WA Insurance
Client Profile Survey
Company Information
Basic contact and business details
Business Details
Type of Business
Retail
Healthcare
Manufacturing
Technology
Construction
Professional Services
Nonprofit
Hospitality
Education
Transportation
Other
Primary Contact
Secondary Contact (Optional)
Employee Information
Workforce demographics and compensation
Employee Count
Yes
No
Payroll
In-House
External / PEO
Workforce Demographics
♂
♀
50/50
Growth Expectations
Stable (no change)
Modest growth (1–10%)
Significant growth (11–25%)
Rapid growth (25%+)
Downsizing planned
Uncertain
HR Technology (25+ Employees)
None
ADP
Gusto
Rippling
Bamboo HR
Paychex
Zenefits
Other
Yes
No
Current Benefits
Existing coverage and plan details
Does the Company Offer a Group Health Plan?
Yes
No
1
2
3
4
5
Yes
No
Employee Contributions
Yes — employer contributes
Employee pays full cost
Additional Benefits Offered
Dental
Vision
Life Insurance
Short-Term Disability
Long-Term Disability
Section 125 / FSA
HSA
401(k) / Retirement
EAP
Wellness Program
Voluntary Benefits
Workers' Compensation
Yes
No
Existing Broker?
Yes
No
Goals & Challenges
Understanding what matters most to this client
Biggest Challenges with Current Benefits Program
Cost too high
Poor employee participation
Limited plan options
Admin burden
Renewal surprises
Poor service / responsiveness
Employee communication
Compliance concerns
Desired Changes (Cost No Object)
Lower deductibles
Add dental / vision
Add life insurance
Add disability coverage
Reduce employee cost
Better wellness programs
Telehealth / virtual care
Improve enrollment tech
Better employee education
Expand mental health
Employee Requests
Competitive Talent Strategy
How Are Benefits Communicated to Employees?
Benefit letter / packet
Email
In-person meeting
HR portal / intranet
No formal process
Review & Send
Review all collected information before emailing
Survey Summary
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Additional Notes