What are the top 3 concerns/issues facing your business today?

1.
2.
3.

What healthcare or employee benefit topic would you like to learn more about?

Would you like to learn more about FSAs, HSAs and Consumer Driven Healthcare?

		Yes, more articles
		Yes, please contact me about FSAs
		Yes, please contact me about HSAs/CDHC
		No

Which of the following benefit(s) do you offer to your employees?

		Medical
		Dental
		Life
		Short term disability
		Long term disability
		Voluntary disability
		Voluntary life
		Flexible Spending Account

Rate the following in order of importance in your selection of a medical/dental plan.

(1 = most important... 5 = less important)
1 2 3 4 5		Benefits
1 2 3 4 5		Rate
1 2 3 4 5		Provider network
1 2 3 4 5		Carrier/Insurance company
1 2 3 4 5		Type of product (PPO, HMO, etc.)

General comments and suggestions:

Are you interested in attending an informational meeting on any of the following, check all that apply

		No Interest
		Long Term Care (LTC)
		Pre Paid Legal Services
		Employee Benefits
		Legislative Update