ROC Fringe Benefit Survey
Are you a Full-Time Employee (scheduled 30 hours or more/weekly)?
*
Yes
No
I am currently enrolled in one of ROC's Health Insurance Plans.
*
Yes
No
I am NOT currently enrolled in ANY Health Insurance Plan.
*
Yes
No
I had health insurance until status changes relating to COVID pandemic.
*
Yes
No
I would like to know if I have the option to enroll in one of ROC's Health Insurance Plans.
*
Yes
No
I am a participant with ROC's flex spending program.
*
Yes
No
I am concerned that I will not be able to expend the amount I have payroll deducted to my card by November 30th.
Yes
No
I would like to know if I have the option to amend my flex spending plan, opt out of the plan, or elect to enroll in a flex spending plan before open enrollment.
*
Yes
No
With changes due to the COVID pandemic, I am aware that I can use my flex spending card to purchase the following items, if needed.
*
Yes
No
Antacids, Pain Relievers, Cold & Flu Medications, Digestive Aids, Antibiotics & Antiseptics, Menstruation Products
Completed by:
*
Submit
Δ