EMPLOYEE INPUT FOR GROUP BENEFIT PLANYOUR THOUGHTS HELP YOUR EMPLOYEE GROUP BENEFITS IMPROVE Web Site Employee Input for Group Benefit Plan The purpose of this survey / questionnaire is to get an understanding from you, the employees, on what works for you. Your feedback is what will help your employer design your employee group benefits to what is important for you and your family! Select the employee group benefits of value to you and your family: Name: e-mail (so we can contact you, should you have any questions): Accidental Death & Dismemberment Yes No Critical Illness – Employee Yes No Critical Illness – Family Members Yes No Dental - Crowns Major Yes No Dental - Regular Yes No Disability - Long Term Yes No Disability - Short Term Yes No Drugs - R/X Prescription Yes No Financial Organization & RRSP Review - FORR Yes No Gym Memberships Yes No Holiday Fund? Yes No Holistic - Medicine(s) Yes No Life - Dependant Insurance Yes No Life - Dependent Insurance Yes No Life Insurance - Employee Yes No Paramedical Services Yes No Pro-active Health Items Yes No RRSP - Group Plans Yes No Student Loans Payment Yes No TFSA - Tax Free Savings Account Yes No Travel Insurance Yes No Virtual Doctor(s) on Demand? Yes No Vision Care Yes No Do you have any questions on your Employee Group Benefits? Is there any benefits not listed here that would be of value to you?