SHOP

Shop Survey 2014 (The Small Business Health Options Program)
Win a Small Business Package worth well over $3,000 !
Just complete and submit your survey and you’ll be eligible for the drawing.

The Albuquerque Hispano Chamber of Commerce in partnership with the American Indian Chamber of Commerce , NM Black Chamber of Commerce and the New Mexico Health Insurance Exchange , request a few minutes of your time to help us better serve your needs regarding health insurance for you, your employees and loved ones.

Average time to fill out survey: 3 minutes:

If you are human, leave this field blank.

Which answer below describes your position *

Owner

Manager

Human Resources Person

Other

N / A

pick one option or specify other

(If you answered "Other" above, please explain:)

Are you involved in making business decisions about your company's healthcare plans *

Yes

No

N / A

pick on answer

Not including yourself, how many full time employees (working 30 hours or more a week) do you have working for you? *

1

2-10

11-25

26-50

more that 50 employees

N / A

Does your business currently offer a health insurance plan for employees? *

Yes

No

Looking for a plan

N / A

How important is it to offer health insurance to your employees *

Very important

Somewhat important

Not that important

N / A

If your business does not offer health insurance to employees what is the major reason: *

Cost

Too complicated

Most of my employees have insurance through their spouse or other programs

My company does offer insurance

I need help exploring options

N / A

(If you answered "I need help exploring options" above, please explain:)

If other, please specify

If you don't currently offer health insurance, how much would you be willing to pay for in monthly premiums for an employee's health coverage? *

nothing

under $50 per month

$50-$75 per month

$75-$100 per month

$100-$200 per month

over $200 per month

N / A

If your business does not offer health insurance, did you refer your employees to the Health Insurance Market Place? *

Yes

No

Most of my employees have health insurance

Not familiar with the Health insurance Market Place

N / A

Is your business familiar with the SHOP (Small Business Health Options Programs) market place? *

Yes

No

Not familiar with the SHOP market place

We are currently enrolled in SHOP

N / A

Have you attended any workshops regarding SHOP (The Small Business Health Options Program)?

Yes

No

Not familiar with the SHOP market place

N / A

Have you used the services of a "Broker" to assist your small business with health insurance options? *

Yes

No

Don't have an insurance broker and don't know their role

N / A

Have you visited the website - www.bewellnm.com to check your options regarding the new heathcare law? *

Yes

No

I plan to

N / A

Would you be interested in knowing more about the Small Business Healh Options Program (SHOP)? *

Yes

No

Maybe

N / A

Would you like to be contacted directly by NMHIX to discuss your small business options under the new healthcare law? *

Yes

No

N / A

Is your company a Minority-Owned Business or a Woman-Owned Business? *

Minority Owned

Woman Owned

Neither

N / A

Please provide your company name *

Best Phone Number to reach you *

*Format: 505-XXX-XXXX you must include area code

Email Address *

Contact person *

Please give the full name

Type of Business *

Bank, Dry Cleaner, Restaurant etc..