UUA Insurance Plans Annual Survey
Annual Insurance Plans Member Survey
Demographics
Section 1
Please indicate your age range:
*
Under 25
25-34
35-44
45-54
55-64
65+
Gender Identity:
*
Please Select
Woman
Man
Transgender Woman
Transgender Man
Non-Binary
Two Spirit
Other
Sex Assigned at Birth:
*
Female
Male
Intersex
Race/ethnicity (check all that apply):
*
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino(a)
Native Hawaiian or Pacific Islander
White
Other
State:
*
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Customer Experience
Section 2
Have you had a recent experience with the UUA Insurance Team staff?
*
Yes
No
How would you rate this interaction?
*
Not Satisfied
1
2
3
4
Very Satisfied
5
1 is Not Satisfied, 5 is Very Satisfied
What went well?
What can be improved on?
What is your preferred option to get information on our plans?
*
UUA Website
Email
Phone call
Text
How satisfied were you with the enrollment process?
*
Not Satisfied
1
2
3
4
Very Satisfied
5
1 is Not Satisfied, 5 is Very Satisfied
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Health Plans
Section 3
Are you currently enrolled or have you ever been enrolled in the UUA Health Plan?
*
Yes
No
I am not enrolled because:
*
I have coverage elsewhere
I cannot afford coverage at this time
Coverage is affordable but not elected
Coverage is not elected because:
*
The coverage offered does not meet my needs
I am electing to not have health coverage
Coverage elected:
*
Employee only
Employee + Spouse
Employee + Child(ren)
Family
Plan Selected:
*
Standard PPO Plan, Group#: 014039-00 (GOLD)
High Deductible PPO Plan WITH HSA, Group#: 014039-20 (SILVER)
High Deductible PPO Plan W/OUT HSA, Group#: 014039-40 (SILVER)
High Deductible PPO Plan WITH HSA, Group#: 014039-25 (BRONZE)
Medicare Supplement Plan, Group#: 014466-10
Please rate how strongly you agree or disagree with each of the statements.
*
Strongly Agree
Agree
Neither agree or disagree
Disagree
Strongly Disagree
I am happy with the network of doctors/hospitals available
The cost of health insurance premiums is affordable
Out-of-pocket costs (deductible, office co-pays, co-insurance, prescription co-pays) are reasonable
I know where to turn for customer service support or claims questions
Insurance claims are processed timely
I understand the different health insurance plan options available to me
I am satisfied overall with the current health insurance provider
What benefit is working well and/or what benefit is not?
What benefit could be expanded?
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Dental/Vision Plan
Section 4
Are you currently enrolled or have you ever been enrolled in the UUA Dental/Vision plan?
*
Yes
No
Please rate how strongly you agree or disagree with each of the statements.
*
Strongly Agree
Agree
Neither agree or disagree
Disagree
Strongly Disagree
I am happy with the network of doctors/hospitals available
The cost of dental insurance premiums is affordable
Out-of-pocket costs (deductible, office co-pays, co-insurance, prescription co-pays) are reasonable
I know where to turn for customer service support or claims questions
Insurance claims are processed timely
I understand the benefit details of my coverage
I am satisfied overall with the current insurance provider
Comments or suggestions for improvement:
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Life and Long-Term Disability Plans
Section 5
Are you currently enrolled or have you ever been enrolled in the UUA Life and/or Long-Term Disability plan(s)?
*
Yes
No
Please rate how strongly you agree or disagree with each of the statements.
*
Strongly Agree
Agree
Neither agree or disagree
Disagree
Strongly Disagree
The cost of insurance premiums is affordable
I know where to turn for customer service support or claims questions
Insurance claims are processed timely
I understand the benefit details of my coverage
I am satisfied overall with the current insurance provider
Comments or suggestions for improvement:
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Member Feedback
Section 6
Are there specific benefits that you would like included in future benefits plans?
Additional comments or suggestions:
Name (Optional)
First Name
Last Name
Email (Optional)
example@example.com
Submit
Should be Empty: