Group Employee Benefits Survey
Your Name
*
First Name
Last Name
Email
*
Phone Number
-
Area Code
Phone Number
1. Are you familiar with the provisions of ACA Obamacare and its impact of your business?
1 Completely unaware its impact
2
3
4 Well aware of its impact
2. Which of the following employee benefits do you currently offer?
Medical
Dental
Vision
Life
Disability
Long Term Care
Pet Insurance
Other
3. Are you familiar with NYC's Commuter Benefits Law which took effect January 1, 2016-http://www1.nyc.gov/site/dca/about/commuter-benefits-FAQs.page
Yes
No
4. Do you offer Executive-Level Benefits?
Yes
No
5. Who does your employee go to with employee benefit questions?
HR Dept
Servicing Broker
Insurance Carrier
Colleague
Other
6. When was the last Open Enrollment communications meeting to review benefit update opportunities
7. Who conducts Open Enrollment Meetings?
HR Dept
Servicing Broker
Insurance Carrier
Other
8. How many Full Time employees do you have?
9. How many Part Time employees do you have?
10. Who is your Payroll provider?
ADP
Paychex
BenefitMall
Brands
iGreen
BDB
in-house
Other
11. How are you being serviced by your employee benefit broker or carrier?
1 (Service is Non-existent)
2
3
4
5 (Service and options are Excellent)
12. Who should we contact to schedule a follow-up discussion? Name, email and phone
Submit
Should be Empty: