MEMBER SURVEY: HEALTH INSURANCE, WORKERS COMPENSATION INSURANCE, BENEFITS, HR AND COMPLIANCE

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* 1. Please rank the importance of the following in your decision to evaluate a group discounted option using a scale from 1 (Most important) to 7 (least important).

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* 2. Which of the following advantages need to be guaranteed for your organization to participate in this program? Check the box to indicate the advantage is required.

Lower our Health Insurance costs and improve benefits

Lower our Workers Compensation insurance costs

Select from a menu of Ancillary and Voluntary employee benefits

Enhance our HR resources and tools

Improve our Compliance tools

Have resources to deal with the new COVID rules & regs

Have tools for applicant tracking, online enrollment and COBRA admin.

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* 3. I am willing to participate (meet/discuss/supply data) to determine whether savings to my organization and improved HR and compliance options are possible.

Yes

No

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* 4. We would be willing to provide all of the following information to a vendor in order to evaluate options for savings (check all that apply). ALL INFORMATION TO BE HELD SECURELY AND CONFIDENTIALLY.

Payroll Records

Workers Compensation loss runs

Employee census to include employee marital status, zip code and DOB, dependent DOB(s) and zip code

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* 5. Organization Name

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* 6. Number of Full Time Equivalent Employees (FTE’s)

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* 7. Annual Operating Budget

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* 8. Your Name

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* 9. Your Title

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* 10. Your Email

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* 11. Your Phone Number