(Insert Company Name/Logo)
Employee Benefits Survey
Employee benefits are a large part of a company’stotal budget and reward package offered to employees. Because we would like to offer benefits that are cost-effective and meet the needs of our employees, we request that you take a few minutes to answer this brief survey about your benefits package. We welcome your feedback and thank you in advance for your consideration of this matter.
- Rank in order the benefits our company currently offers which you consider to be the most important.(1 being the most important)
(Company Representative should alter this list to reflect those benefits currently offered by the company to the employees)
____Medical
____Dental
____Prescription
____Vacation
____Life Insurance
____Supplemental Life Insurance
____Dependent Life Insurance
____Accidental Death and Dismemberment Insurance
____Short-term disability
____Long-term disability
____401k) retirement plan
___Vacation
____Sick Leave
____Legal Services
____Long Term Care
____Dependent Care FSA
____Medical Care FSA
____Health Reimbursement Arrangements
____Health Savings Account
____Tuition Reimbursement
- Referencing the list of current benefit programs from the previous question, are there company benefits available to you that you are currently not using?
____Yes(answer 3 & 4)
____ No (if answer no, go to #5)
- Which company benefits are you currently not using?
(Place a check mark next to each benefit the company offers that you are not using)
(Company Representative should alter this list to reflect those benefits currently offered by the company to the employees)
____Medical
____Dental
____Prescription
____Vacation
____Life Insurance
____Supplemental Life Insurance
____Dependent Life Insurance
____Accidental Death and Dismemberment Insurance
____Short-term disability
____Long-term disability
____401k) retirement plan
___Vacation
____Sick Leave
____Legal Services
____Long Term Care
____Dependent Care FSA
____Medical Care FSA
____Health Reimbursement Arrangements
____Health Savings Account
____Tuition Reimbursement
- Why aren’t you utilizing these benefits?
(Please list the name of the benefit and check the reason below for each benefit)
a)______(Benefit Name)
___Cost of benefit to me
___I don’t want this benefit
___I have this benefit available to me elsewhere
___I don’t understand this benefit
___Other
b)______(Benefit Name)
___Cost of benefit to me
___I don’t want this benefit
___I have this benefit available to me elsewhere
___I don’t understand this benefit
___Other
c)______(Benefit Name)
___Cost of benefit to me
___I don’t want this benefit
___I have this benefit available to me elsewhere
___I don’t understand this benefit
___Other
d)______(Benefit Name)
___Cost of benefit to me
___I don’t want this benefit
___I have this benefit available to me elsewhere
___I don’t understand this benefit
___Other
e)______(Benefit Name)
___Cost of benefit to me
___I don’t want this benefit
___I have this benefit available to me elsewhere
___I don’t understand this benefit
___Other
f)______(Benefit Name)
___Cost of benefit to me
___I don’t want this benefit
___I have this benefit available to me elsewhere
___I don’t understand this benefit
___Other
g)______(Benefit Name)
___Cost of benefit to me
___I don’t want this benefit
___I have this benefit available to me elsewhere
___I don’t understand this benefit
___Other
- Please check the benefits in which you would be interested in our company offering or would like additional information.
(Company Representative should alter this list to reflect those benefits currently offered by the company to the employees)
____Medical
____Dental
____Prescription
____Vacation
____Life Insurance
____Supplemental Life Insurance
____Dependent Life Insurance
____Accidental Death and Dismemberment Insurance
____Short-term disability
____Long-term disability
____401k) retirement plan
___Vacation
____Sick Leave
____Legal Services
____Long Term Care
____Dependent Care FSA
____Medical Care FSA
____Health Reimbursement Arrangements
____Health Savings Account
____Tuition Reimbursement
- Benefits were an important reason why I came to work here.
(Please check which best describes your feeling toward this statement)
___Strongly Agree
___Agree
___Neither Agree nor Disagree
___Disagree
___Strongly Disagree
- Benefits are an important reason why I remain here.
(Please check which best describes your feeling toward this statement)
___Strongly Agree
___Agree
___Neither Agree nor Disagree
___Disagree
___Strongly Disagree
- The materials provided regarding current company benefit plans are thorough and detailed.
(Please check which best describes your feeling toward this statement)
___Strongly Agree
___Agree
___Neither Agree nor Disagree
___Disagree
___StronglyDisagree
- Additional comments/suggestions regarding the benefits package:
______
- (If you provide health insurance, include this question.) The network of health providers and physicians available to me meets my needs.
(Please check which best describes your feeling toward this statement)
___Strongly Agree
___Agree
___Neither Agree nor Disagree
___Disagree
___Strongly Disagree
- (If you provide dental insurance, include this question.) The network of dental providers available to me meets my needs.
(Please check which best describes your feeling toward this statement)
___Strongly Agree
___Agree
___Neither Agree nor Disagree
___Disagree
___Strongly Disagree
- Please rate the responsiveness and knowledgeof the individuals who provide claims assistanceat theemployee benefits hotline number.
(1=needs significant improvement and 10=outstanding)
____Response Time
____Knowledge of Staff
____Resolution of Problems/Claims
____Courteousness of Staff
____Have Not Used
Thank you for taking a few moments to complete our survey. Please return the completed form to (insert company representative’s name) by (due date).