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Dear Users,<br>
<br>
Please take note of the following survey. In particular, if you (or
someone you know) is presently enrolled (or anticipates to enroll) in
the Student/Visitor Health insurance plan offered by Jefferson Lab -<br>
<a moz-do-not-send="true" class="moz-txt-link-freetext"
href="http://www.jlab.org/div_dept/admin/HR/jris/insurance.html">http://www.jlab.org/div_dept/admin/HR/jris/insurance.html</a>
-, <br>
your timely response would be very much helpful! As always, you can
find more on the User Group wiki at<br>
<a moz-do-not-send="true" class="moz-txt-link-freetext"
href="https://wiki.jlab.org/cugwiki/">https://wiki.jlab.org/cugwiki/</a>
under "Ongoing Polls".<br>
<br>
Thanks - Sebastian<br>
<br>
<div class="ss-email-body">If you have trouble viewing or submitting
this form, you can fill it out online: <br>
<a moz-do-not-send="true"
href="https://spreadsheets0.google.com/spreadsheet/viewform?formkey=dFlVdk9LOVUxVXNBSHRzWXh5MTVld0E6MQ">https://spreadsheets0.google.com/spreadsheet/viewform?formkey=dFlVdk9LOVUxVXNBSHRzWXh5MTVld0E6MQ</a>
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<div class="form-body">
<h1 class="ss-form-title">Health Plan Survey </h1>
</div>
<div class="ss-form-desc ss-no-ignore-whitespace">Jefferson Lab is
preparing to renegotiate its insurance plan for students and post-docs.
Please, take a couple minutes to complete the survey. Your answers may
prove useful in selecting the features and cost of the coverage.</div>
<div class="form-body">
<div class="ss-form">
<form id="ss-form" method="post"
action="https://spreadsheets0.google.com/spreadsheet/formResponse?formkey=dFlVdk9LOVUxVXNBSHRzWXh5MTVld0E6MQ&ifq"><br>
<div class="errorbox-good">
<div class="ss-item ss-radio">
<div class="ss-form-entry"><label for="entry_0" class="ss-q-title">Are
you presently using the Beech Street insurance plan offered by
Jefferson Lab? </label> <label for="entry_0" class="ss-q-help"></label>
<ul class="ss-choices">
<li class="ss-choice-item"><label class="ss-choice-label"><input
id="group_0_1" class="ss-q-radio" value="Yes" name="entry.0.group"
type="radio"> Yes</label></li>
<li class="ss-choice-item"><label class="ss-choice-label"><input
id="group_0_2" class="ss-q-radio" value="No" name="entry.0.group"
type="radio"> No</label></li>
</ul>
</div>
</div>
</div>
<br>
<div class="errorbox-good">
<div class="ss-item ss-checkbox">
<div class="ss-form-entry"><label for="entry_1" class="ss-q-title">If
you are familiar with the current plan, are you satifisfied with (check
all what applies): </label> <label for="entry_1" class="ss-q-help"></label>
<ul class="ss-choices">
<li class="ss-choice-item"><label class="ss-choice-label"><input
id="group_1_1" class="ss-q-checkbox"
value="Availability of
in-network providers"
name="entry.1.group" type="checkbox"> Availability of in-network
providers</label></li>
<li class="ss-choice-item"><label class="ss-choice-label"><input
id="group_1_2" class="ss-q-checkbox"
value="Promptness and
fairness of insurance payments"
name="entry.1.group" type="checkbox"> Promptness and fairness of
insurance payments</label></li>
<li class="ss-choice-item"><label class="ss-choice-label"><input
id="group_1_3" class="ss-q-checkbox"
value="Customer
service"
name="entry.1.group" type="checkbox"> Customer service</label></li>
<li class="ss-choice-item"><label class="ss-choice-label"><input
id="group_1_4" class="ss-q-checkbox"
value="None of the
above"
name="entry.1.group" type="checkbox"> None of the above</label></li>
</ul>
</div>
</div>
</div>
<br>
<div class="errorbox-good">
<div class="ss-item ss-checkbox">
<div class="ss-form-entry"><label for="entry_2" class="ss-q-title">If
you are familiar with the current plan, please rate the coverage
offered : </label> <label for="entry_2" class="ss-q-help"></label>
<ul class="ss-choices">
<li class="ss-choice-item"><label class="ss-choice-label"><input
id="group_2_1" class="ss-q-checkbox"
value="The level of
coverage (and premiums) is about right"
name="entry.2.group" type="checkbox"> The level of coverage (and
premiums) is about right</label></li>
<li class="ss-choice-item"><label class="ss-choice-label"><input
id="group_2_2" class="ss-q-checkbox"
value="The coverage
should be increased, even if premiums would
be higher"
name="entry.2.group" type="checkbox"> The coverage should be
increased, even if premiums would be higher</label></li>
<li class="ss-choice-item"><label class="ss-choice-label"><input
id="group_2_3" class="ss-q-checkbox"
value="The premiums
should be lowered, even if this means higher
deductibles/less coverage"
name="entry.2.group" type="checkbox"> The premiums should be lowered,
even if this means higher deductibles/less coverage</label></li>
<li class="ss-choice-item"><label class="ss-choice-label"><input
id="group_2_4" class="ss-q-checkbox"
value="None of the
above"
name="entry.2.group" type="checkbox"> None of the above</label></li>
</ul>
</div>
</div>
</div>
<br>
<div class="errorbox-good">
<div class="ss-item ss-paragraph-text">
<div class="ss-form-entry"><label for="entry_3" class="ss-q-title">Please
provide comments based on your (or your Jlab non-affiliate spouse)
experiences with our current insurance provider (Beechstreet) or other
plans/providers. </label> <label for="entry_3" class="ss-q-help"></label>
<textarea id="entry_3" class="ss-q-long" cols="75" rows="8"
name="entry.3.single"></textarea></div>
</div>
</div>
<br>
<div class="errorbox-good">
<div class="ss-item ss-paragraph-text">
<div class="ss-form-entry"><label for="entry_5" class="ss-q-title">Are
you familiar with a different insurance plan that offers more value for
the money than Beech Street? </label> <label for="entry_5"
class="ss-q-help"></label> <textarea id="entry_5" class="ss-q-long"
cols="75" rows="8" name="entry.5.single"></textarea></div>
</div>
</div>
<br>
<input value="0" name="pageNumber" type="hidden"> <input
name="backupCache" type="hidden">
<div class="ss-item ss-navigate">
<div class="ss-form-entry"> <input value="Submit" name="submit"
type="submit"></div>
</div>
</form>
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<br>
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