call provide useful information about the value of the VGLI program?

? Yes

? No

? Don’t remember

13. Did you visit the VA insurance website, www.insurance.va.gov, for more information on VGLI?

? Yes

? No [Skip to Question 15]

? Don’t remember [Skip to Question 15]

Thank you for your assistance.

Questions about your Military Service

1. When you joined the military, you were automatically enrolled in term life insurance coverage through the Servicemembers’ Group Life Insurance (SGLI) Program. Were you aware of the SGLI program?

 Yes

 No  [Skip to Q3]

2. Thinking about your experiences with the SGLI program, including products, services, and personnel, how would you rate your overall satisfaction with the SGLI program?

 Excellent

 Very good

 Good

 Fair

 Poor

⁶  Don’t know

3. While you were in the military, did you have any life insurance coverage other than your coverage through SGLI?

 Yes

 No

 Don’t know

4. As you were preparing to separate from the military, you may have participated in a separation briefing. How would you rate your overall satisfaction with the separation briefing?

 Excellent

 Very good

 Good

 Fair

 Poor

⁶  Did not attend a separation briefing  [Skip to Q7]

]

5. During your separation briefing, do you recall being briefed about the Veterans’ Group Life Insurance (VGLI)?

 Yes

 No  [Skip to Q7]

 Don’t remember  [Skip to Q7]

6. How satisfied were you with the information you received about the VGLI program at your separation briefing?

 Very satisfied

 Somewhat satisfied

 Neither satisfied nor dissatisfied

 Somewhat dissatisfied

 Very dissatisfied

Questions about the Veterans Group Life Insurance (VGLI) program

7. Do you recall receiving information about the VGLI program through the mail?

 Yes

 No

 Don’t remember

8. You may have received more than one package of information about VGLI. How many VGLI information packages do you recall receiving?

⁰  None  [Skip to Q11]

 One

 Two

 Three or more

 Don’t remember

9. How carefully did you read the information on the VGLI program?

 Read information

 Skimmed information

 Did not read information  [Skip to Q11]

 Never received VGLI information  [Skip to Q11]

10. Please rate the VGLI information package on the following features. (Please check one box in each row.)

Excellent

Very good

Good

Fair

Poor

Don’t remember

a. Information was organized in a way that made sense to me













b. It was easy to under-stand the features and benefits













c. It showed me how to choose a coverage amount













d. It provided me with the premium for coverage













e. It clearly explained the steps to enroll













f. It contained information for people my age













g. It contained information for people whose health is like mine













11. Did you receive a telephone call about the VGLI program?

 Yes

 No  [Skip to Q13]

 Don’t remember  [Skip to Q13]

12. Did the telephone call provide useful information about the value of the VGLI program?

 Yes

 No

 Don’t remember

13. Did you visit the VA insurance website, www.insurance.va.gov, for more information on VGLI?

 Yes

 No  [Skip to Q15]

 Don’t remember  [Skip to Q15]

14. How satisfied were you with the VGLI information from the VA insurance website?

 Very satisfied

 Somewhat satisfied

 Neither satisfied nor dissatisfied

 Somewhat dissatisfied

 Very dissatisfied

 Don’t remember

15. Were you aware of the following features and benefits of VGLI? (Please check yes, no or don’t know for each item.)

	Yes	No	Don’t know
a. If you submit your application within 120 days of separation, you do not need evidence of good health to get VGLI coverage			
b. You can apply for VGLI coverage up to 1 year and 120 days after separation			
c. You can renew VGLI coverage regardless of your health			
d. You can keep VGLI coverage for your entire life			
e. VGLI offers an option for the terminally ill to get 50% of their coverage in a lump sum before death to help pay for medical and other expenses during the last months of life			
f. VGLI provides free financial counseling to survivors			

Questions about your decision not to convert to VGLI

16. Our records indicate you chose not to convert your SGLI to a VGLI policy. Below is a list of possible reasons that may have affected your decision. Please indicate which of the following best describes your reason for not enrolling in VGLI. (Please check yes or no for each item.)
	Yes	No
a. I am unfamiliar with VGLI		
b. I did not know I was eligible for VGLI		
c. I did not understand the features and benefits		
d. It was too difficult/I did not know how to enroll for coverage		
e. Life Insurance coverage is too expensive for me right now		
f. I have life insurance through another company		
g. I do not need life insurance right now		
h. Other (please specify) ___________ _____________________________		

17. Other than VGLI, how easy do you think it would be for someone your age to get life insurance coverage?

 Very easy

 Somewhat easy

 Neither easy nor difficult

 Somewhat difficult

 Very difficult

18. Other than VGLI, how easy do you think it would be for someone in your health to get life insurance coverage?

 Very easy

 Somewhat easy

 Neither easy nor difficult

 Somewhat difficult

 Very difficult

19. Please indicate if you have life insurance coverage through any of the following sources (other than VGLI)? (Please check yes or no for each item.)

	Yes	No
a. An employer?		
b. A spouse’s employer?		
c. A life insurance plan that you purchased on your own?		
d. A military benefits association (e.g., Navy Mutual Aid, etc.)?		
e. Some other source of life insurance (please specify) _______________		

20. What is the total coverage amount of all of your non-VGLI life insurance coverage?

 No additional life insurance coverage

 Up to $24,999

 $25,000 to $99,999

 $100,000 to $199,999

 $200,000 to $499,999

⁶ $500,000 to $999,999

 $1,000,000 or more

21. Which of the following reasons prompted you to select the life insurance company you chose to purchase coverage from? (Please check yes or no for each item.)

	Yes	No
a. The coverage is provided through my employer		
b. The premiums for the coverage I obtained were less than I would have paid for VGLI		
c. Needed more coverage than VGLI offered		
d. Needed different coverage than VGLI offered (e.g., I wanted whole life or permanent life insurance, not term life insurance)		
e. Insurance company’s reputation		
f. Other (please specify) ___________ _____________________________.		

22. How important do you feel it is for you personally to have life insurance coverage at this time?

 Very important

 Somewhat important

 Not very important

 Not at all important  [Skip to Q24]

23. When thinking about life insurance coverage, how important are each of the following factors to you at this time? (Please check one box in each row.)

	Very important	Somewhat important	Not very important	Not at all important	N/A at this time
a. Insurance coverage to provide for dependent children					
b. Insurance coverage to provide for a spouse					
c. Insurance coverage to provide for burial costs					
d. Insurance coverage to provide for final medical costs					

Background questions about you

24. At the time of separation, were you a Reserve Component or National Guard member?

 Yes

 No

25. At the time of separation, what was your rank?

 O4 or above

 O1 - O3

 WO1 - CW4

 E8 - E9

 E5 - E7

⁶  E1 - E4

26. Are you male or female?

 Male

 Female

27. What is your age?

 Under 25

 25-29

 30-34

 35-44

 45-54

⁶  55-64

 65 or over

28. What is your marital status

 Married

 Widowed

 Divorced

 Separated

 Never married

29. What is the highest grade or degree you have completed in school?

 High school diploma/grade 12/GED/equavalent

 Vocational/technical/trade school

 Associate degree

 Bachelor’s degree

 Master’s or doctoral degree

30. Which of the following were you doing last week? (Please check all that apply.)

 Working

 Temporarily absent from a job or business

 Looking for work

 Going to school/student full-time

 Caring for children/keeping house

⁶  Retired

 On disability

⁹⁵  Other (please specify) ____________________

31. Please indicate if you have any of the following dependents of any age. (Please check yes or no for each item.)

	Yes	No
a. Dependent children (of any age)		
b. Other dependents		

32. Do you have a service-connected disability rating?

 Yes

 No  [Skip to Q34]

33. What is the percent rating of your service-connected disability rating?

___________

34. Which of the following categories best describes your total individual income for 2007 before taxes? This should include wages and salaries, net income from business or farm, pensions, dividends, interest, rent, disability payments, and any other money you receive.

 Less than $25,000

 $25,000-$49,999

 $50,000-$74,999

 $75,000-$99,999

 $100,000 or more

Thank you for completing this important survey. Please return your completed survey in the self-addressed, postage-paid envelope included in your survey packet.

35. Which of the following categories best describes your total household income for 2007 before taxes? This should include wages and salaries, net income from business or farm, pensions, dividends, interest, rent, disability payments, and any other money income received by all members of the household.

 Less than $25,000

 $25,000-$49,999

 $50,000-$74,999

 $75,000-$99,999

 $100,000 or more

36. Including yourself, how many people does this income support?

___________ [number of people]