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) 1Cost of health insurance premiums per paycheckMove up Cost of health insurance premiums per paycheckMove down Cost of health insurance premiums per paycheck2Out-of-pocket costs (deductible, office co-pays, co-insurance, and prescription co-pays)Move up Out-of-pocket costs (deductible, office co-pays, co-insurance, and prescription co-pays)Move down Out-of-pocket costs (deductible, office co-pays, co-insurance, and prescription co-pays)3Network of doctors and hospitalsMove up Network of doctors and hospitalsMove down Network of doctors and hospitals4Customer service support on claims questionsMove up Customer service support on claims questionsMove down Customer service support on claims questions5Timeliness of claims processingMove up Timeliness of claims processingMove down Timeliness of claims processing 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) 1Cost of dental insurance premiums per paycheckMove up Cost of dental insurance premiums per paycheckMove down Cost of dental insurance premiums per paycheck2Out-of-pocket costs (deductible, co-pays, and co-insurance)Move up Out-of-pocket costs (deductible, co-pays, and co-insurance)Move down Out-of-pocket costs (deductible, co-pays, and co-insurance)3Network of dentistsMove up Network of dentistsMove down Network of dentists4Customer service support on claims questionsMove up Customer service support on claims questionsMove down Customer service support on claims questions5Timeliness of claims processingMove up Timeliness of claims processingMove down Timeliness of claims processing 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
