Employee Health Insurance Survey Question Title * 1. Please select the type of health coverage you currently have: (Choose one) Single Limited Family (Employee + Spouse or Employee + Children) Full Family (Employee, Spouse + Children) Question Title * 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) Strongly Agree Somewhat Agree Neutral Somewhat Disagree Strongly Disagree Question Title * 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) $0 - $500 $501 - $1,000 $1,001 - $1,500 $1,501 - $2,000 $2,001 or more Question Title * 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) Question Title * 5. How would you rate your overall level of satisfaction with the current health insurance carrier: (Choose one) Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied Question Title * 6. What additional or supplemental benefits would you like to see offered? Additional life insurance for family members and myself Additional long-term disability coverage Long-term care for dependents or myself Additional short-term disability coverage Cancer insurance, accident policy, hospital indemnity plan Other (please specify) Question Title * 7. Please select the type of dental coverage you currently have: (Choose one) Single Limited Family (Employee + Spouse or Employee + Children) Full Family (Employee, Spouse + Children Question Title * 8. Please rate your level of satisfaction with the current dental coverage: (Choose one) Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied Question Title * 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) Question Title * 10. Are there additional dental coverages that you would like to see offered? If so, please list them. Question Title * 11. Please select the type of vision coverage your currently have: (Choose one) None Single Limited Family (Employee + Spouse or Employee + Children) Full Family (Employee, Spouse + Children) If "None" was chosen, please clarify if it was because you have coverage elsewhere, cannot afford coverage at this time, or coverage is affordable but not elected. Question Title * 12. Please rate your level of satisfaction with the current vision coverage: (Circle one) Very Satisfied Somewhat Satisfied Neutral Somewhat Dissatisfied Very Dissatisfied Question Title * 13. Does the current vision coverage meet your needs? If no, please explain: Yes No If no, please explain Question Title * 14. If you have any additional comments, please feel free to leave them here. Thank you, for completing this survey. Done
