Attachment A - Precanvass Questionnaire

Introduction for 2025 MEPS-PreCanvass (PC) Operation
The MEPS_PC Operation will be conducted electronically, via Centurion. The dates of the
operation are scheduled for 5 May – 30 May. The sample size consists of approximately 42,000
cases.

Content for MEPS-PC
Respondents are asked to make any applicable changes to the sampled establishment, which
includes the following fields:
Company Name
Street Address
City, State and Zip Code

Question Content
Is the organization still in operation?
Answer Options:
Yes
No
In 2025, did your organization offer any health insurance plans to its ACTIVE employees?
Answer Options:
Yes
No
In 2025, how many employees were on your organization’s/government unit’s payroll AT
THIS LOCATION for a typical pay period?
Answer Space:
All Employees

For the same TYPICAL pay period, how many of the employees reported above worked
part-time?
Answer Space:
Part-time
How many of the employees reported above worked fewer than 30 hours per week?
Answer Space:
Employees worked fewer than 30 hours
Checkbox for No Employees worked fewer than 30 hours

Provide information for a TYPICAL pay period in 2025
Approximately what percentage of the employees at this location were:
Answer Options:
Union Members
Percentage
Checkbox for No union members
Women employees
Percentage
Employees 50 years old or older
Percentage
For the employees at this location, approximately what percentage earned:

Answer Options: Percentage Requested for each category
Less than $18.00 per hour? (Approximately $37,440 a year or less)
Between $18.00 and $39.00 per hour? (Approximately $37,440 to $81,120 a year or less)
More than $39.00 per hour? (Approximately $81,120 a year or less)
Did your organization offer the following fringe benefits to its employees at this location?
Answer Options: Yes, No or Don’t Know for each category
Paid Vacation
Paid Sick Leave
Life Insurance
Disability Insurance
Critical Illness Insurance
Did your organization offer any of these tax-advantaged benefits to its employees at this
location?
Answer Options: Yes, No or Don’t Know for each category
Employee contributions to health insurance made on a pre-tax basis
Flexible Spending Accounts (FSA) for healthcare
Flexible Benefits Plans

Did your organization provide health insurance coverage to any person who retired in
2025 OR BEFORE, or to any of their survivors?
If COBRA was the only coverage offered, select "No."
Answer Options:
Yes
No
Don’t Know
Contact and Mailing Information
[This information is only collected for establishments that offer health insurance.]
Please provide the information for the person in the company who is most
knowledgeable about health insurance benefits offered by your organization/government
unit:
Answer spaces:
Name
Title
Telephone Number
Extension
Email
Mailing Name
Mailing Name2
Mailing Address
Mailing Address 2
City, State and Zip Code
Country Name
Postal Code