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Exit Survey
 
 
Are you currently enrolled in the employee health care plan?
 
Yes 
 
No 
 
 
 
If you answered no to question 1, are you:

 
Covered under spouse’s plan?
 
Covered under another plan? 
 
Uninsured? 
 
 
 
If you do not have health insurance, are you uninsured because of:
 
Cost 
 
Other  - please explain: ________________________________
 
 
 
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Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
Which benefits are most important to you? Rank the following benefit plans in order of
importance, with number 1 being most important, and number 6 being least important.
 
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____ Dental plan
 
____ Prescription plan
 
____ Employee Assistance Program
 
____ Short-term disability plan
 
____ Long-term disability plan
 
 
 
Which benefits are most important to you? Rank the following benefit plans in order of
importance, with number 1 being most important, and number 6 being least important.
 
-- Content Blocked --
 
____ Dental plan
 
____ Prescription plan
 
____ Employee Assistance Program
 
____ Short-term disability plan
 
____ Long-term disability plan
 
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