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BurnOrange Benefits Discovery Form

Section 1: Company Details


Company Name

Type of Business

Location

Job Title

Email

Phone Number

Preferred Contact Method

Number of Employees

Full Time
Part Time
Remote
1099

Payroll Frequency

Payroll Company

Payroll Company
A
B

Decision Maker Name(s) and Title(s)

Contact Person Name(s) and Title(s)


Section 2: Core Benefit Details


Do you offer your employer core benefits?

Do you offer your employer core benefits?
A
B
C

Broker Name

What portion of the premium do you pay?

What is the deductible?

What is the deductible?

Vision
Dental
Life Insurance

How are benefits decisions made?


Section 125 (Pre-Taxing) Tell me about your HR paint points

Do you currently use an HR Platform or Technology?

How are you currently onboarding new hires?

How are your benefits communicated and enrolled?

What are the open enrollment dates for your benefits?


Section 2: Core Benefit Details

Please select any voluntary or additional benefits your company currently offers or is interested in learning more about. This helps us understand how to best support your team’s needs.

Please select any voluntary or additional benefits your company currently offers or is interested in learning more about. This helps us understand how to best support your team’s needs.

Is there a benefit that your employees have asked for that you are not currently offering?

What would you NOT change about your benefits offering?

In the last 3–5 years, have you experienced medical plan rate increases or changes?

In the last 3–5 years, have you experienced medical plan rate increases or changes?
A
B

Do you feel employees understand and appreciate your investment in their benefits?

Do you feel employees understand and appreciate your investment in their benefits?
A
B

Section 4: GENERAL QUESTIONS

What do you feel has kept you from offering any benefits?

What sets your company apart in attracting, hiring, and retaining top talent compared to others in your industry?

If one of your employees was in financial distress, would they come to you for assistance?

Do you feel your company experiences an abnormal amount of workers' comp claims?

If there was one benefit you could offer your employees, regardless of cost, what would that be?


Section 4: GENERAL QUESTIONS