SAMPLE - ABC Company Employee Benefits Survey

ABC Company strives to provide valuable, comprehensive and affordable benefit programs for our employees. Each year, we review our current programs, particularly our health and ancillary benefits, to ensure they live up to these goals and meet the needs of our employees.

Please take a few moments to complete this survey and help us with our annual benefits review process. Your input is important to us regardless of whether or not you currently participate in any of the benefit offerings.

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* 1. Are you currently enrolled in the ABC Company group Medical plan?

Yes

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* 2. If enrolled in the ABC Company benefits, what are your reasons for participating?

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* 3. Do you consider the ABC Company Benefit program to be affordable? If not, please explain.

Yes

No (If no, please share what you think would be affordable)

No (please explain)

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* 4. How well do you currently understand how your benefits work? (1 meaning very well and 5 meaning not at all)

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* 5. Currently, ABC Company provides a Basic Life/AD&D policy (worth $10,000) to all benefit-eligible employees. If given the option, would you be interested in purchasing additional Life Insurance coverage on a voluntary basis?

Yes

No (If no, please explain)

(If no, please explain)

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* 6. Would you prefer to pay more money from your paycheck for medical insurance (premium contributions), or more money when you actually go to the doctor or hospital (for example, pay higher deductibles and high co-payments when treatment is necessary)?

More money from my paycheck

More money only when I go to the doctor or hospital

Do not understand

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* 7. If you were given the opportunity to combine Voluntary Accident, Hospital confinement and Critical Illness supplemental coverage together and pay one premium per month, would you be interested?

Yes

No (If no, please explain)

(If no, please explain)

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* 8. If you are enrolled in the ABC Company Dental plan, are there certain benefits you feel are missing? If so, please explain

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* 9. Please provide any additional comments on how we can improve upon the employee benefit programs, or how ABC Company can better meet your needs.

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* 10. Which benefits are most important to you? Rank the following benefits in order of importance, with number 1 being most important, and number 9 being least important. Note: Supplemental plans are those that provide a reimbursement for a claim, they do not coordinate with the Health/Medical plan. Current supplemental plans are offered by Aflac.

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* 11. On a scale of 1 to 5 where 5 equals "a lot" and 1 equals "not at all," how much of an impact did ABC Company's benefits have on:

	1	2	3	4	5
Your decision to join the company?	Your decision to join the company? 1	Your decision to join the company? 2	Your decision to join the company? 3	Your decision to join the company? 4	Your decision to join the company? 5
If over 3, which benefits?
Your decision to stay with the company?	Your decision to stay with the company? 1	Your decision to stay with the company? 2	Your decision to stay with the company? 3	Your decision to stay with the company? 4	Your decision to stay with the company? 5
If over 3, which benefits?

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* 12. Are you currently enrolled in the ABC Company Dental plan?

Yes

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* 13. Please mark the answer that best describes your overall feeling about the indicated ABC Company benefit plans or plan elements.

	Poor	Below Average	Average	N/A	Above Average	Excellent
Medical Plan	Medical Plan Poor	Medical Plan Below Average	Medical Plan Average	Medical Plan N/A	Medical Plan Above Average	Medical Plan Excellent
Medical Plan Provider Network (Blue Options)	Medical Plan Provider Network (Blue Options) Poor	Medical Plan Provider Network (Blue Options) Below Average	Medical Plan Provider Network (Blue Options) Average	Medical Plan Provider Network (Blue Options) N/A	Medical Plan Provider Network (Blue Options) Above Average	Medical Plan Provider Network (Blue Options) Excellent
Dental Plan	Dental Plan Poor	Dental Plan Below Average	Dental Plan Average	Dental Plan N/A	Dental Plan Above Average	Dental Plan Excellent
Basic Life/AD&D Plan	Basic Life/AD&D Plan Poor	Basic Life/AD&D Plan Below Average	Basic Life/AD&D Plan Average	Basic Life/AD&D Plan N/A	Basic Life/AD&D Plan Above Average	Basic Life/AD&D Plan Excellent
Vision Plan	Vision Plan Poor	Vision Plan Below Average	Vision Plan Average	Vision Plan N/A	Vision Plan Above Average	Vision Plan Excellent
Health Savings Account	Health Savings Account Poor	Health Savings Account Below Average	Health Savings Account Average	Health Savings Account N/A	Health Savings Account Above Average	Health Savings Account Excellent
Flexible Spending Account	Flexible Spending Account Poor	Flexible Spending Account Below Average	Flexible Spending Account Average	Flexible Spending Account N/A	Flexible Spending Account Above Average	Flexible Spending Account Excellent
Voluntary Supplemental Plans (Accident, Short Term Disability, Hospital confinement, Critical Illness)	Voluntary Supplemental Plans (Accident, Short Term Disability, Hospital confinement, Critical Illness) Poor	Voluntary Supplemental Plans (Accident, Short Term Disability, Hospital confinement, Critical Illness) Below Average	Voluntary Supplemental Plans (Accident, Short Term Disability, Hospital confinement, Critical Illness) Average	Voluntary Supplemental Plans (Accident, Short Term Disability, Hospital confinement, Critical Illness) N/A	Voluntary Supplemental Plans (Accident, Short Term Disability, Hospital confinement, Critical Illness) Above Average	Voluntary Supplemental Plans (Accident, Short Term Disability, Hospital confinement, Critical Illness) Excellent
Voluntary Life Insurance	Voluntary Life Insurance Poor	Voluntary Life Insurance Below Average	Voluntary Life Insurance Average	Voluntary Life Insurance N/A	Voluntary Life Insurance Above Average	Voluntary Life Insurance Excellent

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* 14. If you answered "no" to question 1, are you:

Covered under a Spouse's plan?

Covered under a Parent's plan?

Covered on and Individual Plan?

Covered under Medicaid/Medicare?

Not covered

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* 15. If you do not have health insurance, are you uninsured because of:

Cost

Other-Please explain

Other (please exlain)

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* 16. If you answered "no" to question 4, are you:

Covered under a Spouse's plan?

Covered under a Parent's plan?

Not covered

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* 17. If you are not enrolled in Dental, are you uninsured because of:

Cost

Other-please explain

Other (please explain)

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* 18. How would you rate the information you receive from ABC Company about your benefit programs?

Excellent

Above average

Average

Below average

Poor

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* 19. What is your preferred method for receiving benefits communication? (Choose all that apply)

Written

Easily accessible website

Slide or Video presenations

Employee meetings

Other-Please explain

Other (please explain)

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* 20. When you want detailed information about how your benefits work, where would you turn? Please rank your answers as 1 being the first place and 5 being the last place you would turn.

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* 21. How well do you want to understand how your benefits work? (1 meaning very well and 5 meaning not at all)

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* 22. If married, is your spouse eligible for medical insurance and/or other benefits from his/her own employer?

Yes

N/A

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* 23. If your spouse is eligible for benefits from his/her own employer, does he/she participate in those benefit plans?

Yes

N/A

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* 24. What do you think is the annual cost per employee for providing Medical/Dental/Vision?

$1,500-$2,500

$2,500-$5,000

$5,000-$7,000

$7,500 +

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* 25. What is your impression of ABC Company's benefit program compared to other local employers?

Excellent

Above average

Average

Below average

Poor

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* 26. Please rate the following benefits in terms of importance to you.

	Very Important	Important	Undecided	Not too Important	Not at all Important
Health (Medical) plan	Health (Medical) plan Very Important	Health (Medical) plan Important	Health (Medical) plan Undecided	Health (Medical) plan Not too Important	Health (Medical) plan Not at all Important
Dental plan	Dental plan Very Important	Dental plan Important	Dental plan Undecided	Dental plan Not too Important	Dental plan Not at all Important
Vision plan	Vision plan Very Important	Vision plan Important	Vision plan Undecided	Vision plan Not too Important	Vision plan Not at all Important
Employee Assistance Program (EAP)	Employee Assistance Program (EAP) Very Important	Employee Assistance Program (EAP) Important	Employee Assistance Program (EAP) Undecided	Employee Assistance Program (EAP) Not too Important	Employee Assistance Program (EAP) Not at all Important
Voluntary Life Insurance (in addition to Life insurance provided by ABC Company)	Voluntary Life Insurance (in addition to Life insurance provided by ABC Company) Very Important	Voluntary Life Insurance (in addition to Life insurance provided by ABC Company) Important	Voluntary Life Insurance (in addition to Life insurance provided by ABC Company) Undecided	Voluntary Life Insurance (in addition to Life insurance provided by ABC Company) Not too Important	Voluntary Life Insurance (in addition to Life insurance provided by ABC Company) Not at all Important
Basic Life/AD&D insurance	Basic Life/AD&D insurance Very Important	Basic Life/AD&D insurance Important	Basic Life/AD&D insurance Undecided	Basic Life/AD&D insurance Not too Important	Basic Life/AD&D insurance Not at all Important
Voluntary Supplemental benefits-Accident, Critical Illness, Hospital confinement, Short Term Disability	Voluntary Supplemental benefits-Accident, Critical Illness, Hospital confinement, Short Term Disability Very Important	Voluntary Supplemental benefits-Accident, Critical Illness, Hospital confinement, Short Term Disability Important	Voluntary Supplemental benefits-Accident, Critical Illness, Hospital confinement, Short Term Disability Undecided	Voluntary Supplemental benefits-Accident, Critical Illness, Hospital confinement, Short Term Disability Not too Important	Voluntary Supplemental benefits-Accident, Critical Illness, Hospital confinement, Short Term Disability Not at all Important
Retirement Plan	Retirement Plan Very Important	Retirement Plan Important	Retirement Plan Undecided	Retirement Plan Not too Important	Retirement Plan Not at all Important
Health Savings Account	Health Savings Account Very Important	Health Savings Account Important	Health Savings Account Undecided	Health Savings Account Not too Important	Health Savings Account Not at all Important
Holidays	Holidays Very Important	Holidays Important	Holidays Undecided	Holidays Not too Important	Holidays Not at all Important
Vacation	Vacation Very Important	Vacation Important	Vacation Undecided	Vacation Not too Important	Vacation Not at all Important
Sick Pay	Sick Pay Very Important	Sick Pay Important	Sick Pay Undecided	Sick Pay Not too Important	Sick Pay Not at all Important
Flexible Spending Account for Medical	Flexible Spending Account for Medical Very Important	Flexible Spending Account for Medical Important	Flexible Spending Account for Medical Undecided	Flexible Spending Account for Medical Not too Important	Flexible Spending Account for Medical Not at all Important
Flexible Spending Account for Dependent Care (Daycare expense)	Flexible Spending Account for Dependent Care (Daycare expense) Very Important	Flexible Spending Account for Dependent Care (Daycare expense) Important	Flexible Spending Account for Dependent Care (Daycare expense) Undecided	Flexible Spending Account for Dependent Care (Daycare expense) Not too Important	Flexible Spending Account for Dependent Care (Daycare expense) Not at all Important

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* 27. Please answer the following questions related to possible plan alternatives.

Would you like to have different medical plan designs to choose from? One may cost more and provide first dollar coverage, while another may cost less and require more payment up front for doctor visits and prescriptions.

Yes

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* 28. Would you like the opportunity to trade some of your current benefits for others of more importance to you?

Yes

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* 29. Would you consider trading (or giving up) some of your benefits in order to receive more money in your paycheck?

Yes