Old Employment and Private Related Insurance (OE) Section
BOX_01
======
----------------------------------------------------
| IF ONE OR MORE RU MEMBERS STILL HOLD A ‘CURRENT |
| MAIN’ OR ‘CURRENT MISCELLANEOUS’ JOB THIS ROUND |
| THAT WAS REPORTED DURING THE PREVIOUS ROUND AS |
| PROVIDING HEALTH INSURANCE ON THE DATE OF THE |
| PREVIOUS ROUND’S INTERVIEW, THAT IS: |
| |
| IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE |
| RU MEET THE FOLLOWING CONDITIONS: |
| - RJ01 OR RJ06 WAS CODED ‘1’ (YES) DURING THIS |
| ROUND FOR THIS PAIR, AND |
| - PERSON IS A JOBHOLDER AT ESTABLISHMENT, AND |
| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |
| INSURANCE, AND |
| - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING |
| THE PREVIOUS ROUND AS ‘PROVIDES HEALTH |
| INSURANCE’ AND, |
| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT |
| COVERED PERSON ON THE DATE OF THE PREVIOUS |
| ROUND’S INTERVIEW (HQ01 WAS CODED ‘1’ (WHOLE |
| TIME) OR HQ02 WAS CODED ‘1’ (YES) IN THE |
| PREVIOUS ROUND), AND |
| - JOB AT ESTABLISHMENT IS NOT FLAGGED AS ‘SELF- |
| EMPLOYED’ WITH A FIRM-SIZE-1, |
| |
| CONTINUE WITH LOOP_01 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_10 |
----------------------------------------------------
----------------------------------------------------
| NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT |
| IN THE RU ON THE PREVIOUS ROUND’S INTERVIEW DATE, |
| THE FIFTH CONDITION IN THE ABOVE BOX CAN BE MET |
| IF AT LEAST ONE DEPENDENT WAS COVERED BY |
| POLICYHOLDER’S INSURANCE ON THE PREVIOUS ROUND’S |
| INTERVIEW DATE. THE LOOP WILL CYCLE ON THE |
| POLICYHOLDER’S NAME. |
----------------------------------------------------
----------------------------------------------------
| NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE |
| POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, |
| INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT |
| ROUND’S INTERVIEW DATE, BUT WHERE THE |
| ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO |
| ARE STILL RU MEMBERS MAY STILL QUALIFY FOR |
| LOOP_01. |
----------------------------------------------------
LOOP_01
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- |
| PAIRS-ROSTER, ASK OE01 - END_LP01. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: |
| |
| LOOP_01 COLLECTS INFORMATION ABOUT THE |
| CONTINUATION OF INSURANCE COVERAGE THROUGH A |
| ‘CURRENT MAIN’ OR ‘CURRENT MISCELLANEOUS’ JOB THAT|
| WAS COLLECTED IN THE PREVIOUS ROUND. THIS LOOP |
| CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE|
| FOLLOWING CONDITIONS: |
| |
| - RJ01 OR RJ06 WAS CODED ‘1’ (YES) DURING THIS |
| ROUND FOR THIS PAIR, AND |
| - PERSON IS A JOBHOLDER AT ESTABLISHMENT, AND |
| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |
| INSURANCE, AND |
| - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING |
| THE PREVIOUS ROUND AS ‘PROVIDES HEALTH |
| INSURANCE’ AND, |
| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT |
| COVERED PERSON ON THE DATE OF THE PREVIOUS |
| ROUND’S INTERVIEW (HQ01 WAS CODED ‘1’ (WHOLE |
| TIME) OR HQ02 WAS CODED ‘1’ (YES) IN THE |
| PREVIOUS ROUND), AND |
| - JOB AT ESTABLISHMENT IS NOT FLAGGED AS ‘SELF- |
| EMPLOYED’ WITH A FIRM-SIZE-1 |
-----------------------------------------------------
OE01
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
During the last interview, we recorded that someone in the
family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health
insurance. {(Are/Is)/(Were/Was)} (POLICYHOLDER) or anyone in
the family covered by (POLICYHOLDER)’s health insurance through
(ESTABLISHMENT) as of {today,} (END DATE)?
YES ................................... 1 {BOX_02}
NO .................................... 2
REF ................................... -7 {END_LP01}
DK .................................... -8 {END_LP01}
----------------------------------------------------
| DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY |
| ‘(Was/Were)’ IF ROUND 5. |
| |
| DISPLAY ‘today,’ IF NOT ROUND 5. OTHERWISE, USE A|
| NULL DISPLAY. |
----------------------------------------------------
OE02
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
On what date did (POLICYHOLDER)’s health insurance through
(ESTABLISHMENT) end?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| EDIT (FOR ROUND 5 ONLY): COMPLETE DATE ENTERED |
| CANNOT BE AFTER 12/31/2006. IF A DATE AFTER |
| 12/31/2006 IS ENTERED, DISPLAY THE FOLLOWING |
| MESSAGE: ‘DATE CANNOT BE AFTER 12/31/2006. IF |
| INSURANCE ENDED AFTER 12/31/2006, USE CTRL/B TO |
| BACK-UP AND CHANGE RESPONSE TO OE01. |
----------------------------------------------------
----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE02OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_02 |
----------------------------------------------------
OE02OV
======
Can you just tell me if (POLICYHOLDER) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
BOX_02
======
----------------------------------------------------
| IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT |
| THE PREVIOUS ROUND’S INTERVIEW DATE BY THE |
| INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, |
| AUTOMATICALLY CODE OE03 AS ‘1’ (YES) AND GO TO |
| BOX_03 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH OE03 |
----------------------------------------------------
OE03
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
During the last interview, we recorded that (READ NAMES BELOW)
(were/was) covered by (POLICYHOLDER)’s health insurance
through (ESTABLISHMENT).
{Are/Were} they all covered by this health insurance {until
{{OE02 DATE}/it ended}/on (END-DT)}?
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- |
| PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY |
| THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: |
| - PERSON WAS COVERED AT THE PREVIOUS ROUND’S |
| INTERVIEW DATE BY THE INSURANCE FROM THIS |
| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |
| POLICYHOLDER |
| - PERSON IS AN RU MEMBER |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘Are’ IF OE01 IS CODED ‘1’ (YES). |
| DISPLAY ‘Were’ IF OE01 IS CODED ‘2’ (NO) OR IF |
| CURRENT ROUND IS ROUND 5. |
| |
| DISPLAY ‘until {OE02 DATE}’ IF OE01 IS CODED ‘2’ |
| (NO). |
| DISPLAY ‘on (END-DT)’ IF OE01 IS CODED ‘1’ (YES). |
| |
| DISPLAY THE DATE RECORDED AT OE02 FOR ‘OE02 DATE’.|
| IF THE MONTH AND DAY FIELD AT OE02 IS CODED ‘-7’ |
| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|
| FOR ‘OE02 DATE’. |
----------------------------------------------------
BOX_03
======
----------------------------------------------------
| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |
| TO THE END DATE OF THE CURRENT ROUND, THAT IS: |
| |
| IF OE01 IS CODED ‘1’ (YES) AND OE03 IS CODED ‘1’ |
| (YES), |
| |
| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |
| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|
| THE REFERENCE PERIOD END DATE AND |
| |
| GO TO BOX_05 |
----------------------------------------------------
----------------------------------------------------
| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |
| TO PART OF THE CURRENT ROUND, THAT IS: |
| |
| IF OE01 IS CODED ‘2’ (NO) AND OE03 IS CODED ‘1’ |
| (YES), |
| |
| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |
| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|
| THE DATE RECORDED AT OE02 AND |
| |
| GO TO BOX_05 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE (I.E., OE03 CODED ‘2’ (NO), ‘-7’ |
| (REFUSED), OR ‘-8’ (DON’T KNOW)), |
| CONTINUE WITH OE04 |
----------------------------------------------------
OE04
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Who {is/was} no longer covered by (POLICYHOLDER)’s health
insurance through (ESTABLISHMENT) {until {{OE02 DATE}/it ended}/on
(END-DT)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- |
| PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY |
| THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: |
| - PERSON WAS COVERED AT THE PREVIOUS ROUND’S |
| INTERVIEW DATE BY THE INSURANCE FROM THIS |
| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |
| POLICYHOLDER |
| - PERSON IS AN RU MEMBER |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘is’ IF OE01 IS CODED ‘1’ (YES). |
| DISPLAY ‘was’ IF OE01 IS CODED ‘2’ (NO) OR IF |
| CURRENT ROUND IS ROUND 5. |
| |
| DISPLAY ‘until {OE02 DATE}’ IF OE01 IS CODED ‘2’ |
| (NO). |
| DISPLAY ‘on (END-DT)’ IF OE01 IS CODED ‘1’ (YES). |
| |
| DISPLAY THE DATE RECORDED AT OE02 FOR ‘OE02 DATE’.|
| IF THE MONTH AND DAY FIELD AT OE02 IS CODED ‘-7’ |
| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|
| FOR ‘OE02 DATE’. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY STILL HAS INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED ‘1’ |
| (YES)), FLAG INSURANCE FOR ALL PERSONS NOT |
| SELECTED AT OE04 AS CONTINUOUS COVERAGE FROM THE |
| REFERENCE PERIOD START DATE UNTIL THE REFERENCE |
| PERIOD END DATE. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |
| THIS ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED ‘2’ |
| (NO), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED |
| AT OE04 AS ‘CONTINUOUS COVERAGE’ FROM THE |
| REFERENCE PERIOD START DATE UNTIL DATE RECORDED |
| AT OE02. |
----------------------------------------------------
LOOP_02
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |
| PERS-TRPLS-ROSTER, ASK OE05 - END_LP02. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_02 COLLECTS THE DATE ON |
| WHICH THE INSURANCE COVERAGE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER|
| WHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCE|
| PERIOD END DATE OR THE DATE REPORTED IN OE02. |
| THIS LOOP CYCLES ON PERSONS SELECTED AT OE04. |
----------------------------------------------------
OE05
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
On what date did the health insurance through (ESTABLISHMENT)
end for (PERSON)?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE05OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_04 |
----------------------------------------------------
OE05OV
======
Can you just tell me if (PERSON) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
BOX_04
======
----------------------------------------------------
| FLAG INSURANCE FOR PERSON AS ‘CONTINUOUS COVERAGE’|
| THROUGH THE COMPLETE DATE RECORDED AT OE05 AND |
| OE05OV. |
----------------------------------------------------
END_LP02
========
----------------------------------------------------
| 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_02 AND CONTINUE WITH BOX_05 |
----------------------------------------------------
BOX_05
======
----------------------------------------------------
| IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY |
| THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,|
| (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU |
| MEMBERS NOT COVERED BY THIS INSURANCE ON THE |
| PREVIOUS ROUND’S INTERVIEW DATE, BUT EXCLUDES RU |
| MEMBERS JUST MARKED AS NO LONGER COVERED IN OE04),|
| CONTINUE WITH OE06 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE08A |
----------------------------------------------------
OE06
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, have
any persons living here, we have not yet mentioned, been covered
by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?
YES ................................... 1
NO .................................... 2 {OE08A}
REF ................................... -7 {OE08A}
DK .................................... -8 {OE08A}
PRESS F1 FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
OE07
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Who {has been/was} covered by (POLICYHOLDER)’s health insurance
through (ESTABLISHMENT) {since (START DATE)/between (START DATE)
and (END DATE)} that we have not yet mentioned?
PROBE: Who else {has been/was} covered by (POLICYHOLDER)’s health
insurance through (ESTABLISHMENT) {since (START DATE)/between
(START DATE) and (END DATE)} that we have not yet mentioned?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS|
| ON THE RU-MEMBERS-ROSTER WHO WERE NOT COVERED BY |
| THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- |
| PAIR ON THE PREVIOUS ROUND’S INTERVIEW DATE. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY ON|
| THIS ROSTER. |
----------------------------------------------------
----------------------------------------------------
| WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- |
| COVRD-PERS-TRPLS-ROSTER. |
----------------------------------------------------
----------------------------------------------------
| IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG |
| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |
| AS ‘COVERING PERSON NOT LISTED IN RU’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT|
| ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) |
| and (END DATE)’ IF ROUND 5. |
----------------------------------------------------
LOOP_03
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |
| PERS-TRPLS-ROSTER, ASK OE08 - END_LP03. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_03 COLLECTS THE COVERAGE |
| START DATE FOR ALL PERSONS NEWLY COVERED DURING |
| THE CURRENT ROUND BY THE INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON |
| PERSONS SELECTED AT OE07. |
----------------------------------------------------
OE08
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
On what date did the health insurance through (ESTABLISHMENT)
begin for (PERSON)?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE08OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_06 |
----------------------------------------------------
OE08OV
======
Can you just tell me if (PERSON) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
| EDIT: COMPLETE DATE AT OE08 MUST BE < THAN |
| COMPLETE DATE AT OE02 IF A DATE IS RECORDED AT |
| OE02 OR < THAN REFERENCE PERIOD END DATE IF NO |
| DATE IS RECORDED AT OE02. |
----------------------------------------------------
BOX_06
======
----------------------------------------------------
| IF FAMILY STILL HAS INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED ‘1’ |
| (YES)), FLAG INSURANCE FOR THIS PERSON AS |
| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE08 |
| UNTIL THE REFERENCE PERIOD END DATE. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |
| ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED ‘2’ (NO))|
| FLAG INSURANCE FOR THIS PERSON AS ‘CONTINUOUS |
| COVERAGE’ FROM DATE RECORDED AT OE08 UNTIL DATE |
| RECORDED AT OE02. |
----------------------------------------------------
END_LP03
========
----------------------------------------------------
| CYCLE ON NEXT PERSON IN 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 GO TO BOX_07 |
----------------------------------------------------
OE08A
=====
{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 OE07 |
----------------------------------------------------
BOX_07
======
----------------------------------------------------
| IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THE|
| INSURANCE THROUGH THE ESTABLISHMENT-PERSON-PAIR |
| ON THE CURRENT ROUND’S INTERVIEW DATE, THAT IS, |
| OE01 IS CODED ‘1’ (YES), CONTINUE WITH BOX_07A |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO END_LP01 |
----------------------------------------------------
BOX_07A
=======
----------------------------------------------------
| IF ROUND 3, CONTINUE WITH OE09A |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE09 |
----------------------------------------------------
OE09A
=====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
For the coverage through (ESTABLISHMENT), does anyone in the
family pay all of the premium or cost, some of the premium or
cost, or none of the premium or cost?
[Do not include the cost of any copayments, coinsurance or
deductibles anyone in the family may have had to pay.]
[Do include any contribution made to the plan as part of a
paycheck.]
YES, PAY ALL OF PREMIUM/COST ........... 1
YES, PAY SOME OF PREMIUM/COST .......... 2
YES, BUT DON’T KNOW IF PAY ALL OR SOME
OF PREMIUM/COST ........................ 3
NO, DO NOT PAY ......................... 4 {OE09AAA}
REF ................................... -7 {OE09}
DK .................................... -8 {OE09}
[Code One]
PRESS F1 FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |
| DISPLAYED HERE FOR THE INSURANCE FROM A |
| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |
| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |
| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |
| DIRECTLY PURCHASED CATEGORY. |
----------------------------------------------------
OE09AA
======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
How much (do/does) (POLICYHOLDER) pay for the (ESTABLISHMENT)
coverage?
PROBE: Is that per year, per month, per week, or what?
[Enter Amount in Dollars] ..............
REF ................................... -7 {BOX_08A}
DK .................................... -8 {BOX_08A}
----------------------------------------------------
| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |
| DISPLAYED HERE FOR THE INSURANCE FROM A |
| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |
| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |
| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |
| DIRECTLY PURCHASED CATEGORY. |
----------------------------------------------------
OE09AAOV1
=========
ENTER UNIT OF COVERAGE:
PER YEAR ............................... 1 {BOX_08A}
QUARTERLY/EVERY 3 MONTHS ............... 2 {BOX_08A}
BIMONTHLY/EVERY 2 MONTHS ............... 3 {BOX_08A}
PER MONTH .............................. 4 {BOX_08A}
PER WEEK ............................... 5 {BOX_08A}
BIWEEKLY/EVERY 2 WEEKS ................. 6 {BOX_08A}
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 {BOX_08A}
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 {BOX_08A}
OTHER ................................. 91
REF ................................... -7 {BOX_08A}
DK .................................... -8 {BOX_08A}
[Code One]
OE09AAOV2
=========
ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
BOX_08A
=======
-----------------------------------------------------
| IF OE09A IS CODED ‘1’ (YES, PAY ALL OF PREMIUM/ |
| COST), GO TO OE09 |
-----------------------------------------------------
-----------------------------------------------------
| OTHERWISE, CONTINUE WITH OE09AAA |
-----------------------------------------------------
OE09AAA
=======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
Who {else} pays {some of/for} the premium or cost
of this insurance?
FEDERAL GOVERNMENT .................... 1
STATE GOVERNMENT ...................... 2
LOCAL GOVERNMENT ...................... 3
SOME GOVERNMENT ....................... 4
EMPLOYER .............................. 5
UNION ................................. 6
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
----------------------------------------------------
| DISPLAY ‘else’ IF OE09A IS CODED ‘2’ (YES, PAY |
| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |
| IF PAY ALL OR SOME OF PREMIUM/COST). OTHERWISE, |
| USE A NULL DISPLAY |
| |
| DISPLAY ‘some of’ IF OE09A IS CODED ‘2’ (YES, PAY |
| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |
| IF PAY ALL OR SOME OF PREMIUM/COST). DISPLAY ‘for’|
| IF OE09A IS CODED ‘4’ (NO, DO NOT PAY). |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |
| WITH ANY OTHER CODE, CONTINUE WITH OE09AAAOV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE09 |
----------------------------------------------------
OE09AAAOV
=========
ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
OE09
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
{Last time we recorded that (POLICYHOLDER) (were/was) covered
by (READ INSURER NAME(S) BELOW).}
{Since (START DATE), has there been/Between (START DATE) and
(END DATE), was there} any change in the plan name of the health
insurance (POLICYHOLDER) {has/had} through (ESTABLISHMENT)?
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
YES ................................... 1
NO .................................... 2 {END_LP01}
REF ................................... -7 {END_LP01}
DK .................................... -8 {END_LP01}
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL |
| INSURERS IN THE RU-ESTB-PERSON-INSURER-TRIPLES- |
| ROSTER THAT ARE FLAGGED AS ‘SUPPLYING HOSPITAL AND|
| PHYSICIAN BENEFITS’ AND/OR ‘SUPPLYING MEDICARE |
| SUPPLEMENT/MEDIGAP BENEFITS’ AND ARE ASSOCIATED |
| WITH THE INSURANCE THROUGH THIS ESTABLISHMENT- |
| PERSON-PAIR. |
-----------------------------------------------------
-----------------------------------------------------
| DISPLAY FIRST PARAGRAPH AND THE ROSTER OF INSURER |
| NAMES IF THE INSURANCE THROUGH THIS ESTABLISHMENT- |
| PERSON-PAIR HAD ANY INSURERS FLAGGED AS PROVIDING |
| MEDIGAP OR HOSPITAL/PHYSICIAN BENEFITS AT ANY TIME |
| DURING THE PREVIOUS ROUND. |
-----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘Since (START DATE), has there been’ AND |
| ‘has’ IF NOT ROUND 5. DISPLAY ‘Between (START |
| DATE) and (END DATE), was there’ AND ‘had’ IF |
| ROUND 5. |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), FLAG PREVIOUS ROUND’S INSURER AS CURRENT |
| ROUND’S INSURER FOR THIS ESTABLISHMENT-PERSON- |
| PAIR. |
----------------------------------------------------
OE10
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
SHOW CARD OE-1.
What type of health insurance {(do/does)/did} (POLICYHOLDER)
{now} have through (ESTABLISHMENT)’s new plan {on (END DATE)}?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS,
INCLUDING COVERAGE THROUGH AN HMO ... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER’S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.]
----------------------------------------------------
| DISPLAY ‘(do/does)’ IF NOT ROUND 5. DISPLAY ‘did’|
| IF ROUND 5. |
| |
| DISPLAY ‘now’ IF NOT ROUND 5. OTHERWISE, USE A |
| NULL DISPLAY. |
| |
| DISPLAY ‘on (END DATE)’ IF ROUND 5. OTHERWISE, |
| USE A NULL DISPLAY. |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |
| WITH ANY OTHER CODES, CONTINUE WITH OE10OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_08 |
----------------------------------------------------
OE10OV
======
ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
BOX_08
======
----------------------------------------------------
| IF OE10 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |
| BENEFITS) OR ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), |
| ALONE OR WITH ANY OTHER COMBINATION OF CODES, |
| CONTINUE WITH OE11 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO END_LP01 |
----------------------------------------------------
----------------------------------------------------
| NOTE: ALL ESTABLISHMENTS WHICH ARE BEING LOOPED |
| ON HERE ARE EMPLOYERS. THEREFORE, IT IS NOT |
| NECESSARY TO AUTOMATICALLY CODE OE11 IF THE |
| ESTABLISHMENT IS AN INSURANCE CO. OR HMO (BECAUSE |
| WE KNOW IT IS NOT). |
----------------------------------------------------
OE11
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
What is the new plan name for (POLICYHOLDER)’s health
insurance through (ESTABLISHMENT) which provides the {hospital
and physician benefits/Medicare Supplement or Medigap benefit}?
IF MORE THAN ONE NAME, PROBE: What is the main new plan name?
RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE {HOSPITAL
AND PHYSICIAN/MEDIGAP} BENEFITS FOR THIS PAIR.
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, CODE 2 (HMO).
NAME OF INSURER: [Enter Insurer] TYPE: 1 = INSURANCE COMPANY
2 = HMO
3 = COMPANY IS SELF-INSURED
PRESS F1 FOR DEFINITION OF INSURANCE CO/HMO/SELF-INSURED CO.
-----------------------------------------------------
| DISPLAY ‘hospital and physician benefits’ AND |
| ‘HOSPITAL’ IF OE10 IS CODED ‘1’ (HOSPITAL AND |
| PHYSICIAN BENEFITS), BUT NOT CODED ‘5’ (MEDICARE |
| SUPPLEMENT/MEDIGAP). DISPLAY ‘Medicare supplement |
| or Medigap benefits’ AND ‘MEDIGAP’ IF OE10 IS CODED|
| ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP). |
-----------------------------------------------------
-----------------------------------------------------
| WRITE INSURER(S) TO THE RU-ESTAB-PERSON-INSURER- |
| TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR. |
-----------------------------------------------------
----------------------------------------------------
| FLAG INSURER(S) COLLECTED AT OE11 AS CURRENT |
| ROUND’S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- |
| PAIR. |
----------------------------------------------------
-----------------------------------------------------
| IF OE10 IS CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP) |
| FLAG INSURANCE CO./HMO AS ‘SUPPLYING MEDICARE |
| SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES |
| HOSPITAL/PHYSICIAN BENEFITS)’ FOR THE CURRENT |
| ROUND. |
-----------------------------------------------------
----------------------------------------------------
| IF OE10 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |
| BENEFITS), BUT NOT ‘5’ (MEDICARE SUPPLEMENT/ |
| MEDIGAP), FLAG INSURANCE CO./HMO AS ‘SUPPLYING |
| HOSPITAL/PHYSICIAN BENEFITS’ FOR THE CURRENT |
| ROUND. |
----------------------------------------------------
LOOP_04
=======
----------------------------------------------------
| FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- |
| TRIPLES-ROSTER, ASK OE11A - END_LP04. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_04 COLLECTS OTHER POLICY |
| NAMES AND MANAGED CARE INFORMATION FOR INSURERS |
| COLLECTED AT OE11. THIS LOOP CYCLES ON TRIPLES |
| THAT MEET THE FOLLOWING CONDITIONS: |
| |
| - ESTABLISHMENT-PERSON-PAIR PROVIDES THE INSURANCE|
| BEING ASKED ABOUT |
| - INSURER IS ENTERED AT OE11 |
----------------------------------------------------
OE11A
=====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
Is there any other name for the {INSURANCE COMPANY OR HMO
NAME} policy, such as Option A, $100 Deductible Plan, 90/80
Plan, Gold Plan, or High Option Plan?
YES, ANOTHER NAME ...................... 1
NO OTHER NAME .......................... 2 {BOX_09A}
REF ................................... -7 {BOX_09A}
DK .................................... -8 {BOX_09A}
PRESS F1 FOR DEFINITION OF LOW OPTION/HIGH OPTION.
[Code One]
----------------------------------------------------
| DISPLAY THE NAME OF THE INSURANCE CO/HMO |
| RECORDED IN OE11_01 WHICH IS BEING LOOPED ON |
| FOR ‘INSURANCE...NAME.’ |
----------------------------------------------------
OE11AOV
=======
ENTER OTHER NAME:
[Enter Policy Name] ....................
REF ................................... -7
DK .................................... -8
BOX_09A
=======
----------------------------------------------------
| IF INSURER BEING LOOPED ON IS CODED ‘2’ (HMO) IN |
| OE11_02, CONTINUE WITH OE11B |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_09 |
----------------------------------------------------
OE11B
=====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
Will (POLICYHOLDER)’s plan pay for any of the costs of
visits to doctors who are not part of (POLICYHOLDER)’s
HMO, even if (POLICYHOLDER) (do/does) not have a referral?
YES .................................... 1 {END_LP04}
NO ..................................... 2 {END_LP04}
REF ................................... -7 {END_LP04}
DK .................................... -8 {END_LP04}
BOX_09
======
----------------------------------------------------
| ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER|
| |
| AT COMPLETION OF MANAGED CARE (MC) SECTION, |
| CONTINUE WITH END_LP04 |
----------------------------------------------------
END_LP04
========
----------------------------------------------------
| CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- |
| INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS |
| STATED IN THE LOOP DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER INSURERS MEET THE STATED CONDITIONS, |
| END LOOP_04 AND CONTINUE WITH END_LP01 |
----------------------------------------------------
END_LP01
========
----------------------------------------------------
| CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-|
| PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN |
| THE LOOP DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END |
| LOOP_01 AND CONTINUE WITH BOX_10 |
----------------------------------------------------
BOX_10
======
----------------------------------------------------
| IF ONE OR MORE RU MEMBERS DOES NOT STILL HOLD A |
| ‘CURRENT MAIN’ OR ‘CURRENT MISCELLANEOUS’ JOB THIS|
| ROUND THAT WAS REPORTED DURING THE PREVIOUS ROUND |
| AS PROVIDING HEALTH INSURANCE ON THE DATE OF THE |
| PREVIOUS ROUND’S INTERVIEW, THAT IS: |
| |
| IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE |
| RU MEET THE FOLLOWING CONDITIONS: |
| - RJ01 OR RJ06 WAS CODED ‘2’ (NO), ‘-7’ (REFUSED),|
| ‘-8’ (DON’T KNOW) DURING THIS ROUND FOR THIS |
| PAIR, AND |
| - PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND |
| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |
| INSURANCE, AND |
| - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING |
| THE PREVIOUS ROUND AS ‘PROVIDES HEALTH |
| INSURANCE’ AND, |
| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT |
| COVERED PERSON ON THE DATE OF THE PREVIOUS |
| ROUND’S INTERVIEW (HQ01 WAS CODED ‘1’ (WHOLE |
| TIME) OR HQ02 WAS CODED ‘1’ (YES) IN THE |
| PREVIOUS ROUND), AND |
| - JOB AT ESTABLISHMENT IS NOT FLAGGED AS ‘SELF- |
| EMPLOYED’ WITH A FIRM-SIZE-1, |
| |
| CONTINUE WITH LOOP_05 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_19 |
----------------------------------------------------
----------------------------------------------------
| NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT |
| IN THE RU ON THE PREVIOUS ROUND’S INTERVIEW DATE, |
| THE FIFTH CONDITION IN THE ABOVE BOX CAN BE MET |
| IF AT LEAST ONE DEPENDENT WAS COVERED BY |
| POLICYHOLDER’S INSURANCE ON THE PREVIOUS ROUND’S |
| INTERVIEW DATE. COVERAGE FOR THE POLICYHOLDER IS |
| ASSUMED IN THAT CASE AND THE LOOP WILL CYCLE ON |
| THE POLICYHOLDER’S NAME. |
----------------------------------------------------
----------------------------------------------------
| NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE |
| POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, |
| INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT |
| ROUND’S INTERVIEW DATE, BUT WHERE THE |
| ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO |
| ARE STILL RU MEMBERS MAY STILL QUALIFY FOR |
| LOOP_05. |
----------------------------------------------------
LOOP_05
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- |
| PAIRS-ROSTER, ASK OE12-END_LP05. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: |
| |
| LOOP_05 COLLECTS INFORMATION ABOUT THE |
| CONTINUATION OF INSURANCE COVERAGE THROUGH A |
| NO LONGER HELD ‘CURRENT MAIN’ OR ‘CURRENT |
| MISCELLANEOUS’ JOB THAT WAS COLLECTED IN THE |
| PREVIOUS ROUND. THIS LOOP CYCLES ON |
| ESTABLISHMENT-PERSON-PAIRS THAT MEET THE |
| FOLLOWING CONDITIONS: |
| |
| - RJ01 OR RJ06 WAS CODED ‘2’ (NO), ‘-7’ (REFUSED),|
| ‘-8’ (DON’T KNOW) DURING THIS ROUND FOR THIS |
| PAIR, AND |
| - PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND |
| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |
| INSURANCE, AND |
| - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING |
| THE PREVIOUS ROUND AS ‘PROVIDES HEALTH |
| INSURANCE’ AND, |
| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT |
| COVERED PERSON ON THE DATE OF THE PREVIOUS |
| ROUND’S INTERVIEW (HQ01 WAS CODED ‘1’ (WHOLE |
| TIME) OR HQ02 WAS CODED ‘1’ (YES) IN THE |
| PREVIOUS ROUND), AND |
| - JOB AT ESTABLISHMENT IS NOT FLAGGED AS ‘SELF- |
| EMPLOYED’ WITH A FIRM-SIZE-1. |
-----------------------------------------------------
OE12
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
During the last interview, we recorded that someone in the
family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health
insurance. {(Are/Is)/(Were/Was)} (POLICYHOLDER) or anyone in
the family covered by (POLICYHOLDER)’s health insurance through
(ESTABLISHMENT) as of {today,} (END DATE)?
YES ................................... 1 {OE16}
NO .................................... 2
REF ................................... -7 {END_LP05}
DK .................................... -8 {END_LP05}
----------------------------------------------------
| DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY |
| ‘(Was/Were)’ IF ROUND 5. |
| |
| DISPLAY ‘today,’ IF NOT ROUND 5. OTHERWISE, USE A|
| NULL DISPLAY. |
----------------------------------------------------
OE13
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Did the health insurance (POLICYHOLDER) had through
(ESTABLISHMENT) continue for any period of time after
(POLICYHOLDER) stopped working at (ESTABLISHMENT)?
YES ................................... 1
NO .................................... 2 {OE15}
REF ................................... -7 {OE15}
DK .................................... -8 {OE15}
OE14
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Did that health insurance continue through COBRA?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF COBRA.
OE15
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
On what date did (POLICYHOLDER)’s health insurance through
(ESTABLISHMENT) end?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| EDIT (FOR ROUND 5 ONLY): COMPLETE DATE ENTERED |
| CANNOT BE AFTER 12/31/2006. IF A DATE AFTER |
| 12/31/2006 IS ENTERED, DISPLAY THE FOLLOWING |
| MESSAGE: ‘DATE CANNOT BE AFTER 12/31/2006. IF |
| INSURANCE ENDED AFTER 12/31/2006, USE CTRL/B TO |
| BACK-UP AND CHANGE RESPONSE TO OE12. |
----------------------------------------------------
----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE15OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_11 |
----------------------------------------------------
OE15OV
======
Can you just tell me if (POLICYHOLDER) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 {BOX_11}
PART OF THE MONTH ..................... 2 {BOX_11}
REF ................................... -7 {BOX_11}
DK .................................... -8 {BOX_11}
[Code One]
OE16
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Is (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)
now extended through COBRA?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF COBRA.
BOX_11
======
----------------------------------------------------
| IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT |
| THE PREVIOUS ROUND’S INTERVIEW DATE BY THE |
| INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, |
| AUTOMATICALLY CODE OE17 AS ‘1’ (YES) AND GO TO |
| BOX_12 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH OE17 |
----------------------------------------------------
OE17
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
During the last interview, we recorded that (READ NAMES BELOW)
(were/was) covered by (POLICYHOLDER)’s health insurance
through (ESTABLISHMENT).
{Are/Were} they all covered by this health insurance {until
{{OE15 DATE}/it ended}/on (END-DT)}?
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- |
| PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY |
| THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: |
| - PERSON WAS COVERED AT THE PREVIOUS ROUND’S |
| INTERVIEW DATE BY THE INSURANCE FROM THIS |
| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |
| POLICYHOLDER |
| - PERSON IS AN RU MEMBER |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘Are’ IF OE12 IS CODED ‘1’ (YES). |
| DISPLAY ‘Were’ IF OE12 IS CODED ‘2’ (NO) OR IF |
| CURRENT ROUND IS ROUND 5. |
| |
| DISPLAY ‘until {OE15 DATE}’ IF OE12 IS CODED ‘2’ |
| (NO). DISPLAY ‘on (END-DT)’ IF OE12 IS CODED ‘1’ |
| (YES). |
| |
| DISPLAY THE DATE RECORDED AT OE15 FOR ‘OE15 DATE’.|
| IF THE MONTH AND DAY FIELD AT OE15 IS CODED ‘-7’ |
| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|
| FOR ‘OE15 DATE’. |
----------------------------------------------------
BOX_12
======
----------------------------------------------------
| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |
| TO THE END DATE OF THE CURRENT ROUND, THAT IS: |
| |
| IF OE12 IS CODED ‘1’ (YES) AND OE17 IS CODED ‘1’ |
| (YES), |
| |
| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |
| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|
| THE REFERENCE PERIOD END DATE AND |
| |
| GO TO BOX_14 |
----------------------------------------------------
----------------------------------------------------
| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |
| TO PART OF THE CURRENT ROUND, THAT IS: |
| |
| IF OE12 IS CODED ‘2’ (NO) AND OE17 IS CODED ‘1’ |
| (YES), |
| |
| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |
| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|
| THE DATE RECORDED AT OE15 AND |
| |
| GO TO BOX_14 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE (I.E., OE17 CODED ‘2’ (NO), ‘-7’ |
| (REFUSED), OR ‘-8’ (DON’T KNOW)), CONTINUE WITH |
| OE18 |
----------------------------------------------------
OE18
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Who {is/was} no longer covered by (POLICYHOLDER)’s health
insurance through (ESTABLISHMENT) {until {{OE15 DATE}/it ended}/
on (END-DT)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- |
| PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY |
| THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: |
| - PERSON WAS COVERED AT THE PREVIOUS ROUND’S |
| INTERVIEW DATE BY THE INSURANCE FROM THIS |
| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |
| POLICYHOLDER |
| - PERSON IS AN RU MEMBER |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘is’ IF OE12 IS CODED ‘1’ (YES). |
| DISPLAY ‘was’ IF OE12 IS CODED ‘2’ (NO) OR IF |
| CURRENT ROUND IS ROUND 5. |
| |
| DISPLAY ‘until {OE15 DATE}’ IF OE12 IS CODED ‘2’ |
| (NO). DISPLAY ‘on (END-DT)’ IF OE12 IS CODED ‘1’ |
| (YES). |
| |
| DISPLAY THE DATE RECORDED AT OE15 FOR ‘OE15 DATE’.|
| IF THE MONTH AND DAY FIELD AT OE15 IS CODED ‘-7’ |
| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|
| FOR ‘OE15 DATE’. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY STILL HAS INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED ‘1’ |
| (YES)), FLAG INSURANCE FOR ALL PERSONS NOT |
| SELECTED AT OE18 AS ‘CONTINUOUS COVERAGE’ FROM THE|
| REFERENCE PERIOD START DATE UNTIL THE REFERENCE |
| PERIOD END DATE. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |
| THIS ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED ‘2’,|
| (NO)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED|
| AT OE18 AS CONTINUOUS COVERAGE FROM THE REFERENCE |
| PERIOD START DATE UNTIL DATE RECORDED AT OE15. |
----------------------------------------------------
LOOP_06
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |
| PERS-TRPLS-ROSTER, ASK OE19 - END_LP06. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_06 COLLECTS THE DATE ON |
| WHICH THE INSURANCE COVERAGE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER|
| WHOSE COVERAGE ENDED PRIOR TO THE REFERENCE PERIOD|
| END DATE OR THE DATE REPORTED IN OE15. THIS LOOP |
| CYCLES ON PERSONS SELECTED AT OE18. |
----------------------------------------------------
OE19
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
On what date did the health insurance through (ESTABLISHMENT)
end for (PERSON)?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE19OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_13 |
----------------------------------------------------
OE19OV
======
Can you just tell me if (PERSON) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
BOX_13
======
----------------------------------------------------
| FLAG INSURANCE FOR PERSON AS ‘CONTINUOUS COVERAGE’|
| THROUGH THE COMPLETE DATE RECORDED AT OE19 AND |
| OE19OV. |
----------------------------------------------------
END_LP06
========
----------------------------------------------------
| 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_06 AND CONTINUE WITH BOX_14 |
----------------------------------------------------
BOX_14
======
----------------------------------------------------
| IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY |
| THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,|
| (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU |
| MEMBERS NOT COVERED BY THIS INSURANCE ON THE |
| PREVIOUS ROUND’S INTERVIEW DATE, EXCLUDES RU |
| MEMBERS JUST MARKED AS NO LONGER COVERED IN OE18),|
| CONTINUE WITH OE20 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE22A |
----------------------------------------------------
OE20
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, have
any persons living here, that we have not yet mentioned, been
covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?
YES ................................... 1
NO .................................... 2 {OE22A}
REF ................................... -7 {OE22A}
DK .................................... -8 {OE22A}
PRESS F1 FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
OE21
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Who {has been/was} covered by (POLICYHOLDER)’s health insurance
through (ESTABLISHMENT) {since (START DATE)/between (START DATE)
and (END DATE)} that we have not yet mentioned?
PROBE: Who else {has been/was} covered by (POLICYHOLDER)’s health
insurance through (ESTABLISHMENT) {since (START DATE)/between
(START DATE) and (END DATE)} that we have not yet mentioned?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS|
| ON THE RU-MEMBERS-ROSTER WHO WERE NOT COVERED BY |
| THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- |
| PAIR ON THE PREVIOUS ROUND’S INTERVIEW DATE. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY ON|
| THIS ROSTER. |
----------------------------------------------------
----------------------------------------------------
| WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- |
| COVRD-PERS-TRPLS-ROSTER. |
----------------------------------------------------
----------------------------------------------------
| IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG |
| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |
| AS ‘COVERING PERSON NOT LISTED IN RU’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT|
| ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) |
| and (END DATE)’ IF ROUND 5. |
----------------------------------------------------
LOOP_07
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |
| PERS-TRPLS-ROSTER, ASK OE22 - END_LP07. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_07 COLLECTS THE COVERAGE |
| START DATE FOR ALL PERSONS NEWLY COVERED DURING |
| THE CURRENT ROUND BY THE INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON |
| PERSONS SELECTED AT OE21. |
----------------------------------------------------
OE22
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
On what date did the health insurance through (ESTABLISHMENT)
begin for (PERSON)?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE22OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_15 |
----------------------------------------------------
OE22OV
======
Can you just tell me if (PERSON) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
| EDIT: COMPLETE DATE AT OE22 MUST BE < THAN |
| COMPLETE DATE AT OE15 IF A DATE IS RECORDED AT |
| OE15 OR < THAN REFERENCE PERIOD END DATE IF NO |
| DATE IS RECORDED AT OE15. |
----------------------------------------------------
BOX_15
======
----------------------------------------------------
| IF FAMILY STILL HAS INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED ‘1’ |
| (YES)), FLAG INSURANCE FOR THIS PERSON AS |
| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE22 |
| UNTIL THE REFERENCE PERIOD END DATE. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |
| THIS ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED ‘2’ |
| (NO)), FLAG INSURANCE FOR THIS PERSON AS |
| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE22 |
| UNTIL DATE RECORDED AT OE15. |
----------------------------------------------------
END_LP07
========
----------------------------------------------------
| 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_07 AND GO TO BOX_16 |
----------------------------------------------------
OE22A
=====
{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 OE21 |
----------------------------------------------------
BOX_16
======
----------------------------------------------------
| IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THE|
| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |
| ON THE CURRENT ROUND’S INTERVIEW DATE, THAT IS, |
| OE12 IS CODED ‘1’(YES), CONTINUE WITH BOX_16A |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO END_LP05 |
----------------------------------------------------
BOX_16A
=======
----------------------------------------------------
| IF ROUND 3, CONTINUE WITH OE23A |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE23 |
----------------------------------------------------
OE23A
=====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
For the coverage through (ESTABLISHMENT), does anyone in the
family pay all of the premium or cost, some of the premium or
cost, or none of the premium or cost?
[Do not include the cost of any copayments, coinsurance or
deductibles anyone in the family may have had to pay.]
[Do include any contribution made to the plan as part of a
paycheck.]
YES, PAY ALL OF PREMIUM/COST ........... 1
YES, PAY SOME OF PREMIUM/COST .......... 2
YES, BUT DON’T KNOW IF PAY ALL OR SOME
OF PREMIUM/COST ........................ 3
NO, DO NOT PAY ......................... 4 {OE23AAA}
REF ................................... -7 {OE23}
DK .................................... -8 {OE23}
[Code One]
PRESS F1 FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |
| DISPLAYED HERE FOR THE INSURANCE FROM A |
| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |
| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |
| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |
| DIRECTLY PURCHASED CATEGORY. |
----------------------------------------------------
OE23AA
======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
How much (do/does) (POLICYHOLDER) pay for the (ESTABLISHMENT)
coverage?
PROBE: Is that per year, per month, per week, or what?
[Enter Amount in Dollars] ..............
REF ................................... -7 {BOX_17A}
DK .................................... -8 {BOX_17A}
----------------------------------------------------
| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |
| DISPLAYED HERE FOR THE INSURANCE FROM A |
| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |
| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |
| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |
| DIRECTLY PURCHASED CATEGORY. |
----------------------------------------------------
OE23AAOV1
=========
ENTER UNIT OF COVERAGE:
PER YEAR ............................... 1 {BOX_17A}
QUARTERLY/EVERY 3 MONTHS ............... 2 {BOX_17A}
BIMONTHLY/EVERY 2 MONTHS ............... 3 {BOX_17A}
PER MONTH .............................. 4 {BOX_17A}
PER WEEK ............................... 5 {BOX_17A}
BIWEEKLY/EVERY 2 WEEKS ................. 6 {BOX_17A}
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 {BOX_17A}
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 {BOX_17A}
OTHER ................................. 91
REF ................................... -7 {BOX_17A}
DK .................................... -8 {BOX_17A}
[Code One]
OE23AAOV2
=========
ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
BOX_17A
=======
-----------------------------------------------------
| IF OE23A IS CODED ‘1’ (YES, PAY ALL OF PREMIUM/ |
| COST), GO TO OE23 |
-----------------------------------------------------
-----------------------------------------------------
| OTHERWISE, CONTINUE WITH OE23AAA |
-----------------------------------------------------
OE23AAA
=======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
Who {else} pays {some of/for} the premium or cost
of this insurance?
FEDERAL GOVERNMENT .................... 1
STATE GOVERNMENT ...................... 2
LOCAL GOVERNMENT ...................... 3
SOME GOVERNMENT ....................... 4
EMPLOYER .............................. 5
UNION ................................. 6
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
----------------------------------------------------
| DISPLAY ‘else’ IF OE23A IS CODED ‘2’ (YES, PAY |
| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |
| IF PAY ALL OR SOME OF PREMIUM/COST). OTHERWISE, |
| USE A NULL DISPLAY |
| |
| DISPLAY ‘some of’ IF OE23A IS CODED ‘2’ (YES, PAY |
| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |
| IF PAY ALL OR SOME OF PREMIUM/COST). DISPLAY ‘for’|
| IF OE23A IS CODED ‘4’ (NO, DO NOT PAY). |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |
| WITH ANY OTHER CODE, CONTINUE WITH OE23AAAOV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE23 |
----------------------------------------------------
OE23AAAOV
=========
ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
OE23
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
{Last time we recorded that (POLICYHOLDER) (were/was) covered
by (READ INSURER NAME(S) BELOW).}
{Since (START DATE), has there been/Between (START DATE) and
(END DATE), was there} any change in the plan name of the health
insurance (POLICYHOLDER) {has/had} through (ESTABLISHMENT)?
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
YES ................................... 1
NO .................................... 2 {END_LP05}
REF ................................... -7 {END_LP05}
DK .................................... -8 {END_LP05}
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL |
| INSURERS IN THE RU-ESTB-PERSON-INSURER-TRIPLES- |
| ROSTER THAT ARE FLAGGED AS ‘SUPPLYING HOSPITAL AND|
| PHYSICIAN BENEFITS’ AND/OR ‘SUPPLYING MEDICARE |
| SUPPLEMENT/MEDIGAP BENEFITS’ AND ARE ASSOCIATED |
| WITH THE INSURANCE THROUGH THIS ESTABLISHMENT- |
| PERSON-PAIR. |
-----------------------------------------------------
----------------------------------------------------
| DISPLAY FIRST PARAGRAPH AND THE ROSTER OF INSURER |
| NAMES IF THE INSURANCE THROUGH THIS ESTABLISHMENT-|
| PERSON-PAIR HAD ANY INSURERS FLAGGED AS PROVIDING |
| MEDIGAP OR HOSPITAL/PHYSICIAN BENEFITS AT ANY TIME|
| DURING THE PREVIOUS ROUND. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘Since (START DATE), has there been’ AND |
| ‘has’ IF NOT ROUND 5. DISPLAY ‘Between (START |
| DATE) and (END DATE), was there’ AND ‘had’ IF |
| ROUND 5. |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), FLAG PREVIOUS ROUND’S INSURER AS CURRENT |
| ROUND’S INSURER FOR THIS ESTABLISHMENT-PERSON- |
| PAIR. |
----------------------------------------------------
OE24
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
SHOW CARD OE-1.
What type of health insurance {(do/does)/did} (POLICYHOLDER)
{now} have through (ESTABLISHMENT)’s new plan {on (END DATE)}?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS,
INCLUDING COVERAGE THROUGH AN HMO ... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER’S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.]
----------------------------------------------------
| DISPLAY ‘(do/does)’ IF NOT ROUND 5. DISPLAY ‘did’|
| IF ROUND 5. |
| |
| DISPLAY ‘now’ IF NOT ROUND 5. OTHERWISE, USE A |
| NULL DISPLAY. |
| |
| DISPLAY ‘on (END DATE)’ IF ROUND 5. OTHERWISE, |
| USE A NULL DISPLAY. |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |
| WITH ANY OTHER CODES, CONTINUE WITH OE24OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_17 |
----------------------------------------------------
OE24OV
======
ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
BOX_17
======
----------------------------------------------------
| IF OE24 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |
| BENEFITS) OR ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), |
| ALONE OR WITH ANY OTHER COMBINATION OF CODES, |
| CONTINUE WITH OE25 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO END_LP05 |
----------------------------------------------------
----------------------------------------------------
| NOTE: ALL ESTABLISHMENTS WHICH ARE BEING LOOPED |
| ON HERE ARE EMPLOYERS. THEREFORE, IT IS NOT |
| NECESSARY TO AUTOMATICALLY CODE OE25 IF THE |
| ESTABLISHMENT IS AN INSURANCE CO. OR HMO (BECAUSE |
| WE KNOW IT IS NOT). |
----------------------------------------------------
OE25
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
What is the new plan name for (POLICYHOLDER)’s health insurance
through (ESTABLISHMENT) which provides the {hospital and
physician benefits/Medicare supplement or Medigap benefit}?
IF MORE THAN ONE NAME, PROBE: What is the main new plan name?
RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE {HOSPITAL
AND PHYSICIAN/MEDIGAP} BENEFITS FOR THIS PAIR.
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, CODE 2 (HMO).
NAME OF INSURER: [Enter Insurer] TYPE: 1 = INSURANCE COMPANY
2 = HMO
3 = COMPANY IS SELF-INSURED
PRESS F1 FOR DEFINITION OF INSURANCE CO/HMO/SELF-INSURED CO.
-----------------------------------------------------
| DISPLAY ‘hospital and physician benefits’ AND |
| ‘HOSPITAL’ IF OE24 IS CODED ‘1’ (HOSPITAL AND |
| PHYSICIAN BENEFITS), BUT NOT CODED ‘5’ (MEDICARE |
| SUPPLEMENT/MEDIGAP). DISPLAY ‘Medicare supplement |
| or Medigap benefits’ AND ‘MEDIGAP’ IF OE24 IS CODED|
| ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP). |
-----------------------------------------------------
----------------------------------------------------
| WRITE INSURER(S) TO THE RU-ESTB-PERSON-INSURER- |
| TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR. |
----------------------------------------------------
----------------------------------------------------
| FLAG INSURER(S) COLLECTED AT OE25 AS CURRENT |
| ROUND’S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- |
| PAIR. |
----------------------------------------------------
----------------------------------------------------
| IF OE24 IS CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP)|
| FLAG INSURANCE CO./HMO AS ‘SUPPLYING MEDICARE |
| SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES |
| HOSPITAL/PHYSICIAN BENEFITS)’ FOR THE CURRENT |
| ROUND. |
----------------------------------------------------
----------------------------------------------------
| IF OE24 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |
| BENEFITS), BUT NOT ‘5’ (MEDICARE SUPPLEMENT/ |
| MEDIGAP), FLAG INSURANCE CO./HMO AS ‘SUPPLYING |
| HOSPITAL/PHYSICIAN BENEFITS’ FOR THE CURRENT |
| ROUND. |
----------------------------------------------------
LOOP_08
=======
----------------------------------------------------
| FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- |
| TRIPLES-ROSTER, ASK OE25AA - END_LP08. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_08 COLLECTS OTHER POLICY |
| NAMES AND MANAGED CARE INFORMATION FOR INSURERS |
| COLLECTED AT OE25. THIS LOOP CYCLES ON TRIPLES |
| THAT MEET THE FOLLOWING CONDITIONS: |
| |
| - ESTABLISH-PERSON PAIR PROVIDES THE INSURANCE |
| BEING ASKED ABOUT |
| - INSURER IS ENTERED AT OE25 |
----------------------------------------------------
OE25AA
======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
Is there any other name for the {INSURANCE COMPANY OR HMO
NAME} policy, such as Option A, $100 Deductible Plan, 90/80
Plan, Gold Plan, or High Option Plan?
YES, ANOTHER NAME ...................... 1
NO OTHER NAME .......................... 2 {BOX_18A}
REF ................................... -7 {BOX_18A}
DK .................................... -8 {BOX_18A}
PRESS F1 FOR DEFINITION OF LOW OPTION/HIGH OPTION.
[Code One]
----------------------------------------------------
| DISPLAY THE NAME OF THE INSURANCE CO/HMO |
| RECORDED IN OE25_01 WHICH IS BEING LOOPED ON |
| FOR ‘INSURANCE...NAME.’ |
----------------------------------------------------
OE25AAOV
========
ENTER OTHER NAME:
[Enter Policy Name] ....................
REF ................................... -7
DK .................................... -8
BOX_18A
=======
----------------------------------------------------
| IF INSURER BEING LOOPED ON IS CODED ‘2’ (HMO) IN |
| OE25_02, CONTINUE WITH OE25B |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_18 |
----------------------------------------------------
OE25B
=====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
Will (POLICYHOLDER)’s plan pay for any of the costs of
visits to doctors who are not part of (POLICYHOLDER)’s
HMO, even if (POLICYHOLDER) (do/does) not have a referral?
YES .................................... 1 {END_LP08}
NO ..................................... 2 {END_LP08}
REF ................................... -7 {END_LP08}
DK .................................... -8 {END_LP08}
BOX_18
======
----------------------------------------------------
| ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER|
| |
| AT COMPLETION OF MANAGED CARE (MC) SECTION, |
| CONTINUE WITH END_LP08 |
----------------------------------------------------
END_LP08
========
----------------------------------------------------
| CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- |
| INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS |
| STATED IN THE LOOP DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER INSURERS MEET THE STATED CONDITIONS, |
| END LOOP_08 AND CONTINUE WITH END_LP05 |
----------------------------------------------------
END_LP05
========
----------------------------------------------------
| CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-|
| PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN |
| THE LOOP DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER PAIRS MEET THE STATED CONDITIONS, |
| END LOOP_05 AND CONTINUE WITH BOX_19 |
----------------------------------------------------
BOX_19
======
----------------------------------------------------
| IF ONE OR MORE OR RU MEMBERS WAS COVERED BY |
| INSURANCE THROUGH A NON-CURRENT EMPLOYER FROM THE |
| PREVIOUS ROUND, AN EMPLOYER FLAGGED AS ‘SELF- |
| EMPLOYED’ WITH A FIRM-SIZE-1, OR A DIRECT PURCHASE|
| SOURCE ON THE PREVIOUS ROUND’S INTERVIEW DATE, |
| THAT IS: |
| |
| IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE |
| RU MEETS THE FOLLOWING CONDITIONS: |
| - ESTABLISHMENT IS ONE OF THE FOLLOWING TYPES: |
| - FLAGGED AS A DIRECT PURCHASE SOURCE |
| - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE-1, |
| FLAGGED DURING THE PREVIOUS ROUND AS |
| ‘PROVIDES HEALTH INSURANCE’, OR |
| - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE- |
| GREATER-THAN-1, FLAGGED DURING THE PREVIOUS |
| ROUND AS ‘PROVIDES HEALTH INSURANCE’, AND |
| HAD ONE OF THE FOLLOWING JOB SUBTYPES DURING |
| THE PREVIOUS ROUND: |
| - ‘FORMER MAIN WITHIN REFERENCE PERIOD’ |
| - ‘FORMER MISCELLANEOUS JOB WITHIN REFERENCE |
| PERIOD’ |
| - ‘LAST JOB OUTSIDE REFERENCE PERIOD’ |
| - ‘RETIREMENT JOB’ |
| - PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT,|
| IF THE ESTABLISHMENT IS ONE OF THE SECOND 2 |
| TYPES NOTED ABOVE; |
| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |
| INSURANCE; |
| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT|
| COVERED PERSON ON THE DATE OF THE PREVIOUS |
| ROUND’S INTERVIEW (HQ WAS CODED ‘1’ (WHOLE |
| TIME) OR HQ02 WAS CODED ‘1’ (YES) IN THE |
| PREVIOUS ROUND); |
| |
| CONTINUE WITH LOOP_09 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_29 |
----------------------------------------------------
----------------------------------------------------
| NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT |
| IN THE RU ON THE PREVIOUS ROUND’S INTERVIEW DATE, |
| THE LAST CONDITION IN THE ABOVE BOX CAN BE MET |
| IF AT LEAST ONE DEPENDENT WAS COVERED BY |
| POLICYHOLDER’S INSURANCE ON THE PREVIOUS ROUND’S |
| INTERVIEW DATE. THE LOOP WILL CYCLE ON THE |
| POLICYHOLDER’S NAME. |
----------------------------------------------------
----------------------------------------------------
| NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE |
| POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, |
| INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT |
| ROUND’S INTERVIEW DATE, BUT WHERE THE |
| ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO |
| ARE STILL RU MEMBERS MAY STILL QUALIFY FOR |
| LOOP_09. |
----------------------------------------------------
----------------------------------------------------
| NOTE: FOR DIRECT PURCHASE AND SELF-EMPLOYED-FIRM-|
| SIZE-1, THE CONTEXT HEADER SHOULD DISPLAY THE NAME|
| OF THE SOURCE PROVIDING THE INSURANCE RATHER THAN |
| THE NAME OF THE DIRECT PURCHASE CATEGORY OR THE |
| SELF-EMPLOYED-FIRM-SIZE-1 EMPLOYER NAME OR TYPE OF|
| PURCHASE CATEGORY. FOR EMPLOYERS WHICH ARE NOT |
| SELF-EMPLOYED WITH FIRM-SIZE-1, USE THE JOBHOLDER |
| NAME AND EMPLOYER NAME IN THE CONTEXT HEADER. |
----------------------------------------------------
LOOP_09
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- |
| PAIRS-ROSTER, ASK BOX_19A - END_LP09 |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_09 COLLECTS INFORMATION |
| ABOUT THE CONTINUATION OF INSURANCE COVERAGE |
| THROUGH A NON-CURRENT EMPLOYER FROM THE PREVIOUS |
| ROUND, AN EMPLOYER FLAGGED AS ‘SELF-EMPLOYED’ WITH|
| A FIRM-SIZE-1, OR A DIRECT PURCHASE SOURCE THAT |
| WAS COLLECTED IN THE PREVIOUS ROUND. THIS LOOP |
| CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET |
| THE FOLLOWING CONDITIONS: |
| |
| - ESTABLISHMENT IS ONE OF THE FOLLOWING TYPES: |
| - FLAGGED AS A DIRECT PURCHASE SOURCE |
| - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE-1, |
| FLAGGED DURING THE PREVIOUS ROUND AS ‘PROVIDES|
| HEALTH INSURANCE’, OR |
| - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE- |
| GREATER-THAN-1, FLAGGED DURING THE PREVIOUS |
| ROUND AS ‘PROVIDES HEALTH INSURANCE’, AND HAD |
| ONE OF THE FOLLOWING JOB SUBTYPES DURING THE |
| PREVIOUS ROUND: |
| - ‘FORMER MAIN WITHIN REFERENCE PERIOD’ |
| - ‘FORMER MISCELLANEOUS JOB WITHIN REFERENCE |
| PERIOD’ |
| - ‘LAST JOB OUTSIDE REFERENCE PERIOD’ |
| - ‘RETIREMENT JOB’ |
| - PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT, |
| IF THE ESTABLISHMENT IS ONE OF THE SECOND 2 |
| TYPES NOTED ABOVE; |
| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |
| INSURANCE; |
| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT |
| COVERED PERSON ON THE DATE OF THE PREVIOUS |
| ROUND’S INTERVIEW (HQ WAS CODED ‘1’ (WHOLE TIME)|
| OR HQ02 WAS CODED ‘1’ (YES) IN THE PREVIOUS |
| ROUND) |
----------------------------------------------------
BOX_19A
=======
----------------------------------------------------
| IF THE POLICYHOLDER OF THIS ESTABLISHMENT-PERSON- |
| PAIR IS FLAGGED AS ‘POLICYHOLDER NOT LISTED IN RU |
| (DU)’ OR ‘POLICYHOLDER DECEASED’, CONTINUE WITH |
| OE25A |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE26 |
----------------------------------------------------
OE25A
=====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT........} {STR-DT}
{END-DT}
INTERVIEWER: IF (POLICYHOLDER)’S NAME IS LISTED ON THE
ROSTER BELOW, SELECT IT. IF NOT, SELECT ‘NAME NOT ON ROSTER’
AND CONTINUE.
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 One]
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS |
| ON THE DU-MEMBERS-ROSTER. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘NAME NOT ON ROSTER’ AS LAST ENTRY ON THIS|
| ROSTER. |
----------------------------------------------------
----------------------------------------------------
| IF A DU MEMBER’S NAME IS SELECTED FROM THE |
| ROSTER, REPLACE THIS NAME AS THE CURRENT |
| POLICYHOLDER OF THIS ESTABLISHMENT-PERSON-PAIR. |
| IF ‘NAME NOT ON ROSTER’ SELECTED LEAVE THE |
| POLICYHOLDER NAME OF THIS ESTABLISHMENT-PERSON- |
| PAIR AS IS. |
----------------------------------------------------
OE26
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT........} {STR-DT}
{END-DT}
During the last interview, we recorded that someone in the
family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health
insurance. {(Are/Is)/(Were/Was)} (POLICYHOLDER) or anyone in
the family covered by (POLICYHOLDER)’s health insurance through
(ESTABLISHMENT) as of {today,} (END DATE)?
YES .................................... 1
NO ..................................... 2 {OE28}
REF ................................... -7 {END_LP09}
DK .................................... -8 {END_LP09}
----------------------------------------------------
| DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY |
| ‘(Was/Were)’ IF ROUND 5. |
| |
| DISPLAY ‘today,’ IF NOT ROUND 5. OTHERWISE, USE A|
| NULL DISPLAY. |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘1’ (YES) AND THIS ESTABLISHMENT-PERSON- |
| PAIR IS AN ESTABLISHMENT FLAGGED AS ‘SELF- |
| EMPLOYED’ WITH FIRM-SIZE-1, CONTINUE WITH OE27 |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘1’ (YES) AND ESTABLISHMENT-PERSON-PAIR |
| IS NOT AN ESTABLISHMENT WITH FIRM-SIZE-1, GO TO |
| BOX_20 |
----------------------------------------------------
OE27
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT........} {STR-DT}
{END-DT}
Is this insurance still through (POLICYHOLDER)’s self-employed
business?
YES .................................... 1 {BOX_20}
NO ..................................... 2 {BOX_20}
REF ................................... -7 {BOX_20}
DK .................................... -8 {BOX_20}
PRESS F1 FOR DEFINITION OF SELF-EMPLOYED.
OE28
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT........} {STR-DT}
{END-DT}
On what date did (POLICYHOLDER)’s health insurance through
(ESTABLISHMENT) end?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| EDIT (FOR ROUND 5 ONLY): COMPLETE DATE ENTERED |
| CANNOT BE AFTER 12/31/2006. IF A DATE AFTER |
| 12/31/2006 IS ENTERED, DISPLAY THE FOLLOWING |
| MESSAGE: ‘DATE CANNOT BE AFTER 12/31/2006. IF |
| INSURANCE ENDED AFTER 12/31/2006, USE CTRL/B TO |
| BACK-UP AND CHANGE RESPONSE TO OE26. |
----------------------------------------------------
----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE28OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_20 |
----------------------------------------------------
OE28OV
======
Can you just tell me if (POLICYHOLDER) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
BOX_20
======
----------------------------------------------------
| IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT |
| THE PREVIOUS ROUND’S INTERVIEW DATE BY THE |
| INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, |
| AUTOMATICALLY CODE OE29 AS ‘1’ (YES) AND GO TO |
| BOX_21 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH OE29 |
----------------------------------------------------
OE29
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
During the last interview, we recorded that (READ NAMES BELOW)
(were/was) covered by (POLICYHOLDER)’s health insurance
through (ESTABLISHMENT).
{Are/Were} they all covered by this health insurance {until
{{OE28 DATE}/it ended}/on (END-DT)}?
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- |
| PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY |
| THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: |
| - PERSON WAS COVERED AT THE PREVIOUS ROUND’S |
| INTERVIEW DATE BY THE INSURANCE FROM THIS |
| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |
| POLICYHOLDER |
| - PERSON IS AN RU MEMBER |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘Are’ IF OE26 IS CODED ‘1’ (YES). |
| DISPLAY ‘Were’ IF OE26 IS CODED ‘2’ (NO) OR IF |
| CURRENT ROUND IS ROUND 5. |
| |
| DISPLAY ‘until {OE28 DATE}’ IF OE26 IS CODED ‘2’ |
| (NO). DISPLAY ‘on (END-DT)’ IF OE26 IS CODED ‘1’ |
| (YES). |
| |
| DISPLAY THE DATE RECORDED AT OE28 FOR ‘OE28 DATE’.|
| IF THE MONTH AND DAY FIELD AT OE28 IS CODED ‘-7’ |
| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|
| FOR ‘OE28 DATE’. |
----------------------------------------------------
BOX_21
======
----------------------------------------------------
| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |
| TO THE END DATE OF THE CURRENT ROUND, THAT IS: |
| |
| IF OE26 IS CODED ‘1’ (YES) AND OE29 IS CODED ‘1’ |
| (YES), |
| |
| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |
| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|
| THE REFERENCE PERIOD END DATE AND |
| |
| GO TO BOX_23 |
----------------------------------------------------
----------------------------------------------------
| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |
| TO PART OF THE CURRENT ROUND, THAT IS: |
| |
| IF OE26 IS CODED ‘2’ (NO) AND OE29 IS CODED ‘1’ |
| (YES). |
| |
| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |
| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|
| THE DATE RECORDED AT OE28 AND |
| |
| GO TO BOX_23 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE (I.E., OE29 CODED ‘2’ (NO), ‘-7’ |
| (REFUSED), OR ‘-8’ (DON’T KNOW)), CONTINUE WITH |
| OE30 |
----------------------------------------------------
OE30
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Who {is/was} no longer covered by (POLICYHOLDER)’s health
insurance through (ESTABLISHMENT) {{until {OE28 DATE}/it ended}/
on (END-DT)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- |
| PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY |
| THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: |
| - PERSON WAS COVERED AT THE PREVIOUS ROUND’S |
| INTERVIEW DATE BY THE INSURANCE FROM THIS |
| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |
| POLICYHOLDER |
| - PERSON IS AN RU MEMBER |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘is’ IF OE26 IS CODED ‘1’ (YES). |
| DISPLAY ‘was’ IF OE26 IS CODED ‘2’ (NO) OR IF |
| CURRENT ROUND IS ROUND 5. |
| |
| DISPLAY ‘until {OE28 DATE}’ IF OE26 IS CODED ‘2’ |
| (NO). |
| DISPLAY ‘on (END-DT)’ IF OE26 IS CODED ‘1’ (YES). |
| |
| DISPLAY THE DATE RECORDED AT OE28 FOR ‘OE28 DATE’.|
| IF THE MONTH AND DAY FIELD AT OE28 IS CODED ‘-7’ |
| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|
| FOR ‘OE28 DATE’. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY STILL HAS INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED ‘1’ |
| (YES)), FLAG INSURANCE FOR ALL PERSONS NOT |
| SELECTED AT OE30 AS ‘CONTINUOUS COVERAGE’ FROM THE|
| REFERENCE PERIOD START DATE UNTIL THE REFERENCE |
| PERIOD END DATE. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |
| THIS ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED ‘2’ |
| (NO)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED|
| AT OE30 AS CONTINUOUS COVERAGE FROM THE REFERENCE |
| PERIOD START DATE UNTIL DATE RECORDED AT OE28 |
----------------------------------------------------
LOOP_10
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |
| PERS-TRPLS-ROSTER, ASK OE31 - END_LP10. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_10 COLLECTS THE DATE ON |
| WHICH THE INSURANCE COVERAGE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER|
| WHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCE|
| PERIOD END DATE OR THE DATE REPORTED IN OE28. |
| THIS LOOP CYCLES ON PERSONS SELECTED AT OE30. |
-----------------------------------------------------
OE31
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT........} {STR-DT}
{END-DT}
On what date did the health insurance through (ESTABLISHMENT)
end for (PERSON)?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE31OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_22 |
----------------------------------------------------
OE31OV
======
Can you just tell me if (PERSON) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
BOX_22
======
----------------------------------------------------
| FLAG INSURANCE FOR PERSON AS ‘CONTINUOUS COVERAGE’|
| THROUGH THE COMPLETE DATE RECORDED AT OE31 AND |
| OE31OV. |
----------------------------------------------------
END_LP10
========
----------------------------------------------------
| 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_10 AND CONTINUE WITH BOX_23 |
----------------------------------------------------
BOX_23
======
----------------------------------------------------
| IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY |
| THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,|
| (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU |
| MEMBERS NOT COVERED BY THIS INSURANCE ON THE |
| PREVIOUS ROUND’S INTERVIEW DATE, BUT EXCLUDES RU |
| MEMBERS JUST MARKED AS NO LONGER COVERED IN OE30),|
| CONTINUE WITH OE32 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE34A |
----------------------------------------------------
OE32
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT........} {STR-DT}
{END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, have
any persons living here, we have not yet mentioned, been covered
by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?
YES ................................... 1
NO .................................... 2 {OE34A}
REF ................................... -7 {OE34A}
DK .................................... -8 {OE34A}
PRESS F1 FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
OE33
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT........} {STR-DT}
{END-DT}
Who {has been/was} covered by (POLICYHOLDER)’s health insurance
through (ESTABLISHMENT) {since (START DATE)/between (START DATE)
and (END DATE)} that we have not yet mentioned?
PROBE: Who else {has been/was} covered by (POLICYHOLDER)’s health
insurance through (ESTABLISHMENT) {since (START DATE)/between
(START DATE) and (END DATE)} that we have not yet mentioned?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS|
| ON THE RU-MEMBERS-ROSTER WHO WERE NOT COVERED BY |
| THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- |
| PAIR ON THE PREVIOUS ROUND’S INTERVIEW DATE. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY ON|
| THIS ROSTER. |
----------------------------------------------------
----------------------------------------------------
| WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- |
| COVRD-PERS-TRPLS-ROSTER. |
----------------------------------------------------
----------------------------------------------------
| IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG |
| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |
| AS ‘COVERING PERSON NOT LISTED IN RU’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT|
| ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) |
| and (END DATE)’ IF ROUND 5. |
----------------------------------------------------
LOOP_11
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |
| PERS-TRPLS-ROSTER, ASK OE34 - END_LP11. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_11 COLLECTS THE COVERAGE |
| START DATE FOR ALL PERSONS NEWLY COVERED DURING |
| THE CURRENT ROUND BY THE INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON |
| PERSONS SELECTED AT OE33. |
----------------------------------------------------
OE34
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
On what date did the health insurance through (ESTABLISHMENT)
begin for (PERSON)?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
-----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T |
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE34OV |
-----------------------------------------------------
-----------------------------------------------------
| OTHERWISE, GO TO BOX_24 |
-----------------------------------------------------
OE34OV
======
Can you just tell me if (PERSON) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
| EDIT: COMPLETE DATE AT OE34 MUST BE < THAN |
| COMPLETE DATE AT OE28 IF A DATE IS RECORDED AT |
| OE28 OR < THAN REFERENCE PERIOD END DATE IF NO |
| DATE IS RECORDED AT OE28. |
----------------------------------------------------
BOX_24
======
----------------------------------------------------
| IF FAMILY STILL HAS INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED ‘1’ |
| (YES)), FLAG INSURANCE FOR THIS PERSON AS |
| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE34 |
| UNTIL THE REFERENCE PERIOD END DATE. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |
| THIS ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED ‘2’ |
| (NO)), FLAG INSURANCE FOR THIS PERSON AS |
| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE34 |
| UNTIL DATE RECORDED AT OE28. |
----------------------------------------------------
END_LP11
========
----------------------------------------------------
| 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_11 AND GO TO BOX_25 |
----------------------------------------------------
OE34A
=====
{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 OE33 |
----------------------------------------------------
BOX_25
======
----------------------------------------------------
| IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THE|
| INSURANCE THROUGH THE ESTABLISHMENT-PERSON-PAIR ON|
| THE CURRENT ROUND’S INTERVIEW DATE, THAT IS, OE26 |
| IS CODED ‘1’(YES), CONTINUE WITH BOX_25A |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO END_LP09 |
----------------------------------------------------
BOX_25A
=======
----------------------------------------------------
| IF ROUND 3, CONTINUE WITH OE35A |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE35 |
----------------------------------------------------
OE35A
=====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
For the coverage through (ESTABLISHMENT), does anyone in the
family pay all of the premium or cost, some of the premium or
cost, or none of the premium or cost?
[Do not include the cost of any copayments, coinsurance or
deductibles anyone in the family may have had to pay.]
[Do include any contribution made to the plan as part of a
paycheck.]
YES, PAY ALL OF PREMIUM/COST ........... 1
YES, PAY SOME OF PREMIUM/COST .......... 2
YES, BUT DON’T KNOW IF PAY ALL OR SOME
OF PREMIUM/COST ........................ 3
NO, DO NOT PAY ......................... 4 {OE35AAA}
REF ................................... -7 {OE35}
DK .................................... -8 {OE35}
[Code One]
PRESS F1 FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |
| DISPLAYED HERE FOR THE INSURANCE FROM A |
| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |
| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |
| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |
| DIRECTLY PURCHASED CATEGORY. |
----------------------------------------------------
OE35AA
======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
How much (do/does) (POLICYHOLDER) pay for the (ESTABLISHMENT)
coverage?
PROBE: Is that per year, per month, per week, or what?
[Enter Amount in Dollars] ..............
REF ................................... -7 {BOX_26A}
DK .................................... -8 {BOX_26A}
----------------------------------------------------
| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |
| DISPLAYED HERE FOR THE INSURANCE FROM A |
| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |
| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |
| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |
| DIRECTLY PURCHASED CATEGORY. |
----------------------------------------------------
OE35AAOV1
=========
ENTER UNIT OF COVERAGE:
PER YEAR ............................... 1 {BOX_26A}
QUARTERLY/EVERY 3 MONTHS ............... 2 {BOX_26A}
BIMONTHLY/EVERY 2 MONTHS ............... 3 {BOX_26A}
PER MONTH .............................. 4 {BOX_26A}
PER WEEK ............................... 5 {BOX_26A}
BIWEEKLY/EVERY 2 WEEKS ................. 6 {BOX_26A}
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 {BOX_26A}
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 {BOX_26A}
OTHER ................................. 91
REF ................................... -7 {BOX_26A}
DK .................................... -8 {BOX_26A}
[Code One]
OE35AAOV2
=========
ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
BOX_26A
=======
-----------------------------------------------------
| IF OE35A IS CODED ‘1’ (YES, PAY ALL OF PREMIUM/ |
| COST), GO TO OE35 |
-----------------------------------------------------
-----------------------------------------------------
| OTHERWISE, CONTINUE WITH OE35AAA |
-----------------------------------------------------
OE35AAA
=======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
Who {else} pays {some of/for} the premium or cost
of this insurance?
FEDERAL GOVERNMENT .................... 1
STATE GOVERNMENT ...................... 2
LOCAL GOVERNMENT ...................... 3
SOME GOVERNMENT ....................... 4
EMPLOYER .............................. 5
UNION ................................. 6
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
----------------------------------------------------
| DISPLAY ‘else’ IF OE35A IS CODED ‘2’ (YES, PAY |
| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |
| IF PAY ALL OR SOME OF PREMIUM/COST). OTHERWISE, |
| USE A NULL DISPLAY |
| |
| DISPLAY ‘some of’ IF OE35A IS CODED ‘2’ (YES, PAY |
| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |
| IF PAY ALL OR SOME OF PREMIUM/COST). DISPLAY ‘for’|
| IF OE35A IS CODED ‘4’ (NO, DO NOT PAY). |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |
| WITH ANY OTHER CODE, CONTINUE WITH OE35AAAOV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE35 |
----------------------------------------------------
OE35AAAOV
=========
ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
OE35
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT........} {STR-DT}
{END-DT}
{Last time we recorded that (POLICYHOLDER) (were/was) covered
by (READ INSURER NAME(S) BELOW).}
{Since (START DATE), has there been/Between (START DATE) and
(END DATE), was there} any change in the plan name of the health
insurance (POLICYHOLDER) {has/had} through (ESTABLISHMENT)?
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
YES ................................... 1
NO .................................... 2 {END_LP09}
REF ................................... -7 {END_LP09}
DK .................................... -8 {END_LP09}
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL |
| INSURERS IN THE RU-ESTB-PERSON-INSURER-TRIPLES- |
| ROSTER THAT ARE FLAGGED AS ‘SUPPLYING HOSPITAL AND|
| PHYSICIAN BENEFITS’ AND/OR ‘SUPPLYING MEDICARE |
| SUPPLEMENT/MEDIGAP BENEFITS’ AND ARE ASSOCIATED |
| WITH THE INSURANCE THROUGH THIS ESTABLISHMENT- |
| PERSON-PAIR. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY FIRST PARAGRAPH AND THE ROSTER OF INSURER |
| NAMES IF THE INSURANCE THROUGH THIS ESTABLISHMENT-|
| PERSON-PAIR HAD ANY INSURERS FLAGGED AS PROVIDING |
| MEDIGAP OR HOSPITAL/PHYSICIAN BENEFITS AT ANY TIME|
| DURING THE PREVIOUS ROUND. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘Since (START DATE), has there been’ AND |
| ‘has’ IF NOT ROUND 5. DISPLAY ‘Between (START |
| DATE) and (END DATE), was there’ AND ‘had’ IF |
| ROUND 5. |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), FLAG PREVIOUS ROUND’S INSURER AS CURRENT |
| ROUND’S INSURER FOR THIS ESTABLISHMENT-PERSON- |
| PAIR. |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘1’ (YES) AND ESTABLISHMENT IS FLAGGED AS|
| AN INSURANCE CO. OR HMO, CONTINUE WITH OE36 |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘1’ (YES) AND ESTABLISHMENT IS NOT |
| FLAGGED AS AN INSURANCE CO. OR HMO, GO TO OE37 |
----------------------------------------------------
OE36
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT........} {STR-DT}
{END-DT}
What is the new plan name of (POLICYHOLDER)’s health insurance
through (ESTABLISHMENT)?
[Enter Plan Name/Establishment Name] ..............
----------------------------------------------------
| WRITE ESTABLISHMENT NAME CORRECTION TO THE RU- |
| ESTABLISHMENT-PERSONS-PAIRS-ROSTER. THIS IS THE |
| CORRECTED ESTABLISHMENT NAME. |
----------------------------------------------------
----------------------------------------------------
| FLAG INSURER ENTERED ABOVE AS CURRENT ROUND’S |
| INSURER FOR THIS POLICYHOLDER-ESTABLISHMENT PAIR. |
----------------------------------------------------
----------------------------------------------------
| NOTE: IF A SOURCE OF INSURANCE WAS DIRECTLY |
| PURCHASED FROM AN HMO OR INSURANCE COMPANY, THE |
| ESTABLISHMENT NAME IS THE SAME AS THE INSURER |
| NAME. THEREFORE, ANY CHANGE IN PLAN NAME |
| AUTOMATICALLY DICTATES A CHANGE IN THE |
| ESTABLISHMENT NAME. |
----------------------------------------------------
OE37
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
SHOW CARD OE-1.
What type of health insurance {(do/does)/did} (POLICYHOLDER)
{now} have through (ESTABLISHMENT)’s new plan {on (END DATE)}?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS,
INCLUDING COVERAGE THROUGH AN HMO ... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER’S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.]
----------------------------------------------------
| DISPLAY ‘(do/does)’ IF NOT ROUND 5. DISPLAY ‘did’|
| IF ROUND 5. |
| |
| DISPLAY ‘now’ IF NOT ROUND 5. OTHERWISE, USE A |
| NULL DISPLAY. |
| |
| DISPLAY ‘on (END DATE)’ IF ROUND 5. OTHERWISE, |
| USE A NULL DISPLAY. |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |
| WITH ANY OTHER CODES, CONTINUE WITH OE37OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_26 |
----------------------------------------------------
OE37OV
======
ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
BOX_26
======
----------------------------------------------------
| IF OE37 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |
| BENEFITS) OR ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), |
| ALONE OR WITH ANY OTHER COMBINATION OF CODES, |
| CONTINUE WITH BOX_27 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO END_LP09 |
----------------------------------------------------
BOX_27
======
----------------------------------------------------
| IF ESTABLISHMENT ALREADY FLAGGED AS ‘INSURANCE |
| CO.’ OR ‘HMO’, AUTOMATICALLY CODE OE38 WITH |
| APPROPRIATE RESPONSES AND GO TO LOOP_12 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH OE38 |
----------------------------------------------------
OE38
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
What is the new plan name for (POLICYHOLDER)’s health insurance
through (ESTABLISHMENT) which provides the {hospital and
physician benefits/Medicare supplement or Medigap benefits}?
IF MORE THAN ONE NAME, PROBE: What is the main new plan name?
RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE {HOSPITAL
AND PHYSICIAN/MEDIGAP} BENEFITS FOR THIS PAIR.
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, CODE 2 (HMO).
NAME OF INSURER: [Enter Insurer] TYPE: 1 = INSURANCE COMPANY
2 = HMO
3 = COMPANY IS SELF-INSURED
PRESS F1 FOR DEFINITION OF INSURANCE CO/HMO/SELF-INSURED CO.
-----------------------------------------------------
| DISPLAY ‘hospital and physician benefits’ AND |
| ‘HOSPITAL’ IF OE37 IS CODED ‘1’ (HOSPITAL AND |
| PHYSICIAN BENEFITS), BUT NOT CODED ‘5’ (MEDICARE |
| SUPPLEMENT/MEDIGAP). DISPLAY ‘Medicare supplement |
| or Medigap benefits’ AND ‘MEDIGAP’ IF OE37 IS CODED|
| ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP). |
-----------------------------------------------------
-----------------------------------------------------
| WRITE INSURER(S) TO THE RU-ESTAB-PERSON-INSURER- |
| TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR |
-----------------------------------------------------
----------------------------------------------------
| FLAG INSURER(S) COLLECTED AT OE38 AS CURRENT |
| ROUND’S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- |
| PAIR. |
----------------------------------------------------
----------------------------------------------------
| IF OE37 IS CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP)|
| FLAG INSURANCE CO./HMO AS ‘SUPPLYING MEDICARE |
| SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES |
| HOSPITAL/PHYSICIAN BENEFITS)’ FOR THE CURRENT |
| ROUND. |
----------------------------------------------------
----------------------------------------------------
| IF OE37 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |
| BENEFITS), BUT NOT ‘5’ (MEDICARE SUPPLEMENT/ |
| MEDIGAP), FLAG INSURANCE CO./HMO AS ‘SUPPLYING |
| HOSPITAL/PHYSICIAN BENEFITS’ FOR THE CURRENT |
| ROUND. |
----------------------------------------------------
LOOP_12
=======
----------------------------------------------------
| FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- |
| TRIPLES-ROSTER, ASK OE38A - END_LP12. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_12 COLLECTS OTHER POLICY |
| NAMES AND MANAGED CARE INFORMATION FOR INSURERS |
| COLLECTED AT OE38. THIS LOOP CYCLES ON TRIPLES |
| THAT MEET THE FOLLOWING CONDITIONS: |
| |
| - ESTABLISHMENT-PERSON-PAIR PROVIDES THE INSURANCE|
| BEING ASKED ABOUT |
| - INSURER IS ENTERED AT OE38 |
----------------------------------------------------
OE38A
=====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
Is there any other name for the {INSURANCE COMPANY OR HMO
NAME} policy, such as Option A, $100 Deductible Plan, 90/80
Plan, Gold Plan, or High Option Plan?
YES, ANOTHER NAME ...................... 1
NO OTHER NAME .......................... 2 {BOX_28A}
REF ................................... -7 {BOX_28A}
DK .................................... -8 {BOX_28A}
PRESS F1 FOR DEFINITION OF LOW OPTION/HIGH OPTION.
[Code One]
----------------------------------------------------
| DISPLAY THE NAME OF THE INSURANCE CO/HMO |
| RECORDED IN OE38_01 WHICH IS BEING LOOPED ON |
| FOR ‘INSURANCE...NAME.’ |
----------------------------------------------------
OE38AOV
=======
ENTER OTHER NAME:
[Enter Policy Name] ....................
REF ................................... -7
DK .................................... -8
BOX_28A
=======
----------------------------------------------------
| IF INSURER BEING LOOPED ON IS CODED ‘2’ (HMO) IN |
| OE38_02, CONTINUE WITH OE38B |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_28 |
----------------------------------------------------
OE38B
=====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
Will (POLICYHOLDER)’s plan pay for any of the costs of
visits to doctors who are not part of (POLICYHOLDER)’s
HMO, even if (POLICYHOLDER) (do/does) not have a referral?
YES .................................... 1 {END_LP12}
NO ..................................... 2 {END_LP12}
REF ................................... -7 {END_LP12}
DK .................................... -8 {END_LP12}
BOX_28
======
----------------------------------------------------
| ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER|
| |
| AT COMPLETION OF MANAGED CARE (MC) SECTION, |
| CONTINUE WITH END_LP12 |
----------------------------------------------------
END_LP12
========
----------------------------------------------------
| CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- |
| INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS |
| STATED IN THE LOOP DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER INSURERS MEET THE STATED CONDITIONS, |
| END LOOP_12 AND CONTINUE WITH END_LP09 |
----------------------------------------------------
END_LP09
========
----------------------------------------------------
| CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-|
| PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN |
| THE LOOP DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END |
| LOOP_09 AND CONTINUE WITH BOX_29 |
----------------------------------------------------
BOX_29
======
----------------------------------------------------
| IF ONE OR MORE RU MEMBERS WAS A COVERED PERSON BY |
| AN ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS |
| ROUND’S INTERVIEW DATE WHERE THE ESTABLISHMENT IS |
| A PRIVATE SOURCE OF INSURANCE AND THE POLICYHOLDER|
| IS FLAGGED AS ‘POLICYHOLDER/DEPENDENT IN DIFFERENT|
| RUS’ AT THE CURRENT ROUND’S INTERVIEW DATE, |
| CONTINUE WITH LOOP_13 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_33 |
----------------------------------------------------
----------------------------------------------------
| NOTE: WHEN A POLICYHOLDER LEAVES AN RU, WE WILL |
| NEVER ASK RJ AND THAT POLICYHOLDER WILL NEVER |
| QUALIFY FOR LOOPS 01, 05, OR 09. WE CREATED A |
| NEW LOOP, LOOP_13 THAT WILL HANDLE THE SITUATIONS |
| WHERE THE POLICYHOLDER HAS LEFT THE RU AND LEFT |
| DEPENDENTS BEHIND, OR THE SITUATION WHERE THE |
| DEPENDENTS HAVE LEFT THE RU (WITHOUT THE |
| POLICYHOLDER). THIS SITUATION WILL BE FLAGGED AS |
| ‘POLICYHOLDER/DEPENDENT IN DIFFERENT RUs’. THIS |
| FLAG CAN BE ASSOCIATED WITH ANY ESTABLISHMENT- |
| PERSON-PAIR IN A PARTICULAR RU WHERE THEY ARE |
| COVERED PERSONS, BUT THE POLICYHOLDER IS IN |
| ANOTHER RU. THIS FLAG SHOULD NEVER EXIST ON A |
| PAIR IN AN RU WHERE THE POLICYHOLDER OF THE PAIR |
| IS IN THE SAME RU AS ALL OF THE DEPENDENTS OR |
| WHERE THE POLICYHOLDER OF THE PAIR WAS ORIGINALLY |
| CREATED AS ‘POLICYHOLDER NOT IN RU/DU’ OR |
| ‘POLICYHOLDER DECEASED’. |
----------------------------------------------------
LOOP_13
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- |
| PAIRS-ROSTER, ASK OE39 - END_LP13. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: |
| |
| LOOP_13 COLLECTS INFORMATION ABOUT THE |
| CONTINUATION OF INSURANCE COVERAGE THROUGH AN |
| ESTABLISHMENT-PERSON-PAIR WHERE THE POLICYHOLDER |
| OR THE ELIGIBLE DEPENDENT(S) HAVE MOVED FROM THE |
| RU. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS|
| THAT MEET THE FOLLOWING CONDITIONS: |
| |
| - THE ESTABLISHMENT IS A PRIVATE SOURCE OF |
| INSURANCE |
| - THE ESTABLISHMENT-PERSON-PAIR IS FLAGGED AS |
| ‘POLICYHOLDER/DEPENDENT MOVED’ AT THE CURRENT |
| ROUND’S INTERVIEW DATE FOR THIS RU |
| - AT LEAST ONE RU MEMBER WAS A COVERED PERSON FOR |
| THIS ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS |
| ROUND’S INTERVIEW DATE |
| - POLICYHOLDER IS NOT A CURRENT RU MEMBER |
----------------------------------------------------
OE39
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
During the last interview, we recorded that someone in the
family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health
insurance. {Is/Was} anyone in the family, living here{ now},
covered by (POLICYHOLDER)’s health insurance through
(ESTABLISHMENT) as of {today,} (END DATE)?
IF RESPONDENT VOLUNTEERS THAT THIS INSURANCE HAS ALREADY BEEN
DISCUSSED, CODE ‘3’.
YES ................................... 1 {OE41}
NO .................................... 2
INSURANCE ALREADY DISCUSSED ........... 3 {END_LP13}
REF ................................... -7 {END_LP13}
DK .................................... -8 {END_LP13}
[Code One]
----------------------------------------------------
| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF |
| ROUND 5. |
| |
| DISPLAY ‘today,’ AND ‘ now’ IF NOT ROUND 5. |
| OTHERWISE, USE A NULL DISPLAY. |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘3’ (INSURANCE ALREADY DISCUSSED), FLAG |
| ITEM FOR SOURCE CLEAN-UP. |
----------------------------------------------------
OE40
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
On what date did this health insurance through (ESTABLISHMENT)
end?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| EDIT (FOR ROUND 5 ONLY): COMPLETE DATE ENTERED |
| CANNOT BE AFTER 12/31/2006. IF A DATE AFTER |
| 12/31/2006 IS ENTERED, DISPLAY THE FOLLOWING |
| MESSAGE: ‘DATE CANNOT BE AFTER 12/31/2006. IF |
| INSURANCE ENDED AFTER 12/31/2006, USE CTRL/B TO |
| BACK-UP AND CHANGE RESPONSE TO OE39. |
----------------------------------------------------
----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE40OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE43 |
----------------------------------------------------
OE40OV
======
Can you just tell me if (POLICYHOLDER) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
| IF ONLY ONE PERSON COVERED AT END OF PREVIOUS |
| ROUND, GO TO OE43 |
----------------------------------------------------
OE41
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
During the last interview, we recorded that (READ NAMES BELOW)
(were/was) covered by (POLICYHOLDER)’s health insurance
through (ESTABLISHMENT).
{Are/Were} they all covered by this health insurance {until
{{OE40 DATE}/it ended}/on (END-DT)}?
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- |
| PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY |
| THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: |
| - PERSON WAS COVERED AT THE PREVIOUS ROUND’S |
| INTERVIEW DATE BY THE INSURANCE FROM THIS |
| ESTABLISHMENT-PERSON-PAIR, |
| - PERSON IS AN RU MEMBER |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘Are’ IF OE39 IS CODED ‘1’ (YES). |
| DISPLAY ‘Were’ IF OE39 IS CODED ‘2’ (NO) OR IF |
| CURRENT ROUND IS ROUND 5. |
| |
| DISPLAY ‘until {OE40 DATE}’ IF OE39 IS CODED ‘2’ |
| (NO). |
| DISPLAY ‘on (END-DT)’ IF OE39 IS CODED ‘1’ (YES). |
| |
| DISPLAY THE DATE RECORDED AT OE40 FOR ‘OE40 DATE’.|
| IF THE MONTH AND DAY FIELD AT OE40 IS CODED ‘-7’ |
| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|
| FOR ‘OE40 DATE’. |
----------------------------------------------------
----------------------------------------------------
| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |
| TO THE END DATE OF THE CURRENT ROUND, THAT IS: |
| |
| IF OE39 IS CODED ‘1’ (YES) AND OE41 IS CODED ‘1’ |
| (YES), |
| |
| FLAG INSURANCE FOR ALL COVERED PERSONS AS |
| ‘CONTINUOUS COVERAGE’ THROUGH THE REFERENCE PERIOD|
| END DATE AND |
| |
| GO TO BOX_31 |
----------------------------------------------------
----------------------------------------------------
| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |
| TO PART OF THE CURRENT ROUND, THAT IS: |
| |
| IF OE39 IS CODED ‘2’ (NO) AND OE41 IS CODED ‘1’ |
| (YES), |
| |
| FLAG INSURANCE FOR ALL COVERED PERSONS AS |
| ‘CONTINUOUS COVERAGE’ THROUGH THE DATE RECORDED |
| AT OE40 AND |
| |
| GO TO BOX_31 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE (I.E., OE41 CODED ‘2’ (NO), ‘-7’ |
| (REFUSED), OR ‘-8’ (DON’T KNOW)), |
| CONTINUE WITH OE42 |
----------------------------------------------------
OE42
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Who {is/was} no longer covered by (POLICYHOLDER)’s health
insurance through (ESTABLISHMENT) {until {{OE40 DATE}/it ended}/on
(END-DT)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- |
| PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY |
| THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: |
| - PERSON WAS COVERED AT THE PREVIOUS ROUND’S |
| INTERVIEW DATE BY THE INSURANCE FROM THIS |
| ESTABLISHMENT-PERSON-PAIR, |
| - PERSON IS AN RU MEMBER |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘is’ IF OE39 IS CODED ‘1’ (YES). |
| DISPLAY ‘was’ IF OE39 IS CODED ‘2’ (NO) OR IF |
| CURRENT ROUND IS ROUND 5. |
| |
| DISPLAY ‘until {OE40 DATE}’ IF OE39 IS CODED ‘2’ |
| (NO). |
| DISPLAY ‘on (END-DT)’ IF OE39 IS CODED ‘1’ (YES). |
| |
| DISPLAY THE DATE RECORDED AT OE40 FOR ‘OE40 DATE’.|
| IF THE MONTH AND DAY FIELD AT OE40 IS CODED ‘-7’ |
| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|
| FOR ‘OE40 DATE’. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY STILL HAS INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED ‘1’ |
| (YES)), FLAG INSURANCE FOR ALL PERSONS NOT |
| SELECTED AT OE42 AS CONTINUOUS COVERAGE FROM THE |
| REFERENCE PERIOD START DATE UNTIL THE REFERENCE |
| PERIOD END DATE. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |
| THIS ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED ‘2’ |
| (NO), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED |
| AT OE42 AS ‘CONTINUOUS COVERAGE’ FROM THE |
| REFERENCE PERIOD START DATE UNTIL DATE RECORDED |
| AT OE40. |
----------------------------------------------------
LOOP_14
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |
| PERS-TRPLS-ROSTER, ASK OE43 - END_LP14. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_14 COLLECTS THE DATE ON |
| WHICH THE INSURANCE COVERAGE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER|
| WHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCE|
| PERIOD END DATE OR THE DATE REPORTED IN OE40. |
| THIS LOOP CYCLES ON PERSONS SELECTED AT OE42. |
----------------------------------------------------
OE43
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
On what date did the health insurance through (ESTABLISHMENT)
end for (PERSON)?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE43OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_30 |
----------------------------------------------------
OE43OV
======
Can you just tell me if (PERSON) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
BOX_30
======
----------------------------------------------------
| FLAG INSURANCE FOR PERSON AS ‘CONTINUOUS COVERAGE’|
| THROUGH THE COMPLETE DATE RECORDED AT OE43 AND |
| OE43OV. |
----------------------------------------------------
END_LP14
========
----------------------------------------------------
| 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_14 AND CONTINUE WITH BOX_31 |
----------------------------------------------------
BOX_31
======
----------------------------------------------------
| IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY |
| THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,|
| (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU |
| MEMBERS NOT COVERED BY THIS INSURANCE ON THE |
| PREVIOUS ROUND’S INTERVIEW DATE, BUT EXCLUDES RU |
| MEMBERS JUST MARKED AS NO LONGER COVERED IN OE42),|
| CONTINUE WITH OE44 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO OE47 |
----------------------------------------------------
OE44
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, have
any persons living here, we have not yet mentioned, been covered
by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?
YES ................................... 1
NO .................................... 2 {OE47}
REF ................................... -7 {OE47}
DK .................................... -8 {OE47}
PRESS F1 FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
OE45
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
Who {has been/was} covered by (POLICYHOLDER)’s health insurance
through (ESTABLISHMENT) {since (START DATE)/between (START DATE)
and (END DATE)} that we have not yet mentioned?
PROBE: Who else {has been/was} covered by (POLICYHOLDER)’s health
insurance through (ESTABLISHMENT) {since (START DATE)/between
(START DATE) and (END DATE)} that we have not yet mentioned?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS|
| ON THE RU-MEMBERS-ROSTER WHO WERE NOT COVERED BY |
| THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- |
| PAIR ON THE PREVIOUS ROUND’S INTERVIEW DATE. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY ON|
| THIS ROSTER. |
----------------------------------------------------
----------------------------------------------------
| WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- |
| COVRD-PERS-TRPLS-ROSTER. |
----------------------------------------------------
----------------------------------------------------
| IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG |
| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |
| AS ‘COVERING PERSON NOT LISTED IN RU’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT|
| ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) |
| and (END DATE)’ IF ROUND 5. |
----------------------------------------------------
LOOP_15
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |
| PERS-TRPLS-ROSTER, ASK OE46 - END_LP15. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_15 COLLECTS THE COVERAGE |
| START DATE FOR ALL PERSONS NEWLY COVERED DURING |
| THE CURRENT ROUND BY THE INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON |
| PERSONS SELECTED AT OE45. |
----------------------------------------------------
OE46
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT.........} {STR-DT}
{END-DT}
On what date did the health insurance through (ESTABLISHMENT)
begin for (PERSON)?
[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|
| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |
| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE46OV |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_32 |
----------------------------------------------------
OE46OV
======
Can you just tell me if (PERSON) was covered under that
insurance the whole month or part of the month?
WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
| EDIT: COMPLETE DATE AT OE46 MUST BE < THAN |
| COMPLETE DATE AT OE40 IF A DATE IS RECORDED AT |
| OE40 OR < THAN REFERENCE PERIOD END DATE IF NO |
| DATE IS RECORDED AT OE40. |
----------------------------------------------------
BOX_32
======
----------------------------------------------------
| IF FAMILY STILL HAS INSURANCE THROUGH THIS |
| ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED ‘1’ |
| (YES)), FLAG INSURANCE FOR THIS PERSON AS |
| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE46 |
| UNTIL THE REFERENCE PERIOD END DATE. |
----------------------------------------------------
----------------------------------------------------
| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |
| ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED ‘2’ (NO))|
| FLAG INSURANCE FOR THIS PERSON AS ‘CONTINUOUS |
| COVERAGE’ FROM DATE RECORDED AT OE46 UNTIL DATE |
| RECORDED AT OE40. |
----------------------------------------------------
END_LP15
========
----------------------------------------------------
| CYCLE ON NEXT PERSON IN 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_15 AND GO TO END_LP13 |
----------------------------------------------------
OE47
====
{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 OE45 |
----------------------------------------------------
END_LP13
========
----------------------------------------------------
| CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-|
| PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN |
| THE LOOP DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END |
| LOOP_13 AND CONTINUE WITH BOX_33 |
----------------------------------------------------
BOX_33
======
----------------------------------------------------
| RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN HX. |
----------------------------------------------------
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