UFAA Benefits Survey MGC, a First Insurance Group partner, is working with UFAA to develop a comprehensive group benefits package for agents and their staffs that may be offered in the near future. To help generate the best possible rates and insurance offers available, MGC is asking for a few minutes of your time to answer a survey about this benefits plan and how it might best fit you and your staff. Please be sure to answer all questions before clicking the submit button at the bottom of this page.   Question 1: Long Term Disability Consider a long term disability plan that included the following benefits: Pays 60% of your gross monthly income. You can return to work and still receive partial benefits until fully recovered. The plan would have a better definition of disability than the current Farmers plan. Based on this information, what is your interest level in hearing more about this plan as a possible alternative to the current Farmers long term disability plan? Select One Very interested Somewhat interested Not interested I need more data before deciding.   Question 2: Short Term Disability Consider a short term disability plan that included the following benefits: Pays 60% of your gross weekly income. Own-occ definition and a short elimination period. The plan would have a 3/6 pre-existing condition clause. Based on this information, what is your interest level in hearing more about this plan as a possible alternative to the current Farmers short term disability plan? Select One Very interested Somewhat interested Not interested I need more data before deciding.   Question 3: Comprehensive Vision Plan Consider a vision plan that included the following benefits: Would not require minimum participation. The current Farmers plan requires at least 2-years participation. Providers include Wal-Mart, Costco, Eyemasters and other retailers as well as private practice providers. Based on this information, what is your interest level in hearing more about this plan as a possible alternative to the current Farmers vision plan? Select One Very interested Somewhat interested Not interested I need more data before deciding.   Question 4: Dental Plan Consider a dental plan that included the following benefits: Would not require minimum participation. The current Farmers plan requires at least 1-year participation. Lower deductibles than the current plan which are $75/$150. Two plan options – Base and Enhanced – so you can choose the plan that best suits you. Based on this information, what is your interest level in hearing more about this plan as a possible alternative to the current Farmers dental plan? Select One Very interested Somewhat interested Not interested I need more data before deciding.   Demographics Please provide the following information. Completing this data will help us determine the best possible insurance offerings for UFAA. All fields must be completed. First Name: Last Name: Phone: Email: Month of Birth: Select One January February March April May June July August September October November December Year of Birth: Select One 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 Gender: Select One Male Female Annual Gross Income: Select One $25,000 to $50,000 $50,001 to $75,000 $75,001 to $100,000 $100,001 to $125,000 $125,001 to $150,000 $150,001 to $175,000 $175,001 to $200,000 More than $200,000 THANKS! Click this button to finish. →