Survey Questions Insurance Continued
Dental Insurance
Does your company offer or provide dental insurance coverage for your
employees? [ ] Yes [
] No
What length of service is required before employees are eligible for
dental insurance?
[ ] Hire Date
[ ] End Probation [ ] One Month
[ ] Six months [ ] Other _________________________
Are all employees eligible for coverage?
[ ] Yes [ ] No
If no, which employees are not eligible?
[ ] Part Time [ ] Other Please explain ________________________
Is coverage paid for by the Company?
[ ] Yes [ ] No If yes,
what percentage is company paid?_______ %
Is dependent coverage paid for by the Company? [ ]
Yes [ ] No If yes, what percentage
is company paid? _____%
What is the monthly cost to the employee for:
Employee coverage? $_______
Dependent coverage? $_______
What type of insurance do you offer? [
] Traditional [ ] DMO
[ ] Other_______________________________
What is the annual deductible? $ ___________
What is the annual maximum benefit? [
] $1,000 [ ] $1,500
[ ] $1,750 [ ] No Annual Limit
[ ] Other
How many employees are currently insured on your plan? Is your company
self-insured? [ ] Yes [ ] No
Are employees responsible to pay the company portion of the premium
during leaves or other extended absences?
[ ] Yes [ ] No
If yes, please explain below
______________________________________________________
______________________________________________________
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