2 minutes to complete
All employees of a company are typically eligible to fill out an employee health benefits survey.
Type of health coverage elected
I am happy with our current network of doctors/hospitals through the current provider
Approximate amount you have paid out of pocket this calendar year for health claims (office visit co-pays, deductibles, co-insurance and prescription costs)
Rank in order of importance to you regarding your health insurance
(Rank 1 through 5, 1 being the most important to you, 5 being the least)
Rate your overall level of satisfaction with the current health insurance carrier
I would be interested in electing supplemental benefits such as
Type of dental coverage elected
Rate your level of satisfaction with your current dental coverage
Rank in order of importance to you regarding your dental insurance
Child orthodontics is an important coverage option on the dental plan
I have coverage elsewhere
I cannot afford coverage at this time
Coverage is affordable but not elected