Welcome to the ESP Benefit Design Wellness Survey and thank you for taking the time to participate. The goal is information gathering as it pertains to a company implimenting a wellness program. Once enough data is collected, we will hold a wellness seminar and make available personalized printouts of the results. Our ultimate goal is to educate you about wellness, help impliment a wellness program and ultimately help control your healthcare costs.

Wellness Survey

* Name: First and Last

* E-mail address

* Company Name

* 1- How many full time employees does your company have?

2-50

51-99

100+

* 2-What type of business do you have?

Manufacturing

Service

Health/medical

Other

* 3-What is your companies zip code?

* 4-What is your current single employee deductible?

* 5-When is your current health plan renewal?

* 6-Who is your current healthcare provider?

* 7-What percent increase did you receive at your last renewal?

* 8-Does your company currently have a prescription drug co-pay with the health plan?

Yes

No

* 9-Does your company offer any of the following consumer driven health care plans?

* 10-Medical benefit costs account for how much of your payroll? (educated guess)

Less than 10%

10-15%

Greater than 15%

Not sure

* 11-How many personal or sick days do you allow your employees?

* 12-What percent of your total employee population do you feel use ALL their personal or sick days each year?

* 13-Do your employees have access to an online or interactive company website?

Yes

No

Not sure

* 14-How would you rate your companies overall health?

* 15-What health condition(s) do you think contributes the most to the rise in healthcare costs?

* 16-Do you think overall health of an employee affects productivity in the work place?

Yes

No

Not sure

* 17-What percentage (approx.) of all U.S medical claims do you think are lifestyle related?

<50%

60%

70%

>80%

* 18-What is more important to your company: keeping costs the same or keeping the benefits the same?

Keeping costs the same

Keeping benefits the same

Not sure

* 19a-Do you currently have a health screening process at your company?

Yes

No

Not sure

* 19b- Do you currently have an employee assistance program (EAP) in place?

Yes

No

Not sure

* 20-Do you think wellness programs only work for very large companies (over 1000 employees)?

Yes

No

Not sure

* 21-Do you think a wellness program could help improve your companies image?

Yes

No

Not sure

* 22- Has your company ever considered a wellness program in an effort to reduce overall healthcare costs?

Yes

No

Not sure

* 23-Do you feel a wellness plan plays an important roll in controlling healthcare costs?

Yes

No

Not sure

* 24-Would you consider paying for that wellness program?

Yes

No

* 25-Do you think that there is a "return on investment" aspect to implementing a wellness program?

Yes

No

Not sure

* 26-Are you aware that wellness programs might be available through your healthcare provider or a third party administrator?

Yes

No

Not sure

* 27-Do you know if your current healthcare provider offers disease management programs?

Yes

No

Not sure

* 28-Does your company take advantage of these disease management and or wellness programs currently offered by your healthcare provider?

Yes

No

Not sure

* 29-Have you heard about wellness programs in the media (magazines, newspapers, television) in the last 6 months?

Yes

No

* 30-Does your current broker help educate and implement a wellness program?

Yes

No

* 31-Do you offer a smoking cessation program?

Yes

No

* 32-Does your company have a workout or exercise facility on site?

Yes

No

Thinking about it

* 33-Does your company have a cafeteria?

Yes

No

* 34-Do you have control over the food selections available in your cafeteria?

Yes

No

Not sure

Does not apply

* 35-Would you like to know more about wellness programs?

Yes

No

* 36-Would you be interested in attending a wellness seminar?

Yes

No

Maybe

* 37-Would you be interested in receiving monthly posters, newsletters or payroll stuffers helping to promote wellness in the workplace?

Yes

No

* 38-Would you be interested in a health fair at your office to promote healthy living?

Yes

No

Maybe

* 39-How would you rate the quality of the questions in the survey?

Very interesting

Somewhat interesting

Not interesting at all

Hurry up and get me a copy of the results

* 40-Please list any additional questions or comments in the space provided regarding the survey?

Thank you for taking the time to participate in our Wellness survey. If you have any questions or comments, please feel free to contact us at:

Scott Cooper
ESP Benefit Design
212 S. State St., Suite 100
Westerville, OH 43081
Phone: 614-882-8535
Fax: 614-882-4906
E-mail: scott@espbd.com

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