Health Insurance

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* 1. Company Name?

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* 2. Do you currently offer an employee benefit plan?

Yes

No

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* 3. If you offer an employee benefit plan, is it offered on a fully insured basis or another method of funding?

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* 4. How many eligible employees do you currently employ?

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* 5. If you currently offer a plan, how many employees are covered?

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* 6. On a scale of 1-10 (10 being the highest) what is your level of concern regarding the cost and availability of health care coverage for your employee group?

1

10

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i We adjusted the number you entered based on the slider’s scale.

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* 7. On a scale of 1-10 (10 being the highest) what is your interest level in learning more about the EKOGA Association group health insurance program?

1

10

Clear

i We adjusted the number you entered based on the slider’s scale.