Health Insurance Survey

Health Insurance Survey

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Health Insurance Survey

Our health insurance renewal with our current insurance provider takes place in [Month] and we will be receiving competitive bids from insurance carriers to offer the best and most cost effective program to our employees. Your feedback is important to that process. Please take a few minutes to answer this survey and return it to Human Resources by Monday.

1. Type of health coverage elected? (Circle one)

None

Single

Limited Family (Employee + Spouse or Employee + Children)

Full Family (Employee, Spouse + Children)

If none was circled, please complete this section:

_______ I have coverage elsewhere

_______ I cannot afford coverage at this time

_______ Coverage is affordable, just not elected

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