모든 템플릿

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.

샘플 질문

템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.

질문 16개 · 약 8분
Q01
메시지

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
객관식필수

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
객관식필수

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
객관식필수

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
의견 척도필수

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

척도: 010
최소:Not at all interested최대:Extremely interested
Q06
매트릭스

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

5개 행 × 5개 열
  • 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
: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q07
점수 배분

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
100점 배분
Q08
가격 민감도(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
객관식

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
평점 척도

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

범위: 15
최소:Not at all influential최대:Extremely influential
Q11
AI 인터뷰

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
메시지

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

Q13
객관식

What is your age range?

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

What is your gender?

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

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
메시지

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.

포함된 기능

  • AI 후속 질문

    정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.

  • 주의력 확인 장치

    성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.

  • AI가 작성한 문안

    문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.

  • 자동 리포트

    응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.

다른 서비스와 비교

다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.

이 템플릿을 선택하는 이유

  • 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.

잘하는 점

  • 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

아쉬운 점

  • 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

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