Employer Benefits Mgr / Clinic Sponsor Prospect Profile

Estimated Time to Complete This Survey is 3 Minutes

Question Title

1. What industry do you primarily operate in? (Required.)

Agriculture, Forestry, Fishing and Hunting (NAICS 11)

Mining, Quarrying, and Oil and Gas Extraction (NAICS 21)

Utilities (NAICS 22)

Construction (NAICS 23)

Manufacturing (NAICS 31-33)

Wholesale Trade (NAICS 42)

Retail Trade (NAICS 44-45)

Transportation and Warehousing (NAICS 48-49)

Information (NAICS 51)

Finance and Insurance (NAICS 52)

Real Estate and Rental and Leasing (NAICS 53)

Professional, Scientific, and Technical Services (NAICS 54)

Management of Companies and Enterprises (NAICS 55)

Administrative and Support and Waste Management and Remediation Services (NAICS 56)

Educational Services (NAICS 61)

Health Care and Social Assistance (NAICS 62)

Arts, Entertainment, and Recreation (NAICS 71)

Accommodation and Food Services (NAICS 72)

Other Services (except Public Administration) (NAICS 81)

Public Administration (NAICS 92)

Question Title

2. Please provide your Corporate Health Benefits office address: (Required.)

Question Title

3. Corporate - Contact Person Email: (Required.)

Question Title

4. Corporate - Contact Person Telephone Number: (Required.)

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5. Across the US, how many employees does your company have? (Required.)

1-50

51-200

201-500

501-1000

1001-5000

5001-10000

More than 10000

Question Title

6. What are the key factors that influenced your decision to become self-insured? (select all that apply) (Required.)

Costs were increasing too rapidly

Employee health was declining

We weren't getting information about the costs we had to pay.

We wanted more flexibility and control in our health plan.

We joined a coalition

Other (please specify)

Question Title

7. What were you hoping to achieve by deploying a worksite clinic? (Select all that apply) (Required.)

Provide employees and their families with immediate, affordable access to primary care.

Bring in a partner who could also help us better manage care and cost for the entire health plan.

Get better health outcomes and lower costs.

Obtain more accountability for our health care spend.

Use the investment in primary care to also handle occupational health.

All of the above.

Other (please specify)

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8. What types of insurance coverage do you provide to your employees? Select all that apply (Required.)

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Accident Insurance

Critical Illness Insurance

Other

Question Title

9. How many total clinics do you sponsor (all locations) (Required.)

One

Two

Three

Four

More than four (Please tell us how many)

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10. How likely is it that you would recommend your clinic vendor to a friend or colleague?

Not at all likely

Extremely likely

Employer Benefits Mgr / Clinic Sponsor Prospect Profile

Question Title

* 1. What industry do you primarily operate in? (Required.)

Question Title

* 2. Please provide your Corporate Health Benefits office address: (Required.)

Question Title

* 3. Corporate - Contact Person Email: (Required.)

Question Title

* 4. Corporate - Contact Person Telephone Number: (Required.)

Question Title

* 5. Across the US, how many employees does your company have? (Required.)

Question Title

* 6. What are the key factors that influenced your decision to become self-insured? (select all that apply) (Required.)

Question Title

* 7. What were you hoping to achieve by deploying a worksite clinic? (Select all that apply) (Required.)

Question Title

* 8. What types of insurance coverage do you provide to your employees? Select all that apply (Required.)

Question Title

* 9. How many total clinics do you sponsor (all locations) (Required.)

Question Title

* 10. How likely is it that you would recommend your clinic vendor to a friend or colleague?

1. What industry do you primarily operate in? (Required.)

2. Please provide your Corporate Health Benefits office address: (Required.)

3. Corporate - Contact Person Email: (Required.)

4. Corporate - Contact Person Telephone Number: (Required.)

5. Across the US, how many employees does your company have? (Required.)

6. What are the key factors that influenced your decision to become self-insured? (select all that apply) (Required.)

7. What were you hoping to achieve by deploying a worksite clinic? (Select all that apply) (Required.)

8. What types of insurance coverage do you provide to your employees? Select all that apply (Required.)

9. How many total clinics do you sponsor (all locations) (Required.)

10. How likely is it that you would recommend your clinic vendor to a friend or colleague?