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  5. Health Insurance Survey
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Exit Survey
 
 
How many employees are eligible to participate in health insurance coverage at your institution?
   
 
 
 
What percentage of eligible employees participate in your institution's health insurance coverage?
   
 
 
 
If you have multiple health insurance plans, can you provide a break down of the employee participation per plan in percent?
   
 
 
 
Does your active employee health insurance plan allow for the coverage of pre-Medicare eligible retirees?
 
Yes
 
No
 
 
 
Does your institution offer a Preferred Provider Organization (PPO) plan?
 
Yes
 
No
 
 
If your institution does participate in a PPO plan, please provide the number of participants for each category:
Headcount
Employee
Spouse
Same-sex Domestic Partner
Dependent Children
 
 
If your institution does participate in a PPO plan, please provide the following information:
Employee Only Employee + Spouse/SSDP Employee + Child(ren) Family
Co-Pay Amount
Deductible Amount
Co-Insurance Amount
Out-of-Pocket Maximum Amount
 
 
 
Does your institution offer a High Deductible Health Plan (HDHP)?
 
Yes
 
No
 
 
If your institution does participate in a HDHP plan, please provide the number of participants for each category:
Headcount
Employee
Spouse
Same-sex Domestic Partner
Dependent Children
 
 
If your institution has a HDHP plan, please provide the following information:
Employee Only Employee + Spouse/SSDP Employee + Child(ren) Family
Co-Pay Amount
Deductible Amount
Co-Insurance Amount
Out-of-Pocket Maximum Amount