Private Health Insurance Detail (HP) Section
----------------------------------------------------
| NOTE: FOR ‘CATEGORY NAME FROM HX03 OR HX23’, |
| DISPLAY THE FOLLOWING: |
| |
| - ‘PROFESSIONAL ASSOCIATION’ IF CODED ‘1’ AT HX03 |
| - ‘SMALL BUSINESS GROUP’ IF CODED ‘2’ AT HX03 |
| - ‘UNION’ IF CODED ‘3’ AT HX03 |
| - ‘HEALTH INSURANCE PURCHASING ALLIANCE’ IF CODED |
| ‘4’ AT HX03 |
| - ‘INSURANCE AGENT’ IF CODED ‘5’ AT HX03 |
| - ‘INSURANCE COMPANY’ IF CODED ‘6’ AT HX03 |
| - ‘HMO’ IF CODED ‘7’ AT HX03 |
| - ‘PREVIOUS EMPLOYER’ IF CODED ‘8’ AT HX03 |
| - ‘PREVIOUS EMPLOYER (COBRA)’ IF CODED ‘9’ AT HX03|
| - THE TEXT ENTERED AT HX03OV IF CODED ‘91’ AT HX03|
| - ‘SOURCE THE INSURANCE WAS PURCHASED FROM FOR |
| THAT BUSINESS’ IF CODED ‘-7’ OR ‘-8’ AT HX03 |
| |
| - ‘GROUP OR ASSOCIATION’ IF CODED ‘1’ AT HX23 |
| - ‘HEALTH INSURANCE PURCHASING ALLIANCE’ IF CODED |
| ‘2’ AT HX23 |
| - ‘SCHOOL’ IF CODED ‘3’ AT HX23 |
| - ‘INSURANCE AGENT’ IF CODED ‘4’ AT HX23 |
| - ‘INSURANCE COMPANY’ IF CODED ‘5’ AT HX23 |
| - ‘HMO’ IF CODED ‘6’ AT HX23 |
| - ‘UNION’ IF CODED ‘7’ AT HX23 |
| - ‘ANYONE’S PREVIOUS EMPLOYER (COBRA)’ IF CODED |
| ‘8’ AT HX23 |
| - ‘ANYONE’S PREVIOUS EMPLOYER (NOT COBRA)’ IF |
| CODED ‘9’ AT HX23 |
| - ‘SPOUSE’S/DECEASED SPOUSE’S PREVIOUS EMPLOYER’ |
| IF CODED ‘10’ AT HX23 |
| - ‘SOME OTHER EMPLOYER’ IF CODED ‘11’ AT HX23 |
| - ‘PLAN OF SOMEONE NOT LIVING HERE’ IF CODED ‘12’ |
| AT HX23 |
| - THE TEXT ENTERED AT HX23OV IF CODED ‘91’ AT HX23|
| - ‘SOURCE THAT PROVIDED THE DIRECTLY PURCHASED |
| INSURANCE’ IF CODED ‘-7’ OR ‘-8’ |
-----------------------------------------------------
----------------------------------------------------
| NOTE: FOR ROUND 5, THE END DATE IS DISPLAYED IN |
| THE CONTEXT HEADER FOR QUESTIONS HP04 - HP18. |
-----------------------------------------------------
BOX_01 ======
----------------------------------------------------
| IF LOOPING ON ANY ESTABLISHMENT FLAGGED IN THE |
| EMPLOYMENT (EM) SECTION AS 'PROVIDES HEALTH |
| INSURANCE' AND NOT FLAGGED AS ‘SELF-EMPLOYED’ |
| WITH A FIRM-SIZE-1, GO TO LOOP_01 |
----------------------------------------------------
----------------------------------------------------
| IF LOOPING ON AN HX03 CATEGORY OR IF LOOPING ON |
| AN HX23 CATEGORY (EXCEPT CODE ‘3’ (DIRECTLY FROM |
| A SCHOOL)), GO TO HP03 |
----------------------------------------------------
----------------------------------------------------
| IF LOOPING ON CODE '3' (DIRECTLY FROM A SCHOOL) |
| AT HX23, CONTINUE WITH HP01 |
----------------------------------------------------
HP01 ====
INSURANCE SOURCE: {CATEGORY NAME FROM HX23}
Does this insurance cover only injuries caused by accidents,
or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 {BOX_11}
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HP02 ====
INSURANCE SOURCE: {CATEGORY NAME FROM HX23}
Would this insurance cover health services outside of a school
clinic?
YES .................................... 1
NO ..................................... 2 {BOX_11}
REF ................................... -7
DK .................................... -8
HP03 ====
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
I'd like to talk about the insurance which is from (a/an)
(INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE
SOURCE) HAS NOT ALREADY BEEN
DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE
SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 {BOX_11}
[Code One]
----------------------------------------------------
| IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG |
| ITEM FOR SOURCE CLEAN-UP. |
----------------------------------------------------
LOOP_01 =======
----------------------------------------------------
| FOR EACH OF THE FOLLOWING: |
| |
| ESTABLISHMENT 1 |
| ESTABLISHMENT 2 |
| ESTABLISHMENT 3 |
| ESTABLISHMENT 4 |
| |
| ASK BOX_01A-END_LP01 |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP-01 COLLECTS DETAILED |
| INFORMATION ABOUT INSURANCE PROVIDED THROUGH AN |
| EMPLOYER OR THE ESTABLISHMENT NAMES OF THE |
| INSURANCE SOURCE COLLECTED IN EITHER HX03 OR HX23.|
| IF LOOPING ON INSURANCE PROVIDED FROM AN EMPLOYER |
| ONLY ONE LOOP CYCLE IS COMPLETED. |
| |
| IF LOOPING ON INSURANCE PROVIDED THROUGH AN |
| INSURANCE SOURCE COLLECTED IN HX03 OR HX23, THE |
| FIRST LOOP CYCLE COLLECTS THE MAIN ESTABLISHMENT |
| NAME OF THE INSURANCE SOURCE. SUBSEQUENT CYCLES, |
| IF ANY, ARE DETERMINED BY THE RESPONSE TO HP18. |
| IF HP18 IS CODED '1' (YES), THE LOOP CYCLES AGAIN |
| TO COLLECT THE NEXT ESTABLISHMENT NAME. IF HP18 |
| IS NOT ASKED OR IS CODED '2' (NO), '-7' (REFUSED),|
| OR '-8' (DON'T KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_01A =======
----------------------------------------------------
| IF LOOPING ON ANY ESTABLISHMENT FLAGGED IN |
| EMPLOYMENT AS 'PROVIDES HEALTH INSURANCE' AND NOT |
| FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE-1, |
| GO TO HP09 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH HP04 |
----------------------------------------------------
HP04 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
Please give me the name of one of the {(INSURANCE SOURCE)} {from
which anyone in the family purchased this insurance/which covers
anyone in the family/insurance companies for the insurance
purchased from an agent}.
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT
(ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
| ROSTER. ESTABLISHMENT | HP04_02. STREET | HP04_03. CITY |
|---|---|---|
| 1. Establishment | [Enter Truncated Street Address] |
[Enter Truncated City] |
| 2. Establishment | [Enter Truncated Street Address] |
[Enter Truncated City] |
| 3. Establishment | [Enter Truncated Street Address] |
[Enter Truncated City] |
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL |
| ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE |
| INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS |
| DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS |
| ‘EMPLOYER’ AND ‘SELF-EMPLOYED’ WITH A FIRM-SIZE-1 |
| THAT ARE COMING FROM THE HX03 SERIES). |
----------------------------------------------------
----------------------------------------------------
| ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS: |
| |
| 1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT |
| ALREADY LISTED OR SELECT ‘NONE OF THE ABOVE’. |
| 2. ONLY ONE SELECTION MAY BE MADE. |
| 3. INTERVIEWER CANNOT ADD AT THIS SCREEN. |
| ESTABLISHMENTS ARE ‘ADDED’ BY USING ‘NONE OF |
| THE ABOVE’. |
| 4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E.,|
| CTRL/D). |
----------------------------------------------------
----------------------------------------------------
| DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON |
| THIS ROSTER. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘(INSURANCE SOURCE)’ IF NOT LOOPING ON |
| CODE ‘5’ (INSURANCE AGENT) AT HX03 OR CODE ‘4’ |
| (INSURANCE AGENT) AT HX23. |
| |
| DISPLAY ‘from which anyone in the family purchased|
| this insurance’ IF NOT LOOPING ON CODE ‘5’ |
| (INSURANCE AGENT) AT HX03 OR CODES ‘4’ (INSURANCE |
| AGENT) OR ‘12’ (UNDER PLAN OF SOMEONE NOT LIVING |
| HERE) AT HX23. |
| |
| DISPLAY ‘which covers anyone in the family’ IF |
| LOOPING ON CODE ‘12’ (UNDER PLAN OF SOMEONE NOT |
| LIVING HERE) AT HX23. |
| |
| DISPLAY ‘insurance company for the insurance |
| purchased from an agent’ IF LOOPING ON CODE ‘5’ |
| (INSURANCE AGENT) AT HX03 OR CODE ‘4’ (INSURANCE |
| AGENT) AT HX23. |
----------------------------------------------------
----------------------------------------------------
| NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS |
| HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO |
| THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON |
| (I.E., JOBHOLDER WHEN COMING FROM AN HX03 |
| CATEGORY), CAPI DISPLAYS THE PERSON AND START |
| DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, |
| CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. |
| OTHERWISE, CAPI DISPLAYS THE START DATE. |
----------------------------------------------------
----------------------------------------------------
| IF INFORMED CONSENT PARAGRAPH HAS NOT BEEN READ |
| THIS ROUND, GO TO HP04A. SCREENS CONTAINING |
| INFORMED CONSENT PARAGRAPH ARE: EM06A, EM12A, |
| EM19A, EM28A, EM41A, EM54A, EM71A, EM83A, EM118A, |
| AND HP04A. |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_01B |
----------------------------------------------------
HP04A =====
In order to better understand the kinds of health insurance being
offered to families today, insurance providers and employers
who often provide health insurance may be contacted as part of a
separate study. This separate study will not use any person’s name
from MEPS, so employers and insurance providers can’t identify anyone
in your household.
[PRESS ENTER TO CONTINUE]
BOX_01B =======
----------------------------------------------------
| IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT|
| LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' |
| IS SELECTED, GO TO HP07 |
----------------------------------------------------
----------------------------------------------------
| IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT |
| LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT |
| LIVING HERE) AT HX23, GO TO HP06 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH HP05 |
----------------------------------------------------
HP05 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
Is the address of (ESTABLISHMENT):
{ESTABLISHMENT STREET ADDRESS LINE1.}
{ESTABLISHMENT STREET ADDRESS LINE2.}
{ESTABLISHMENT CITY......., ST, ZIP..}
{EST. TEL #}
ADDRESS AND TELEPHONE CORRECT .......... 1 {BOX_02}
ADD NEW ADDRESS FOR ESTABLISHMENT ...... 2
ABOVE ADDRESS/TELEPHONE NEEDS
CORRECTION .......................... 3 {HP08}
SELECTED WRONG ESTABLISHMENT/ADDRESS ... 4
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}
[Code One]
----------------------------------------------------
| IF CODED '4' (SELECTED WRONG ESTABLISHMENT/ |
| ADDRESS), CAPI REDISPLAYS HP04 SO THE INTERVIEWER |
| CAN SELECT THE CORRECT ESTABLISHMENT. |
----------------------------------------------------
HP06 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
What is the {new} address of (ESTABLISHMENT)?
ENTER COMPLETE (NAME AND) ADDRESS AND VERIFY SPELLING.
IF ESTABLISHMENT HAS MORE THAN ONE LOCATION, RECORD
LOCATION WHERE PERSON PURCHASED INSURANCE.
Current Info: [ESTABLISHMENT]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY]
[STATE]
[ZIP CODE]
[TELEPHONE]
ESTABLISHMENT (HP06_01): [_____________]
STREET ADDRESS1 (HP06_02): [_____________]
STREET ADDRESS2 (HP06_03): [_____________]
CITY (HP06_04): [_____________]
STATE (HP06_05): [_____________]
ZIP CODE (HP06_06): [_____________]
TELEPHONE (HP06_07): [_____________]
PRESS F1 FOR LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
| DISPLAY 'new' IF HP05 IS CODED '2' (ADD NEW |
| ADDRESS FOR ESTABLISHMENT). OTHERWISE, USE A |
| NULL DISPLAY. |
----------------------------------------------------
----------------------------------------------------
| NOTE: SINCE TYPE OF COVERAGE INFORMATION IS NOT |
| COLLECTED UNTIL AFTER WE COLLECT ADDRESS |
| INFORMATION, WE WILL BE COLLECTING ADDRESS |
| INFORMATION FOR SOME ESTABLISHMENTS THAT WILL NOT |
| BE PART OF THE HIPS SAMPLE. |
----------------------------------------------------
----------------------------------------------------
| WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- |
| ROSTER. |
----------------------------------------------------
----------------------------------------------------
| GO TO BOX_02 |
----------------------------------------------------
----------------------------------------------------
| NOTE: WE NOW PLAN TO COLLECT FULL ADDRESS |
| INFORMATION FOR SOURCES OF HEALTH INSURANCE IN |
| ROUND 2 AND BEYOND. THIS ALLOWS US TO CONTINUE TO|
| UNIQUE ESTABLISHMENTS AND ALLOWS FOR MAXIMUM |
| FLEXIBILITY (E.G., IF WE WANT TO HIPS AGAIN). |
----------------------------------------------------
HP07 ====
{STR-DT}
{END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
You mentioned that someone in the family receives health
insurance from the plan of someone not living here. How
does that policyholder get this insurance?
INTERVIEWER: RECORD ESTABLISHMENT NAME BELOW.
ADDRESS INFORMATION IS NOT NECESSARY.
[Enter Establishment Name]
----------------------------------------------------
| NOTE: ONLY CATEGORY ‘12’ (UNDER PLAN OF SOMEONE |
| NOT LIVING HERE) OF HX23 IS ASKED HP07. |
----------------------------------------------------
----------------------------------------------------
| WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- |
| ROSTER. DISPLAY ADDRESS AS ‘NOT NECESSARY'. |
----------------------------------------------------
----------------------------------------------------
| GO TO BOX_02 |
----------------------------------------------------
HP08 ====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
CORRECT ADDRESS OR TELEPHONE FOR: (ESTABLISHMENT)
PRESS ENTER TO CONFIRM ENTRY OF INDIVIDUAL FIELD. RE-TYPE
ENTIRE LINE FOR INCORRECT FIELD.
Current Info: [ESTABLISHMENT]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY]
[STATE]
[ZIP CODE]
[TELEPHONE]
ESTABLISHMENT (HP08_01): [_____________]
STREET ADDRESS1 (HP08_02): [_____________]
STREET ADDRESS2 (HP08_03): [_____________]
CITY (HP08_04): [_____________]
STATE (HP08_05): [_____________]
ZIP CODE (HP08_06): [_____________]
TELEPHONE (HP08_07): [_____________]
PRESS F1 FOR LIST OF STATE ABBREVIATIONS.
BOX_02 ======
----------------------------------------------------
| IF HX03 IS CODED '1' OR '2' FLAG ESTABLISHMENT AS |
| 'GROUP'. |
| IF HX03 IS CODED '3', FLAG ESTABLISHMENT AS |
| 'UNION'. |
| IF HX03 IS CODED '4', FLAG ESTABLISHMENT AS |
| 'HEALTH ALLIANCE'. |
| IF HX03 IS CODED '5', FLAG ESTABLISHMENT AS |
| 'INSURANCE COMPANY-FROM AN AGENT'. |
| IF HX03 IS CODED '6', FLAG ESTABLISHMENT AS |
| 'INSURANCE COMPANY'. |
| IF HX03 IS CODED '7', FLAG ESTABLISHMENT AS 'HMO'.|
| IF HX03 IS CODED '8', FLAG ESTABLISHMENT AS |
| 'PREVIOUS EMPLOYER, NOT COBRA'. |
| IF HX03 IS CODED '9', FLAG ESTABLISHMENT AS |
| 'COBRA'. |
| IF HX03 IS CODED '91', FLAG ESTABLISHMENT AS |
| 'UNKNOWN TYPE-COLLECTED AT OTHER'. |
| |
| IF HX23 IS CODED '1', FLAG ESTABLISHMENT AS |
| 'GROUP'. |
| IF HX23 IS CODED '2', FLAG ESTABLISHMENT AS |
| 'HEALTH ALLIANCE'. |
| IF HX23 IS CODED '3', FLAG ESTABLISHMENT AS |
| 'SCHOOL'. |
| IF HX23 IS CODED '4', FLAG ESTABLISHMENT AS |
| 'INSURANCE COMPANY-FROM AN AGENT’. |
| IF HX23 IS CODED '5', FLAG ESTABLISHMENT AS |
| 'INSURANCE COMPANY'. |
| IF HX23 IS CODED '6', FLAG ESTABLISHMENT AS |
| 'HMO'. |
| IF HX23 IS CODED '7', FLAG ESTABLISHMENT AS |
| 'UNION'. |
| IF HX23 IS CODED '8', FLAG ESTABLISHMENT AS |
| 'COBRA'. |
| IF HX23 IS CODED '9', FLAG ESTABLISHMENT AS |
| 'PREVIOUS EMPLOYER, NOT COBRA'. |
| IF HX23 IS CODED '10', FLAG ESTABLISHMENT AS |
| 'SPOUSE PREVIOUS EMPLOYER'. |
| IF HX23 IS CODED '11', FLAG ESTABLISHMENT AS |
| 'EMPLOYER'. |
| IF HX23 IS CODED '12', FLAG ESTABLISHMENT AS |
| 'UNKNOWN TYPE-OUTSIDE RU'. |
| IF HX23 IS CODED ‘91’, FLAG ESTABLISHMENT AS |
| ‘UNKNOWN TYPE - COLLECTED AT OTHER’. |
----------------------------------------------------
BOX_03 ======
----------------------------------------------------
| IF LOOPING ON AN HX23 CATEGORY, GO TO HP11 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH HP09 |
----------------------------------------------------
HP09 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
{(Are/Is)/As of (END DATE), was} (PERSON) the primary insured
person or policyholder of this health coverage through
(ESTABLISHMENT)?
YES .................................... 1 {LOOP_02}
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
----------------------------------------------------
| DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY ‘As of|
| (END DATE), was’ IF ROUND 5. |
----------------------------------------------------
----------------------------------------------------
| NOTE: PERSON REFERS TO JOBHOLDER. |
----------------------------------------------------
----------------------------------------------------
| IF CODED '1' (YES), FLAG JOBHOLDER AS |
| 'POLICYHOLDER'. |
----------------------------------------------------
HP10 ====
{NAME OF ESTABLISHMENT.........} {STR-DT}
{END-DT}
Who {is/was} the primary insured person or policyholder of this
health coverage through (ESTABLISHMENT) {on (END DATE)}?
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{JOBHOLDER/EMPLOYER-PAIR 1}
{JOBHOLDER/EMPLOYER-PAIR 2}
{JOBHOLDER/EMPLOYER-PAIR 3}
JOBHOLDER/EMPLOYER IS LISTED ........... 1 {END_LP01}
JOBHOLDER/EMPLOYER IS NOT LISTED ....... 2 {END_LP01}
REF ................................... -7 {END_LP01}
DK .................................... -8 {END_LP01}
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code One]
----------------------------------------------------
| DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF |
| ROUND 5. DISPLAY ‘on (END DATE)’ IF ROUND 5. |
| OTHERWISE, USE NULL DISPLAY. |
----------------------------------------------------
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PAIRS |
| ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT |
| MEET BOTH OF THE FOLLOWING CONDITIONS: |
| |
| - ESTABLISHMENT IS FLAGGED AS AN 'EMPLOYER' THAT |
| IS ALSO FLAGGED AS ‘PROVIDES HEALTH INSURANCE’ |
| AND |
| - PERSON IS A JOBHOLDER AT THE JOB PROVIDED BY |
| ESTABLISHMENT |
----------------------------------------------------
----------------------------------------------------
| IF CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T |
| KNOW), FLAG FOR EVENT CLEANUP. |
----------------------------------------------------
HP11 ====
{NAME OF ESTABLISHMENT.........} {STR-DT}
{END-DT}
Who {is/was} the primary insured person or policyholder of this
health coverage through (ESTABLISHMENT) {on (END DATE)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
| DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF |
| ROUND 5. DISPLAY ‘on (END DATE)’ IF ROUND 5. |
| OTHERWISE, USE NULL DISPLAY. |
----------------------------------------------------
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS |
| ON THE DU-MEMBERS-ROSTER. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND |
| 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON |
| THIS ROSTER. |
----------------------------------------------------
----------------------------------------------------
| IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND |
| 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO |
| LOOP_02 |
----------------------------------------------------
----------------------------------------------------
| IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN |
| COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER|
| NOT LISTED IN DU’, GO TO HP11B |
----------------------------------------------------
----------------------------------------------------
| IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE|
| OR IN COMBINATION WITH OTHER NAMES AND/OR |
| ‘POLICYHOLDER DECEASED’, CONTINUE WITH HP11A |
----------------------------------------------------
HP11A =====
{NAME OF ESTABLISHMENT........} {STR-DT}
{END-DT}
INTERVIEWER: ENTER NAME OR DESCRIPTION OF POLICYHOLDER WHO
IS NOT IN THE DU:
[Enter Specify-15] ....................
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
----------------------------------------------------
| NOTE: WHENEVER THIS POLICYHOLDER IS BEING ASKED |
| ABOUT IN THE REMAINDER OF HP, HQ, HX, AND OE, THE |
| POLICYHOLDER NAME IN THE CONTEXT HEADER WILL BE |
| DISPLAYED AS ‘PLCYHLDR NOT IN DU-’ FOLLOWED BY |
| THE 15 CHARACTER ENTRY AT HP11A. |
----------------------------------------------------
----------------------------------------------------
| IF 'POLICYHOLDER DECEASED' SELECTED AT HP11, |
| CONTINUE WITH HP11B |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO LOOP_02 |
----------------------------------------------------
HP11B =====
{NAME OF ESTABLISHMENT........} {STR-DT}
{END-DT}
INTERVIEWER: ENTER NAME OF DECEASED POLICYHOLDER:
[Enter Specify-40] ....................
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
----------------------------------------------------
| FLAG POLICYHOLDER AS ‘DECEASED’. |
----------------------------------------------------
----------------------------------------------------
| NOTE: WHENEVER THE POLICYHOLDER IS BEING ASKED |
| ABOUT IN THE REMAINDER OF HP, HQ, HX, AND OE, THE |
| POLICYHOLDER NAME IN THE CONTEXT HEADER WILL BE |
| DISPLAYED AS ‘PLCYHLDR DECEASED-’ FOLLOWED BY THE |
| FIRST 15 CHARACTERS OF THE ENTRY AT HP11B. |
----------------------------------------------------
LOOP_02 =======
----------------------------------------------------
| FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON- |
| PAIRS-ROSTER, ASK BOX_04-END_LP02 |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION |
| ABOUT THE POLICYHOLDER AND DEPENDENTS FOR EACH |
| ESTABLISHMENT-PERSON. THIS LOOP CYCLES ON EACH |
| ESTABLISHMENT-PERSON-PAIR CREATED AT HP09 AND HP11|
| DURING THE CURRENT ROUND FOR THE ESTABLISHMENT |
| BEING CYCLED ON IN LOOP_01. |
----------------------------------------------------
BOX_04 ======
----------------------------------------------------
| IF LOOPING ON AN ESTABLISHMENT FLAGGED IN |
| EMPLOYMENT AS ‘PROVIDES HEALTH INSURANCE’, GO TO |
| BOX_07 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH BOX_05 |
----------------------------------------------------
BOX_05 ======
----------------------------------------------------
| IF HX23 IS CODED ‘8’ (PREVIOUS EMPLOYER-COBRA), |
| ‘9’ (PREVIOUS EMPLOYER-NOT COBRA), ‘10’ (SPOUSE |
| PREVIOUS EMPLOYER), OR ‘11’ (OTHER EMPLOYER) |
| CONTINUE WITH BOX_06 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_07 |
----------------------------------------------------
BOX_06 ======
----------------------------------------------------
| IF POLICYHOLDER WAS FLAGGED AT HP11 AS 'DECEASED',|
| CODE HP12 AS '4' (DECEASED) AUTOMATICALLY BY CAPI |
| AND GO TO HP13 |
----------------------------------------------------
----------------------------------------------------
| IF POLICYHOLDER IS NOT A CURRENT RU MEMBER, GO TO |
| BOX_07 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH HP12 |
----------------------------------------------------
HP12 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
(Are/Is) (POLICYHOLDER) currently employed at this job,
retired from this job, previously employed at this job, or is
it some other situation?
CURRENTLY EMPLOYED ..................... 1 {HP13}
RETIRED ................................ 2 {HP13}
PREVIOUSLY EMPLOYED .................... 3 {HP13}
DECEASED ............................... 4 {HP13}
OTHER ................................. 91
REF ................................... -7 {HP13}
DK .................................... -8 {HP13}
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
[Code One]
----------------------------------------------------
| EDIT: CODE ‘4’ (DECEASED) CANNOT BE SELECTED FOR |
| A POLICYHOLDER WHO IS A CURRENT RU MEMBER. |
----------------------------------------------------
----------------------------------------------------
| IF CODED '4' (DECEASED), FLAG POLICYHOLDER AS |
| 'DECEASED'. |
----------------------------------------------------
HP12OV ======
ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
HP13 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
{(Are/Is)/(Were/Was)} (POLICYHOLDER) a federal government
employee at this job?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF FEDERAL GOVERNMENT.
----------------------------------------------------
| DISPLAY '(Are/Is)' IF HP12 IS CODED ‘1’ (CURRENTLY|
| EMPLOYED). OTHERWISE, DISPLAY '(Were/Was)'. |
----------------------------------------------------
BOX_07 ======
----------------------------------------------------
| IF ESTABLISHMENT THAT PROVIDES INSURANCE IS |
| FLAGGED AS: |
| |
| 'EMPLOYER' AND JOB SUBTYPE IS NOT 'CURRENT MAIN', |
| 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE |
| PERIOD', 'RETIREMENT JOB', OR UNION |
| OR |
| 'EMPLOYER' AND JOB SUBTYPE IS 'FORMER MAIN', |
| 'FORMER MISCELLANEOUS' OR 'LAST JOB OUTSIDE |
| REFERENCE PERIOD' AND JOB IS ALSO FLAGGED AS 'NOT |
| RETIRED FROM’ |
| OR |
| ‘PREVIOUS EMPLOYER, NOT COBRA’ (I.E., HX03-CODE |
| ‘8’; HX23-CODE ‘9’) |
| OR |
| ‘EMPLOYER’ (I.E., HX23-CODE ‘11’) AND HP12 IS NOT |
| CODED ‘1’ (CURRENTLY EMPLOYED) |
| OR |
| ‘SPOUSE PREVIOUS EMPLOYER’ (I.E., HX23-CODE ‘10’) |
| OR |
| ‘UNKNOWN TYPE-OUTSIDE RU’ (I.E., HX23-CODE ‘12’) |
| OR |
| ‘UNKNOWN TYPE-COLLECTED AT OTHER’ (I.E., HX23- |
| CODE ‘91’), |
| |
| CONTINUE WITH HP14 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO HP15 |
----------------------------------------------------
----------------------------------------------------
| NOTE: FROM THE TAPES AND OBSERVATIONS, IT BECAME |
| OBVIOUS THAT MANY SOURCES OF INSURANCE WERE BEING |
| SENT THROUGH HP14 WHEN IT WAS INAPPROPRIATE. |
| THEREFORE, BOX_07 HAS BEEN REVISED TO SEND ONLY |
| SOURCES OF INSURANCE IDENTIFIED AS EMPLOYER (BUT |
| NOT CURRENT OR COBRA) OR UNKNOWN THROUGH HP14. |
----------------------------------------------------
HP14 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Some employer insurance can be continued after leaving the
company by continuing to pay the premium. This is sometimes
referred to as a COBRA plan.
{Is/Was} (POLICYHOLDER)’s (ESTABLISHMENT) insurance like that
{on (END DATE)}?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF COBRA.
----------------------------------------------------
| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF |
| ROUND 5. DISPLAY ‘on (END DATE)’ IF ROUND 5. |
| OTHERWISE, USE NULL DISPLAY. |
----------------------------------------------------
HP15 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Was anyone {living here} covered as a dependent under
(POLICYHOLDER)'s health coverage through (ESTABLISHMENT)
at any time {since (START DATE)/between (START DATE) and
(END DATE)}?
YES .................................... 1
NO ..................................... 2 {HP17}
REF ................................... -7 {HP17}
DK .................................... -8 {HP17}
PRESS F1 FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
| DISPLAY 'living here' IF LOOPING ON CODE ‘12’ |
| (OUTSIDE RU) AT HX23. |
| |
| DISPLAY ‘since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
HP16 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Who is that?
PROBE: Was anyone else covered as a dependent {since
(START DATE)/between (START DATE) and (END DATE)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35]
[2. First Name,[Middle Name],Last Name-35]
[3. First Name,[Middle Name],Last Name-35]
[Code All That Apply]
----------------------------------------------------
| DISPLAY ‘since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS |
| ON THE RU-MEMBERS-ROSTER, EXCLUDING THE NAME OF |
| THE POLICYHOLDER (I.E., PERSON IN THIS |
| ESTABLISHMENT-PERSON-PAIR BEING ASKED ABOUT) FOR |
| THIS INSURANCE. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY 'PERSON NOT LISTED IN RU' AS LAST ENTRY ON|
| THIS ROSTER. |
----------------------------------------------------
----------------------------------------------------
| IF 'PERSON NOT LISTED IN RU' IS SELECTED, FLAG |
| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |
| AS 'COVERING PERSON NOT LISTED IN RU'. |
----------------------------------------------------
----------------------------------------------------
| GO TO BOX_08 |
----------------------------------------------------
HP17 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
{Does/Between (START DATE) and (END DATE), did} (POLICYHOLDER)'s
health coverage through (ESTABLISHMENT) cover as dependents any
persons who do not live here?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
| DISPLAY ‘Does’ IF NOT ROUND 5. DISPLAY ‘Between |
| (START DATE) and (END DATE), did’ IF ROUND 5. |
----------------------------------------------------
----------------------------------------------------
| IF CODED '1' (YES), FLAG INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT |
| LISTED IN RU' IN HP16. |
----------------------------------------------------
BOX_08 ======
----------------------------------------------------
| IF THERE ARE NO POLICYHOLDERS OR DEPENDENTS WHO |
| ARE CURRENT RU MEMBERS, THAT IS, POLICYHOLDER IS A|
| DU MEMBER BUT NOT A CURRENT RU MEMBER, OR IS |
| FLAGGED AS 'NOT LISTED IN DU' OR 'POLICYHOLDER |
| DECEASED' AND INSURANCE ALSO FLAGGED ONLY AS |
| 'COVERING PERSON NOT IN RU', GO TO END_LP02 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH LOOP_03 |
----------------------------------------------------
LOOP_03 =======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |
| PERS-TRPLS-ROSTER, ASK BOX-09-END_LP03 |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_03 COLLECTS TIME PERIOD |
| COVERAGE FOR ALL CURRENT RU MEMBERS COVERED BY THE|
| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR. |
| THIS LOOP CYCLES ON CURRENT RU MEMBERS WHO ARE |
| SELECTED AS DEPENDENTS AT HP16 AND THE RU MEMBER |
| WHO IS FLAGGED AS THE POLICYHOLDER FOR THIS |
| INSURANCE. |
----------------------------------------------------
BOX_09 ======
----------------------------------------------------
| ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION. |
| |
| AT COMPLETION OF TIME PERIOD COVERED DETAIL (HQ) |
| SECTION, CONTINUE WITH END_LP03 |
----------------------------------------------------
END_LP03 ========
----------------------------------------------------
| CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- |
| COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS |
| STATED IN THE LOOP DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |
| END LOOP_03 AND CONTINUE WITH END_LP02 |
----------------------------------------------------
END_LP02 ========
----------------------------------------------------
| CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-|
| PAIRS-ROSTER WHO MEETS THE CONDITIONS STATED IN |
| THE LOOP DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END |
| LOOP_02 AND CONTINUE WITH BOX_10 |
----------------------------------------------------
BOX_10 ======
----------------------------------------------------
| IF LOOPING ON AN ESTABLISHMENT FLAGGED IN |
| EMPLOYMENT AS 'PROVIDES HEALTH INSURANCE' AND NOT |
| FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE-1, GO |
| TO END_LP01 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH HP18 |
----------------------------------------------------
HP18 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
Aside from (POLICYHOLDER)’s (ESTABLISHMENT) insurance, is there
another health insurance plan that anyone in the family obtains
from (a/an) (INSURANCE SOURCE)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
END_LP01 ========
----------------------------------------------------
| IF HP18 IS CODED '1' (YES), CYCLE TO COLLECT NEXT |
| ESTABLISHMENT NAME. |
----------------------------------------------------
----------------------------------------------------
| IF HP18 IS NOT ASKED OR IS CODED '2' (NO), '-7' |
| (REFUSED), OR '-8' (DON'T KNOW) END LOOP_01 AND |
| CONTINUE WITH BOX_11 |
----------------------------------------------------
BOX_11 ======
----------------------------------------------------
| RETURN TO THE HEALTH INSURANCE (HX) SECTION. |
----------------------------------------------------