Benefit Needs Assessment

Company Name Here

We want to know which benefits are most important to you! Below you will find a list of specific benefits questions. Read each question and provide a score (0-2) depending on how important the topic is to you or whether or not it's relevant to your needs. Each section will produce a score. After filling out each section and clicking "Submit," your scores will be sent to HR anonymously and you will receive a personalized summary of which benefit offerings will be most beneficial to you. Your employer will evaluate all of the individual scores to determine what benefits are most important to the company as a whole. Let's dive in!

Score Key

0Low / Not at all / No

1Medium / Somewhat / Maybe

2High / Important / Yes

Section 1	Employee Score
How important is it for you to pre-plan your yearly medical expenses?	0 1 2
How important is it to you to make a single healthcare contribution that you can use throughout the year?	0 1 2
Are you likely to have Flexible Spending Account (FSA) or Health Savings Account (HSA) leftover funds at the end of the year?	0 1 2
How important is flexibility in your healthcare spending?	0 1 2

Section
Total: 0

Section 2	Employee Score
How important is investing to you?	0 1 2
How important is it to have convenient ways to pay for dental and vision expenses?	0 1 2
How important is it to you to have multiple investment options in your healthcare savings?	0 1 2
How important is it to you to be able to contribute to your healthcare account at any time during the year?	0 1 2
At the end of the year, how important is it to you to carry over as much of your healthcare funds as possible?	0 1 2

Section
Total: 0

Section 3	Employee Score
Do you have children under 13 years of age?	0 1 2
Do you have adult dependents you provide care to?	0 1 2
Do you spend more than $5,000 on dependent care every year?	0 1 2
Are you looking for a way to supplement your Health Savings Account (HSA) and increase tax-savings on dependent care?	0 1 2
Are childcare benefits important to you in making employment decisions?	0 1 2

Section
Total: 0

Section 4	Employee Score
How important is it for you to have your employer set an annual healthcare spending amount for you?	0 1 2
How important is it to you that your employer reimburses your healthcare costs?	0 1 2
How important is it to you that your employer details exactly how you can spend healthcare funds?	0 1 2
If you had a Health Reimbursement Arrangement (HRA), would you use it to cover dependents’ medical expenses?	0 1 2
Would you be interested in a Health Reimbursement Arrangement (HRA) if it was offered as a benefit?	0 1 2

Section
Total: 0

Section 5	Employee Score
Do you commute to work?	0 1 2
Do you use public transportation to get to work?	0 1 2
Do you ever pay to park your vehicle at work?	0 1 2
Would you like to have a special debit card you can use to pay for commuter expenses?	0 1 2

Section
Total: 0

Section 6	Employee Score
How would you rate our benefits package compared to our competition?	0 1 2
Do you have a favorite part of our current benefits package? (If yes or no, please explain below).	0 1 2
Are there any areas where our current benefits fall short? (If yes, please explain below).	0 1 2
How would you rate our current paid time off allowance compared with your previous employer?	0 1 2
Are there areas currently not covered under our insurance plan that you would like to see covered? (If yes, please explain below).	0 1 2
How would you rate our plan features (HSA, FSA, DCA, etc.)?	0 1 2
How would you rate how well do you understand your current benefits?	0 1 2
Do you have 1 benefit you utilize the most? (If yes, please explain below).	0 1 2
Are there benefits we currently don’t offer that you wish we did? (If yes, please explain below).	0 1 2

Section
Total: 0

Please use this section to expand on your section 6 answers and provide any additional information you would like to share.*

Benefit Needs Assessment

Company Name Here

Submit your scores to viewyour personal assessment.

Submit your scores to view
your personal assessment.