Employee Benefits Survey

L Employee Benefits Survey H D B [Company Name] strives to provide valuable, comprehensive and affordable benefit programs for our en employees. Each year, we review our current programs—particularly our health and dental plans—to ensure they live up to these goals and are meeting our employees’ needs. ef it Please take a few moments to complete this survey and help us with our annual benefits review process. Ad Your input is important to us regardless of whether or not you currently participate in any of the programs. v Please return the completed survey to [HR Contact]. iso r s 1. Are you currently enrolled in the [Company Name] employee benfit plans? Yes No 2. If you answered no to question 1, are you: Covered under spouse’s plan? Covered under another plan? Uninsured? 3. Do you clearly understand the benefits your receive from us? Yes No 4. How would you rate the information you receive from [Company Name] about your benefit plans? Excellent Above average Average Below average Poor 5. What is your preferred method for receiving benefits communication? Written material Easily accessible website Slide or video presentations Employee meetings Email Other—please explain

6. Which benefits are most important to you? Rank the following benefit plans in order of importance, with number 1 being most important, and number 8 being least important. Health/medical plan Dental plan Prescription plan Employee Assistance Program Short-term disability plan Long-term disability plan Accidental Death & Dismemberment Life Insurance 7. Please mark the answer that best describes your overall feeling about the indicated [Company Name] benefit plans or plan elements. Poor Below Average Average Above Average Excellent Medical Plan Medical Plan Provider Network Dental Plan Dental Plan Provider Network Accidental Death & Dismemberment Plan Short-term Disability Plan Long-term Disability Plan Prescription Drug Plan Life Insurance Plan

8. Would you prefer to pay more money from your paycheck for medical insurance (premium contributions) or more money when you actually go to the doctor or hospital (for example, pay higher deductibles and higher copayments)? More money from my paycheck More money only when I go to doctor or hospital Do not understand 9. What is your impression of [Company Name] benefit plans compared to other local employers? Excellent Above average Average Below average Poor 10. How Satisfied are you with our benefits enrollment procedures and tools? Excellent Above average Average Below average Poor 11. Do you know whom to contact if you have questions or concerns about your benefits? Excellent Above average Average Below average Poor 12. On a scale of 1 to 5 where 5 equals “a lot” and 1 equals “not at all,” how much of an impact did [Company Name] benefits have on: Your decision to join the company? 1 2 3 4 5 If over 3, which benefits? Your decision to stay with the company? 1 2 3 4 5 If over 3, which benefits? 13. Please provide any additional comments on how we can improve upon our employee benefit plans, or how we can better meet your needs.