すべてのテンプレート
Employee & HR

Employee Interest in Employer GLP-1 Coverage Survey

Measures how aware, interested, and price-sensitive employees are toward employer-sponsored coverage of GLP-1 medications (e.g., Ozempic, Wegovy, Mounjaro). Built for HR and benefits teams weighing whether to add this coverage. The AI follow-up interview digs into the personal reasoning behind interest or hesitation — health goals, cost thresholds, and stigma — that closed questions can't capture.

設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全16問・約8分
Q01
メッセージ

Thanks for taking a few minutes on this one. We're exploring interest in adding coverage for GLP-1 medications (like Ozempic, Wegovy, or Mounjaro) to our health benefits, and want your honest take. Takes about 8 minutes, and your answers are confidential.

Q02
選択式必須

Have you heard of GLP-1 medications such as Ozempic, Wegovy, Mounjaro, or Zepbound?

  • Yes, I'm very familiar with them
  • I've heard of them but don't know much
  • No, this is new to me
Q03
選択式必須

Have you personally used a GLP-1 medication for weight management or diabetes?

  • Currently taking one
  • Have taken one in the past
  • Never taken one, but interested
  • Never taken one, and not interested
Q04
選択式必須

Does your current health insurance (through this employer or elsewhere) cover GLP-1 medications for weight management?

  • Yes, fully covered
  • Yes, partially covered (e.g., prior authorization or step therapy required)
  • No, not covered
  • I don't know
Q05
オピニオンスケール必須

If your employer added coverage for GLP-1 medications specifically for weight management, how interested would you be in using that benefit?

スケール: 0 – 10
最小:Not at all interested最大:Extremely interested
Q06
マトリクス

How much do you agree with each of the following statements?

5行 × 5列
  • I would use a GLP-1 medication if it were affordable to me
  • Coverage should require a documented weight-related health condition (e.g., diabetes, high BMI)
  • I'd want nutrition or lifestyle coaching bundled with medication coverage
  • Cost is the main reason I haven't tried a GLP-1 medication
  • I'm concerned about the side effects of these medications
列: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q07
ポイント配分

If your employer had 100 points to invest across new or improved benefits, how would you split them across these options?

  • GLP-1 medication coverage
  • Mental health / therapy coverage
  • Fertility and family planning benefits
  • Enhanced dental or vision coverage
  • Gym or wellness reimbursement
100ポイントを配分
Q08
価格感度分析(Van Westendorp)

Now a few quick questions about cost. Think about a monthly out-of-pocket amount (copay) for a GLP-1 medication benefit.

  • At what monthly out-of-pocket cost would this coverage seem so cheap that you'd question its quality or limits?
  • At what monthly out-of-pocket cost would this coverage feel like a great deal?
  • At what monthly out-of-pocket cost would this coverage start to feel expensive, though you might still consider it?
  • At what monthly out-of-pocket cost would this coverage be too expensive for you to ever consider it?
Q09
選択式

What would stop you from using a GLP-1 medication benefit if your employer offered one? Select all that apply.

  • Cost of copay or deductible
  • Concerns about side effects
  • Needle or injection discomfort
  • Stigma or privacy concerns
  • Uncertainty about long-term effectiveness
  • Prior authorization or paperwork hassle
  • Nothing would stop me
Q10
評価スケール

How much would better GLP-1 medication coverage influence your choice between two otherwise similar job offers?

範囲: 1 – 5
最小:Not at all influential最大:Extremely influential
Q11
AIインタビュー

Explore the personal story behind this employee's interest level: is it driven by their own health goals, a family member's experience, cost concerns, or skepticism about the medications? If they flagged cost as a barrier, probe what specific monthly out-of-pocket amount would change their mind. If they said they're 'not interested,' distinguish between privacy or stigma concerns versus genuine disinterest in the medication itself, and ask what would need to be true for them to reconsider.

Q12
メッセージ

Almost done — just a few optional background questions to help us understand patterns across teams.

Q13
選択式

What is your age range?

  • Under 25
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65+
  • Prefer not to say
Q14
選択式

What is your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q15
選択式

How long have you worked at this company?

  • Less than 1 year
  • 1-3 years
  • 4-7 years
  • 8+ years
  • Prefer not to say
Q16
メッセージ

That's everything — thank you for your honesty. Your responses will be combined with your colleagues' anonymously to help HR decide whether to add GLP-1 medication coverage to next year's benefits.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Purpose-built around GLP-1 coverage specifically, with awareness, current coverage, and usage questions rather than generic 'employee interest' framing
  • Includes a Van Westendorp pricing module to find real cost thresholds employees would tolerate for a GLP-1 benefit, not just a general satisfaction scale
  • Uses a constant-sum trade-off exercise (100 points across benefits) so HR can see GLP-1 coverage priority relative to other benefit investments
  • Adds an AI follow-up interview that probes the personal reasoning behind interest or hesitation — health goals, cost sensitivity, and stigma — which the closed questions alone can't surface

Jotform

Employee Interest Survey Form Template

This is a generic, fielding-ready employee interest survey form, not tailored to GLP-1 medications, benefits cost trade-offs, or health coverage topics. It's a reasonable starting point if a team wants to build a GLP-1-specific survey from scratch, but the template itself doesn't include any of that subject-matter structure. It's a static form builder output rather than an interview-style research instrument.

優れている点

  • Ready-to-use, customizable form template that can be deployed quickly
  • Familiar drag-and-drop form builder with standard question types
  • Broad applicability across many 'employee interest' topics, not locked to one use case

物足りない点

  • No GLP-1 or benefits-specific question set (coverage awareness, cost thresholds, stigma) — would need to be built manually
  • Static form fields only; no adaptive AI follow-up questioning to explore individual reasoning
  • No built-in pricing sensitivity method (e.g., Van Westendorp) or benefit trade-off allocation tool

よくあるご質問

「Employee Interest in Employer GLP-1 Coverage Survey」テンプレートにはどのような設問が含まれていますか?

すぐに使える設問が16問含まれており、最初の設問は次のとおりです:「Thanks for taking a few minutes on this one. We're exploring interest in adding coverage for GLP-1 medications (like Oze…」・「Have you heard of GLP-1 medications such as Ozempic, Wegovy, Mounjaro, or Zepbound?」・「Have you personally used a GLP-1 medication for weight management or diabetes?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか?

回答者は通常、16問を約8分で回答し終えます。

テンプレートは編集できますか?

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか?

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか?

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

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