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1. Please select the type of health coverage you currently have: (Choose one) (Required.)

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2. How would you rate the following statement: I am happy with the current medical coverages and the network of doctors and hospitals through the current provider: (Choose one) (Required.)

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3. What is the approximate amount of money you have paid out of pocket yearly, on average, for health claims (office visit co-pays, deductibles, co-insurance, and prescription costs): (Choose one) (Required.)

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4. Based on your health insurance needs, please rank the following in order of importance: (Rank 1 through 5, 1 being the most important to you, 5 being the least) (Required.)

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5. How would you rate your overall level of satisfaction with the current health insurance carrier: (Choose one) (Required.)

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6. What additional or supplemental benefits would you like to see offered? (Required.)

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7. Please select the type of dental coverage you currently have: (Choose one) (Required.)

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8. Please rate your level of satisfaction with the current dental coverage: (Choose one) (Required.)

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9. Based on your needs, please rank the following in order of importance: (Rank 1 through 5, 1 being the most important to you, 5 being the least) (Required.)

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10. Are there additional dental coverages that you would like to see offered? If so, please list them. (Required.)

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11. Please select the type of vision coverage your currently have: (Choose one) (Required.)

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12. Please rate your level of satisfaction with the current vision coverage: (Circle one) (Required.)

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13. Does the current vision coverage meet your needs? If no, please explain: (Required.)

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14. If you have any additional comments, please feel free to leave them here. Thank you, for completing this survey.

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