Employee Benefits Survey
RequiredRequired Question(s)
Required

How long have you been an employee at ABC Corporation?

Less than 1 year
1 to 3 years
3 to 5 years
More than 5 years
Required

What is your overall satisfaction with your medical insurance carrier?

Extremely Satisfied
Satisfied
Unsatisfied
Extremely Unsatisfied
Required

Please rate your level of satisfaction with each of the following:

 Extremely Satisfied Satisfied Unsatisfied Extremely Unsatisfied Never Utilized 
Service Quality
Benefits Offered
Range of Services and Benefits
On-line Services
Prescription Benefits
Mail Order Prescription Program
Required

Please rank the following based on their importance to you (1 being most important, 5 being least important).


(1 = Most Important)
 
Low Physician Copayments
Low Prescription Copayments
No Referral Required for Specialist Visits
Coverage for Out-of-Network Providers
No Deductible for In-Network Services
Required

Would you recommend your insurance carrier to a friend?

Absolutely
Very Likely
Unlikely
Absolutely Not
Not Sure
Required

How well do you feel you understand your benefits?

Very Well
Good
Somewhat
Not At All
Not Sure
Required

What percent of the services do you use in-network?

100%
90-99%
80-89%
70-79%
60-69%
50-59%
<50%

What would you do to change or improve the current medical plan?

 

350 characters left.
Required

Do you currently participate in the voluntary dental plan offered through by ABC Corporation?

Yes
No
Required

Which of the voluntary benefits offered by ABC Corporation do you participate in?

Life
Disability
Both
Neither
Required

Would you like additional information on the voluntary life and disability benefits offered by ABC Corporation?

Yes
No
Required

If ABC Corporation offered a voluntary vision plan, would you be interested in participating?

Yes
No
Not Sure
Required

If ABC Corporation offered a Flexible Spending Account (FSA), would you be interested in participating?

Yes
No
Not Sure
I don't know what an FSA is

Your feedback is important to us.  Please use the space below to add any additional comments, concerns, or suggestions you have regarding the current benefits offered:

 

350 characters left.