Employee Benefits Survey- 7 page

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Employee Benefits Survey- 7 page Powered By Docstoc
					DATE:


TO:            ALL ___________________________ EMPLOYEES

FROM:

RE:            EMPLOYEE BENEFITS SURVEY


The overall objective of our employee benefit program is to provide peace of mind for you
and your family members from financial hardship in the event of an accident or sickness,
disability, retirement or death. Additionally, we strive for programs that are user friendly,
promote healthy lifestyles, fit employee needs, offer high value and can be judged superior to
industry averages. In light of these objectives, we are continually faced with financial
pressure to manage cost and obtain the best value for the money spent on our benefit
program.

With this in mind, we are asking you to complete the attached survey to help us understand
your individual and family needs. Your response may be anonymous and all responses will
be kept confidential. We have engaged the services of Clark Benefits, an employee benefits
consultant, to conduct this survey and make recommendations for plans that meet our needs.

From the data collected, we will analyze the following:

  1)    Your satisfaction with our current benefits;

  2)    The type of benefits which are offering the best value to you and your family;

  3)    Your understanding of the benefit options;

  4)    What benefits you would like to see added or changed.


We appreciate your quick response to the survey and request you return the completed
questionnaire to your supervisor by 00/00/00. We will provide you with a summary of the
results, which highlight the impact to you.

Thank you again for your cooperation.
                      EMPLOYEE BENEFITS SURVEY


(1)   Your age:                                                          Under 30     _____
                                                                          30 to 39    _____
                                                                          40 to 49    _____
                                                                          50 to 54    _____
                                                                          55 to 59    _____
                                                                          60 to 64    _____
                                                                       65 or Older    _____

(2)   Your gender:                                                           Male _____
                                                                           Female _____

(3)   Do you smoke:                                                            Yes _____
                                                                               No _____

(4)   Is it fair to give an incentive to employees who are                     Yes _____
      non-smokers and generate lower claims than smokers?                      No _____

(5)   Length of service with our company:                         Less than 1 Year    _____
                                                                      1 to 3 Years    _____
                                                                      3 to 5 Years    _____
                                                                     5 to 10 Years    _____
                                                                        10+ Years     _____

(6)   Do you believe the benefit program should provide                        Yes _____
      additional benefits for longer term employees?                           No _____

(7)   Your marital status:                                                  Single _____
                                                          Married - Single Income _____
                                                           Married - Dual Income _____

(8)   Dependent status:                                         Single w/child(ren)   _____
                                                              Single w/o child(ren)   _____
                                                              Married w/child(ren)    _____
                                                             Married w/o child(ren)   _____

(9)   Your annual salary:                                       $20,001 - $40,000     _____
                                                                $40,001 - $60,000     _____
                                                                $60,001 - $80,000     _____
                                                               $80,000 - $125,000     _____
                                                                $125,001 or more      _____




                                            -1-
                                    PARTICIPATION


(1)   Medical:
      (a) Are you eligible for medical insurance through any                       Yes _____
           other source (i.e. spouse)                                              No _____

      (b)   If yes, are you covered under that plan?                               Yes _____
                                                                                   No _____

      (c)   Are your dependents eligible for medical insurance                     Yes _____
            through any other source?                                              No _____

      (d)   Are your dependents covered under that plan?                           Yes _____
                                                                                   No _____

(2)   Dental:
      (a) Are you eligible for dental insurance through any                        Yes _____
           other source (i.e. spouse)                                              No _____

      (b)   Are you covered under that plan?                                       Yes _____
                                                                                   No _____

      (c)   Are your dependents eligible for dental coverage                       Yes _____
            through any other source?                                              No _____

      (d)   Are your dependents covered under that plan?                           Yes _____
                                                                                   No _____


Please indicate the degree of importance or value you attach to each of the following benefits:

                                        Very Important                       Least Important
                                             1       2                3         4        5

a)    Medical Insurance                     ____        ____       ____        ____       ____
b)    Dental Insurance                      ____        ____       ____        ____       ____
c)    Life Insurance                        ____        ____       ____        ____       ____
d)    Vision Care                           ____        ____       ____        ____       ____
e)    Long Term Disability                  ____        ____       ____        ____       ____
f)    401(k) Plan                           ____        ____       ____        ____       ____
g)    Flexible Benefits (Pre-tax)           ____        ____       ____        ____       ____
h)    EAP                                   ____        ____       ____        ____       ____
i)    Vacation                              ____        ____       ____        ____       ____
j)    Holidays                              ____        ____       ____        ____       ____
k)    Sick Days                             ____        ____       ____        ____       ____




                                               -2-
                               HEALTH COVERAGE


HMO Plan: Complete this section if you are enrolled in an HMO

(1)   The HMO plan that you are enrolled in?                   __________________________


(2)   When was the last time you or a family member used                 Never Used   _____
      the HMO plan:                                                1 - 3 Months Ago   _____
                                                                   4 - 6 Months Ago   _____
                                                                  7 - 12 Months Ago   _____
                                                                    13+ Months Ago    _____

(3)   If you have called for an urgent visit, were you                          Yes _____
      scheduled for an appointment that day:                                    No _____

(4)   If you have called for a regular appointment, how                  1 - 2 Weeks _____
      long do you usually wait for an appointment:                       3 - 4 Weeks _____
                                                                           5+ Weeks _____

(5)   If you needed to be referred to a specialist, how long             1 - 2 Weeks _____
      did the referral process take:                                     3 - 4 Weeks _____
                                                                           5+ Weeks _____

(6)   If you have used your HMO doctor, how would you rate the following:


                                                                 Excellent     Good    Poor
                                                                   1       2    3      4    5

a)    Convenience of office location:
b)    Hours when office visits can be scheduled:
c)    Thoroughness of exams and accuracy of diagnosis:
d)    Ability to diagnose problem quickly:
e)    Quality of doctors and hospitals in network:
f)    Size of provider network:


(7)   Would you prefer the option to see a doctor outside the                   Yes _____
      HMO Network for office visits?                                            No _____

      If yes, what additional amount per month would you                   $5 - $15   _____
      be willing to pay for this option:                                  $16 - $25   _____
                                                                          $26 - $50   _____
                                                                        $51 or More   _____




                                              -3-
PPO/POS Plan: Complete this section if you are enrolled in a PPO/POS Plan

(1)   When was the last time you or a family member used                Never Used   _____
      the Group medical PPO plan:                                 1 - 3 Months Ago   _____
                                                                  4 - 6 Months Ago   _____
                                                                 7 - 12 Months Ago   _____
                                                                  13 + Months Ago    _____

(2)   If you have used the PPO/POS, how would you rate the following:


                                                                Excellent   Good      Poor
                                                                   1      2   3       4    5

a)    Convenience of office location for provider in network:
b)    Hours when office visits can be scheduled:
c)    Ability to diagnose problem quickly:
d)    Quality of doctors and hospitals in network:
e)    Size of provider network:


(3)   Did your doctor require payment up-front or did                    Payment Up-Front ____
      they bill our insurance company:                          Billed Insurance Company ____




                                             -4-
                TO BE COMPLETED BY ALL EMPLOYEES




(1)   How do you rate the importance of your current              Very Important _____
      physician relationship:                                 Somewhat Important _____
                                                                   Not Important _____


(2)   If you were given the choice between maintaining your current doctor relationship and
      paying an additional fee or change to a different list of providers and not pay more,
      which would you choose?

                                                       Maintain Current (add’l fee) _____
                                                             Change (no increase) _____

(3)   Would you be willing to pay to participate in the following programs:

      a)   Dental Insurance                                 Yes   _____         No   _____
      b)   Short Term Disability                            Yes   _____         No   _____
      c)   Long Term Disability                             Yes   _____         No   _____
      d)   Vision Care                                      Yes   _____         No   _____
      e)   Supplemental Life Insurance                      Yes   _____         No   _____

(4)   If yes, what is the maximum contribution you would be willing to pay for coverage on
      a monthly basis:

Dental         ($5-$10) ___         ($11-$20)___         ($21-$30)___         ($31 +)____
STD            ($5-$10) ___         ($11-$20)___         ($21-$30)___         ($31 +)____
LTD            ($5-$10) ___         ($11-$20)___         ($21-$30)___         ($31 +)____
Vision         ($5-$10) ___         ($11-$20)___         ($21-$30)___         ($31 +)____
Life           ($5-$10) ___         ($11-$20)___         ($21-$30)___         ($31 +)____




                                            -5-
                 PRE-TAX REIMBURSEMENT ACCOUNTS



(1)   SECTION 125 (MEDICAL PREMIUM ACCOUNT)
      (Allows you to save approximately 25% by paying your health plan contributions on a
      pre-tax basis.)

      (a)   Do you understand the tax advantages of the Medical             Yes _____
            Premium Account (pay for benefits with pre-tax dollars):        No _____




(2)   SECTION 105 (HEALTH CARE REIMBURSEMENT ACCOUNT)
      (Allows you to save approximately 25% by paying for health care expenses on a pre-
      tax basis.)

      (a)   Do you understand the tax advantages of the                      Yes _____
            Section 105:                                                     No _____

      (b)   How much money per year would you estimate you           $500 or less _____
            and your family currently spend for health services     $501 - $1000 _____
            that are not paid by insurance (i.e. deductible, co-   $1000 or More _____
            insurance)?



(3)   SECTION 129 (DEPENDENT REIMBURSEMENT ACCOUNT)
      (Allows you to save approximately 25% by paying adult and child care expenses not
      covered by insurance on a pre-tax basis.)

      (a)   Do you understand the tax advantages of the                      Yes _____
            Section 129:                                                     No _____


      (b)   How much money per year would you estimate you           $500 or less _____
            and your family spend for adult or child care?          $501 - $1000 _____
                                                                   $1000 or More _____




                                             -6-
                TO BE COMPLETED BY ALL EMPLOYEES


(3)   How do you perceive:

      a)   Communication of our benefits program:                        Excellent     _____
                                                                    Above Average      _____
                                                                          Average      _____
                                                                    Below Average      _____
                                                                             Poor      _____

      b)   Your understanding of benefits offered to you:                Excellent     _____
                                                                    Above Average      _____
                                                                          Average      _____
                                                                    Below Average      _____
                                                                             Poor      _____

(4)   In your opinion, what is the total cost paid by our       Less than $1,000/yr    _____
      company for your benefits, including paid time off:          $1,001 - $2,000     _____
                                                                   $2,001 - $3,000     _____
                                                                   $3,001 - $5,000     _____
                                                                   $5,001 - $8,000     _____
                                                                   $8,000 or More      _____

(5)   Please tell us how you feel our benefits program, in               Excellent     _____
      total, measures up to what other similar situated             Above Average      _____
      companies offer:                                                    Average      _____
                                                                    Below Average      _____
                                                                             Poor      _____


(6)   If you have other comments or opinions concerning our current benefits program, or
      benefits that you would like to see offered, please share them with us here: (please be
      as specific as possible)

      __________________________________________________________________
      _

      __________________________________________________________________
      _

      __________________________________________________________________
      _

      __________________________________________________________________
      _

              This information will be analyzed and used to design your benefits!
                                  Thank you for your input.

                                             -7-