MEPS HC-066: 2002 Person Round Plan Public Use File
August 2004
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
301-427-1406
TABLE OF CONTENTS
A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Insurance Component
4.0 Survey Management
C. Technical and Programming Information
1.0 General Information
2.0 Data File Description
2.1 Complex File Structure With Examples
2.2 Identifiers
2.3 Adding the Characteristics of Covered Persons
2.4 Adding the Policyholder’s Characteristics
2.5 Choosing PRPL Records for Your Research Question
3.0 Data File Contents
3.1 ID Variables
3.2 Person Variables
3.3 Policyholder Variables
3.4 Establishment Variables
3.4.1 Employers and Other Establishments
3.4.2 Types of Coverage through the Establishment
3.4.3 Out-of-Pocket Premiums
3.5 Plan Variables
3.5.1 Household Reports of Managed Care
3.5.2 Family Experience with Plan
3.5.3 Change in Plan Name
3.6 Links to Job Providing Insurance
References
D. Variable Source Crosswalk
A. Data Use Agreement
Individual identifiers have been removed from the micro-data
contained in the files that are part of this Public Use Release.
Nevertheless, under sections 308 (d) and 903 (c) of the Public Health
Service Act (42 U.S.C. 242m and 42 U.S.C. 299 a-1), data collected by
the Agency for Healthcare Research and Quality (AHRQ) and /or the
National Center for Health Statistics (NCHS) may not be used for any
purpose other than for the purpose for which they were supplied; any
effort to determine the identity of any reported cases, is prohibited by
law.
Therefore in accordance with the above referenced Federal Statute, it
is understood that:
No one is to use the data in this data set in any way except for
statistical reporting and analysis; and
If the identity of any person or establishment should be discovered
inadvertently, then (a) no use will be made of this knowledge, (b) The
Director Office of Management AHRQ will be advised of this incident, (c)
the information that would identify any individual or establishment will
be safeguarded or destroyed, as requested by AHRQ, and (d) no one else
will be informed of the discovered identity.
No one will attempt to link this data set with individually
identifiable records from any data sets other than the Medical
Expenditure Panel Survey or the National Health Interview Survey.
By using this data you signify your agreement to comply with the
above stated statutorily based requirements with the knowledge that
deliberately making a false statement in any matter within the
jurisdiction of any department or agency of the Federal Government
violates Title 18 Part 1 Chapter 47 Section 1001 and is punishable by a
fine of up to $10,000 or up to 5 years in prison.
The Agency for Healthcare Research and Quality requests that users
cite AHRQ and the Medical Expenditure Panel Survey as the data source in
any publications or research based upon these data.
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B. Background
This documentation describes one in a series of public use files from
the Medical Expenditure Panel Survey (MEPS). The survey provides a new
and extensive data set on the use of health services and health care in
the United States.
MEPS is conducted to provide nationally representative estimates of
health care use, expenditures, sources of payment, and insurance
coverage for the U.S. civilian non-institutionalized population. MEPS is
cosponsored by the Agency for Healthcare Research and Quality (AHRQ)
(formerly the Agency for Health Care Policy and Research (AHCPR)) and
the National Center for Health Statistics (NCHS).
MEPS comprises three component surveys: the Household Component (HC),
the Medical Provider Component (MPC), and the Insurance Component (IC).
The HC is the core survey, and it forms the basis for the MPC sample and
part of the IC sample. Together these surveys yield comprehensive data
that provide national estimates of the level and distribution of health
care use and expenditures, support health services research, and can be
used to assess health care policy implications.
MEPS is the third in a series of national probability surveys
conducted by AHRQ on the financing and use of medical care in the United
States. The National Medical Care Expenditure Survey (NMCES, also known
as NMES-1) was conducted in 1977, the National Medical Expenditure
Survey (NMES-2) in 1987. Beginning in 1996, MEPS continues this series
with design enhancements and efficiencies that provide a more current
data resource to capture the changing dynamics of the health care
delivery and insurance system.
The design efficiencies incorporated into MEPS are in accordance with
the Department of Health and Human Services (DHHS) Survey Integration
Plan of June 1995, which focused on consolidating DHHS surveys,
achieving cost efficiencies, reducing respondent burden, and enhancing
analytical capacities. To accommodate these goals, new MEPS design
features include linkage with the National Health Interview Survey (NHIS),
from which the sampled households for the MEPS HC are drawn, and
continuous longitudinal data collection for core survey components. The
MEPS HC augments NHIS by selecting a sample of NHIS respondents,
collecting additional data on their health care expenditures, and
linking these data with additional information collected from the
respondents’ medical providers, employers, and insurance providers.
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1.0 Household Component
The MEPS HC, a nationally representative survey of the U.S. civilian
non-institutionalized population, collects medical expenditure data at
both the person and household levels. The HC collects detailed data on
demographic characteristics, health conditions, health status, use of
medical care services, charges and payments, access to care,
satisfaction with care, health insurance coverage, income, and
employment.
The HC uses an overlapping panel design in which data are collected
through a preliminary contact followed by a series of five rounds of
interviews over a 2½ - year period. Using computer-assisted personal
interviewing (CAPI) technology, data on medical expenditures and use
for two calendar years are collected from each household. This
series of data collection rounds is launched each year on a new sample
of households to provide overlapping panels of survey data and, when
combined with other ongoing panels, will provide continuous and current
estimates of health care expenditures.
The sample of households selected for the MEPS HC is drawn from among
respondents to the NHIS, conducted by NCHS. The NHIS provides a
nationally representative sample of the U.S. civilian
non-institutionalized population, with oversampling of Hispanics and
blacks.
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2.0 Medical Provider Component
The MEPS MPC supplements and/or replaces information on medical care
events reported in the MEPS HC by contacting medical providers and
pharmacies identified by household respondents. The MPC sample includes
all home health agencies and pharmacies reported by HC respondents.
Office-based physicians, hospitals, and hospital physicians are also
included in the MPC but may be subsampled at various rates, depending on
burden and resources, in certain years.
Data are collected on medical and financial characteristics of
medical and pharmacy events reported by HC respondents. The MPC is
conducted through telephone interviews and record abstraction.
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3.0 Insurance Component
The MEPS IC collects data on health insurance plans obtained through
employers, unions, and other sources of private health insurance. Data
obtained in the IC include the number and types of private insurance
plans offered, benefits associated with these plans, premiums,
contributions by employers and employees, eligibility requirements, and
employer characteristics.
Establishments participating in the MEPS IC are selected through four
sampling frames:
- A list of employers or other insurance providers identified by
MEPS HC respondents who report having private health insurance at
the Round 1 interview.
- A Bureau of the Census list frame of private sector business
establishments.
- The Census of Governments from Bureau of the Census.
- An Internal Revenue Service list of the self-employed.
To provide an integrated picture of health insurance, data collected
from the first sampling frame (employers and insurance providers) are
linked back to data provided by the MEPS HC respondents. Data from the
other three sampling frames are collected to provide annual national and
State estimates of the supply of private health insurance available to
American workers and to evaluate policy issues pertaining to health
insurance.
The MEPS IC is an annual panel survey. Data are collected from the
selected organizations through a prescreening telephone interview, a
mailed questionnaire, and a telephone followup for nonrespondents.
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4.0 Survey Management
MEPS data are collected under the authority of the Public Health
Service Act. They are edited and published in accordance with the
confidentiality provisions of this act and the Privacy Act. NCHS
provides consultation and technical assistance.
As soon as data collection and editing are completed, the MEPS survey
data are released to the public in staged releases of summary reports
and microdata files. Summary reports are released as printed documents
and/or electronic files on the MEPS web site
(www.meps.ahrq.gov). All
microdata files are available for download from the MEPS web site in
compressed formats (zip and self-extracting executable files.) Selected
data files are available on CD-ROM from the MEPS Clearinghouse.
For printed documents and CD-ROMs that are available through the AHRQ
Publications Clearinghouse, write or call:
AHRQ Publications Clearinghouse
Attn: (publication number)
P.O. Box 8547
Silver Spring, MD 20907
800/358-9295
410/381-3150 (callers outside the United States only)
888/586-6340 (toll-free TDD service; hearing impaired only)
Be sure to specify the AHRQ number of the document or CD-ROM you are
requesting.
Additional information on MEPS is available from the MEPS project
manager or the MEPS public use data manager at the Center for Financing,
Access and Cost Trends, Agency for Healthcare Research and Quality, 540
Gaither Road, Rockville, MD 20850 (301/427-1406).
Return To Table Of Contents
C. Technical and Programming Information
1.0 General Information
This public use data file contains data for each person with private
health insurance reported in rounds 3, 4, and 5 of Panel 6 and rounds 1,
2, and 3 of Panel 7 (i.e., the rounds for the survey panels covering
calendar year 2002) of the Medical Expenditure Panel Survey Household
Component (MEPS HC). Released as an ASCII file with SAS format
statements and in SAS transport format, this public use file provides
information collected on a nationally representative sample of the
civilian noninstitutionalized population of the United States during the
calendar year 2002. The HC-066 file contains records for persons insured
through private establishments providing hospital/physician, medigap,
dental, vision, or prescription medication coverage and includes
variables pertaining to managed care and experiences with plans.
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2.0 Data File Description
The Person-Round-Plan (PRPL) file for 2002 is a complex file of
privately insured persons and their private health insurance plans and
links to the jobs providing insurance. The PRPL file is designed to
facilitate research on the sometimes complex and dynamic relationships
between consumers and their private insurance. It is not a person-level
file, and linking the PRPL file to a person-level file (such as HC-053
and HC-062) requires users making analytic decisions based on
understanding the complexity of the PRPL file.
Records contain the following types of information (Figure 1):
- Flags for whether the person is the policyholder or a
dependent
- Whether enrolled at time of interview
- Months enrolled during the reference period for the
interview
- Interview Round
- Policyholder
- Establishment providing insurance
- Type of establishment (employer, union, insurance agent, etc.)
- Types of coverage (hospital/physician, medigap, dental, vision,
prescription medication, Consolidated Omnibus Budget Reconciliation Act (COBRA), single or family)
1
- Out-of-pocket premiums and employee contributions
1No effort has been
made to validate variables representing type of coverage with external sources.
FIGURE 1
CONCEPTUAL OVERVIEW OF PRPL |
|
Covered
Person:
Policyholder or Dependent
Enrollment at Time of Interview or End of Year |
|
|
|
|
Interview Round |
|
|
|
|
Policyholder |
|
|
|
|
Links to policyholder’s Job at Establishment
(Employment-Based Insurance Only) |
|
|
|
|
Establishment Providing Insurance:
Type of Establishment
Types Coverage
Out-of-Pocket Premiums |
|
|
|
|
Plan
(Hospital/Physician and Medigap Only):
Managed Care
Family Experience with Plan (rounds 2 & 4) |
|
- Plan (for hospital/physician and Medicare supplemental insurance
coverage only)
- Household reports of managed care
- Family experience with plan (collected for rounds 2 and 4)
- Links to the job providing insurance (for employment-based
insurance only, HC-062)
On the records for dependents, variables link to the policyholder’s
job providing insurance, rather than the dependent’s job.
"Establishment" refers to the organization
through which the policyholder obtains private insurance. The establishment
may be an employer, a union, an insurance
agent, an insurance company, a professional association, or
another type of organization. Many questions in the MEPS HC
instrument are asked in reference to the establishment providing
insurance to the policyholder. For example, the MEPS HC asks
about the "types of health insurance" or covered services, such
as hospital/physician and dental coverage, the policyholder gets
through the establishment.
For each establishment, a "plan" is "the
insurance company or Health Maintenance Organization (HMO)" or
self-insured company "from which (POLICYHOLDER) receives"
hospital/physician or Medicare supplemental (Medigap) coverage.
For some focused analyses, it may be important to recognize that
information collected at the establishment level does not
necessarily pertain to the plan level. For example, if a
policyholder obtains from the establishment two separate plans,
a hospital/physician plan and a dental plan, then the dental
plan may not have the same managed care characteristics as the
hospital/physician plan.
Return To Table Of Contents
2.1 Complex File Structure With Examples
The PRPL file is designed to reflect the sometimes complex and dynamic
relationships between people and their private insurance. It allows
maximum flexibility for researchers, but it also requires that they make
analytical decisions in their research.
The PRPL file is a person-round-policyholder-establishment-level file.
There is one unique record for each unique combination of establishment
(source of private insurance), policyholder, interview round, and covered
person (policyholder or dependent). Thus, the PRPL file contains at least
one record for each person in each round with private health insurance,
or 78,004 total records. The PRPL file contains records for persons insured
through establishments providing hospital/physician, medigap, dental,
vision, or prescription medication coverage.
In most cases in this file, one person in the family has insurance from his
or her employer, and this insurance covers everyone in the family. In this
case, there is one record for each family member in each round, and each
record flags the policyholder’s current main job and links to the one
job record in HC-063. However, other cases are more complex, and some
hypothetical examples follow.
Multiple Establishments
- Juan and Maria are both employed parents, both have
health insurance through their employers, and both parents
choose family coverage. In this case, there are two PRPL
records for each family member in each round.
- John and Jane are both employed parents. John has single
coverage from his employer. Jane has family coverage from
her employer. In this case, Jane and the children each have
one PRPL record for each round. John has two records for
each round.
- Jamie has Medicare and Medicare supplemental insurance.
In this case, Jamie has one PRPL record in each round for
the Medicare supplemental insurance. There is no record for
Medicare, because it is public insurance.
- Arlene is a child living with her mother. Both have
Medicaid. Arlene’s father, who does not live with them, has private insurance
that covers Arlene. Arlene has one PRPL record in each round
for the private insurance. There is no record for Medicaid,
because it is public insurance.
No Private Insurance
- Paul is uninsured. In this case, Paul does not have any
PRPL records.
- Mary has Medicaid instead of private coverage. In this
case, Mary does not have any PRPL records.
Sources of Insurance: Employers and Other
Establishments
- Dexter is an employed parent with family coverage
through his current main job. In this case, each family
member’s PRPL record flags Dexter’s current main job as the
source of insurance, and each family member’s PRPL record
links to that job record in PUF HC-063.
- Claire is employed, but she does not have insurance
through her job. Instead she buys a plan directly from an
HMO. In this case, Claire’s PRPL records do not flag her
current main job, nor do they link to any job records in PUF
HC-063.
- Fred has hospital/physician insurance through his
employer, and he buys dental insurance through an insurance
agent. In this case, Fred has two PRPL records, and only the
employment-based insurance flags his current main job and
links to a job record in PUF HC063.
Policyholders Not in the Household
- Edith is a widow and has retiree insurance from her
former husband’s former job. In this case, Edith’s PRPL
record does not link to any employment information in the MEPS. There
is also a PRPL record for Edith’s former husband, where he is
flagged as the policyholder and flagged as deceased, but this record
does not link to any records on any PUFs.
- Matilda’s parents are divorced. She lives with her
father, but her insurance is through her mother’s job. In
this case, Matilda’s PRPL record does not link to any
employment information in the MEPS. There is also a PRPL
record for Matilda’s mother, where she is flagged as the
policyholder and not residing in the Respondent Unit (RU),
but this PRPL record does not link to any records on any PUFs.
Changes in Insurance
- Bob changes jobs between January 1st,
2002 and the date of his MEPS interview, and both jobs
provided health insurance. In this case, Bob has two PRPL
records for the round. EVALCOVR shows whether one or both
plans covered Bob on the interview date.
- Julie quits her job in round 1 (Panel 7) but pays her
previous employer to continue her health insurance while she
looks for another job in round 2. In this case, Julie’ round
1 PRPL record flags her current main job as the source of
her insurance and links to a job record in PUF HC063.
Julie’s round 2 PRPL record does not flag her current main
job as the source of her insurance, but it links to the same
job record from round 1. Thus, the jobs variables from round
1 are no longer current in round 2, but the link exists for users.
Return To Table Of Contents
2.2 Identifiers
Each record contains the following ID variables:
DUPERSID is the person identifier (either a dependent or a policyholder).
RN is the round of the interview in which the enrollment data were collected
PHLDRIDX is the person identifier of the policyholder
ESTBIDX is an ID number for the establishment employer, union, insurance company or other
that is the source of insurance coverage on the record.
EPRSIDX is a combination of ESTBIDX and the PHLDRIDX, and it uniquely identifies the
insurance coverage that a policyholder obtains from an individual establishment.
EPCPIDX is a combination of DUPERSID, RN, and EPRSIDX, and it uniquely identifies
each record.
JOBSIDX is a combination of the PHLDRIDX a round identifier (RN) and a job number
(JOBSN), and it uniquely identifies the policyholder’s job at the establishment
that provided insurance (for employment-based coverage)
For each person covered by a policyholder-establishment combination,
the PHLDRIDX, ESTBIDX, and EPRSIDX appear on each plan record for that
coverage.
A person (DUPERSID) can be listed more than once on this file (1) if
they are covered (as a policyholder or a dependent) by insurance
policies from more than one establishment, or (2) if they are covered in
more than one round. Establishment-policyholder pairs (EPRSIDXs) can be
listed more than once (1) if the health plan a policyholder obtains from
a given establishment also covers his/her dependents, or (2) if the
health plan a policyholder obtains from a given establishment provides
coverage in more than one interview round. As noted above, there is a
PRPL record for each unique combination of establishment (source of
insurance), round, and covered person (policyholder or dependent). The
following table presents a hypothetical example that illustrates the
relationship between the ID variables on this file.
ESTBIDX |
DUPERSID |
PHLDRIDX |
EPRSIDX |
RN |
EPCPIDX |
JOBSIDX |
11 |
42 |
42 |
1142 |
1 |
1142142 |
42101 |
11 |
42 |
42 |
1142 |
2 |
1142242 |
42201 |
11 |
42 |
42 |
1142 |
3 |
1142342 |
42301 |
22 |
53 |
53 |
2253 |
1 |
2253153 |
53101 |
33 |
53 |
53 |
3353 |
1 |
3353153 |
-1 |
44 |
61 |
61 |
4461 |
1 |
4461161 |
61101 |
44 |
62 |
61 |
4461 |
1 |
4461162 |
61101 |
44 |
63 |
61 |
4461 |
1 |
4461163 |
61101 |
55 |
71 |
71 |
5571 |
1 |
5571171 |
71102 |
55 |
71 |
71 |
5571 |
2 |
5571271 |
71102 |
The first three rows of the table represent a
situation where a person (DUPERSID=42) is listed thrice in the PRPL file
because she obtains insurance from the same establishment in all three
rounds. Since the person is the policyholder, her DUPERSIDX is the same
as the PHLDRIDX, which is repeated in the EPRSIDX, EPCPIDX, and JOBSIDX.
The fourth and fifth rows of the table represent a
situation where a person (DUPERSID=53) is listed twice in the PRPL file
because she obtains insurance from more than one establishment. In this
example, the second establishment is not an employer or union, so
JOBSIDX is inapplicable (-1). The sixth, seventh, and eighth rows of the
table represent a situation where a policyholder and two dependents
obtain coverage through the policyholder’s employer (a unique
establishment-policyholder pair, EPRSIDX=4461). The policyholder’s
PHLDRIDX appears in the EPRSIDX and the JOBSIDX for all three covered
persons.
The last two rows of the table represent a situation
where a person is retired and has retiree insurance through a job that
ended prior to 2002. In Panel 7, round 1, the respondent reported the
job from which the sample member retired, and MEPS does not ask about
that job again. However, in each round we ask about the health
insurance. So in round 2 the JOBSIDX contains round number 1, when the
jobs data were last collected.
Finally, note that EPCPIDX uniquely identifies each
record on the file.
In order to conduct person-level analyses, it is
necessary to identify all policies that cover each individual either as
a policyholder or as a dependent. Since each person in the PRPL
file is uniquely identified by the variable DUPERSID, person-level
analyses can be conducted by examining all PRPL records containing each
DUPERSID.
Return To Table Of Contents
2.3 Adding the Characteristics of Covered Persons
The DUPERSID allows you to link on the age, sex,
race, health status, or other person-level variables from the other HC
files. However, this will result in multiple records per person, and
estimates will not be nationally representative unless you use one PRPL
record per person or summarize PRPL records to the person level (and use
weights)
Return To Table Of Contents
2.4 Adding the Policyholder’s Characteristics
The PHLDRIDX allows you to link characteristics of
the policyholder onto the records of every person covered by the plan.
For example, suppose you wanted to study persons whose private
employment-based insurance is through an employee working full time at a
current main job as of the first interview of 2002 (Panel 7 round 1 or
Panel 6 round 3). Then you would select PRPL records matching HC-053
(PUF53FLG=1) where the insurance is through a current main job
(CMJINS=1) and [(PANEL=7 and RN=1) or (PANEL=6 and RN=3)]. From HC-053,
select the DUPERSID and HOUR13 variables and rename DUPERSID to
PHLDRIDX. Merge HOUR13 onto the PRPL file by PHLDRIDX.
Some policyholders do not have records on HC-053 or HC-062. These
include deceased policyholders and policyholders residing outside the
RU. For these policyholders, PUF53FLG and PUF62FLG may be equal to 2,
depending on when the policyholder left the RU. All of the covered
person records for these establishment-policyholder pairs are flagged
with DECPHLDR, OUTPHLDR, or NOPUFLG equal to 1. Deceased policyholders
complicate the estimation of nationally representative statistics on
active policies. For these establishment-policyholder pairs,
users must choose a covered person with a positive weight. However,
establishment-policyholder pairs where the policyholder resides outside
the RU should not be included in estimates, because this will result in
double counting, as RU members covering those outside the RU are already
included.
Return To Table Of Contents
2.5 Choosing PRPL Records for Your Research Question
In order to produce estimates from the data in this
file, researchers must use the person (or family) level weights released
in either of two previously released PUFs, HC-053 or HC-062. Researchers
must consult the documentation for these PUFs for guidance on creating
nationally representative estimates for different time periods.
Note that if there are multiple records per person (DUPERSID)
when you merge on weights, you will double count some people, and your
estimates will not be nationally representative. There are two
solutions: select only one record per person, or aggregate information
across PRPL records.
How you develop your analytical file depends on your
research question. The PRPL file is designed to help answer a wide
variety of research questions. AHRQ cannot anticipate all these
questions, so this section provides examples of how to use the PRPL file
for three research questions.
How many people were covered by two or more private hospital/physician insurance plans at the end of 2002?
Select the Panel 7 round 3 and Panel 6 round 5
records with PRIVCAT>0 and MSUPINS ne 1 and EVALCOVR=1. Count the number
of records for each person (DUPERSID). Create one person-level record
for each DUPERSID that has the number of plans (PRPL records). Merge the
count variable onto PUF HC-062 and use weights, strata, and PSUs to
create nationally representative estimates.
How many people reported private dental coverage from an employer at the end of 2002?
Select the Panel 7 round 3 and Panel 6 round 5
records with DNTLINS=1 and PRIVCAT in (1,4,5) and EVALCOVR=1. Among
these records, select one record for each person (DUPERSID). Merge each
record onto PUF HC-062 and use weights, strata, and PSUs to create
nationally representative estimates.
At the time of the first interview, how many private insurance policies for hospital/physician were not employment-based?
Select the Panel 7 round 1 and Panel 6 round 3
records with PRIVCAT in (2, 3, 99) and EVALCOVR=1. Select one record for
each policyholder-establishment pair (EPRSIDX). To have a positive
weight for the final count, we recommend choosing the covered person
record of the policyholder (PHOLDER=1), unless the policyholder is
deceased (DECPHLDR=1), in which case then the researcher should choose a
different covered person#8217;s
record. Merge each record onto PUF HC-053 and use weights, strata, and
PSUs to create nationally representative estimates.
How many people were in families that gave the highest rating for at least one of their private health plans?
Select the Panel 7 round 2 and Panel 6 round 4 records with SATELIG=1
and RATEPLAN=10. Select one record for each DUPERSID. Merge each record
onto PUF HC-062 and use weights, strata, and PSUs to create nationally
representative estimates.
Return To Table Of Contents
3.0 Data File Contents
3.1 ID Variables
In the MEPS Household Component, the definitions of Dwelling Units (DUs)
and Group Quarters are generally consistent with the definitions
employed for the National Health Interview Survey. The dwelling unit ID
(DUID) is a five-digit random ID number assigned after the case was
sampled for MEPS. The person number (PID) uniquely identifies all
persons within the dwelling unit. The variable DUPERSID is the
combination of the variables DUID and PID. The MEPS - HC - PRPL file can
be linked to other person-level public use files such as MEPS HC-053:
Combined Panel 6, Round 3/Panel 7, Round 1 2002 Population
Characteristics by using the DUPERSID.
PHLDRIDX is the person identifier (DUID + PID) of the policyholder of
the private health insurance plan. Generally, the characteristics of the
policyholder can be linked from other person-level public use files by
using the PHLDRIDX to match the DUPERSID on the other files. However,
when the policyholder is deceased or resides outside the RU, then there
are no person-level variables on public use files (unless the
policyholder was alive and resided in the household at some point during
the time periods covered by the interviews).
ESTIBIDX is an ID number assigned to place of employment and to
sources of insurance.
EPRSIDX is a combination of ESTBIDX and PHLDRIDX. In a few cases,
more than one EPRSIDX may identify a policyholder-source of coverage
pair, because when an RU splits, for example, through divorce or because
a child goes to college, each new RU separately reports insurance
information, and hence MEPS cannot determine with certainty whether
members in both RUs have the same policy. Although both RUs may report
coverage through the same policyholder, the RUs will have different
EPRSIDXs and ESTBIDXs. (The RU letter is embedded in the ESTBIDX and
EPRSIDX.) For each RU (EPRSIDX), there is a PRPL record for the
policyholder as a covered person, but for only one of the EPRSIDX’s (the
one in which the policyholder resides) is the policyholder coded as
having coverage in the STATUS or EVALCOVR variables.
JOBSIDX is a combination of the PHLDRIDX, a round identifier (RN),
and a job number (JOBSN), and it uniquely identifies the policyholder’s
job at the establishment that provided insurance (for employment-based
coverage). The round identifier imbedded in JOBSIDX is the round in
which the job was last reported, which is not necessarily the round in
which the insurance was last reported (for example, when the job ended
but the insurance continued). JOBSIDX can be used to link on
characteristics of the policyholder’s job providing insurance from the
Jobs public use file (HC-063).
Return To Table Of Contents
3.2 Person Variables
There are four person-level variables. Binary
variables indicate whether the person is the policy holder (PHOLDER) or
a dependent (DEPNDNT) on the coverage through the establishment. The
variable PUF53FLG indicates whether the person has a record on HC-053,
and PUF62FLG indicates whether the person has a record on HC-062.
There are 25 person-round-level variables. EVALCOVR
is a binary variable indicating whether the person was covered by
insurance from the establishment at the time of interview (rounds 3, and
4 of Panel 6 and rounds 1, and 2 of Panel 7) or on December 31 (round 3
of Panel 7 and round 5 of Panel 6). The variables STATUS1-STATUS24
indicate whether the respondent reported the person was covered by
insurance from the establishment for at least one day during the month.
For Panel 7, STATUS1-STATUS12 represent coverage from January 2002
through December 2002, and STATUS13-24 are inapplicable, because this
information is in year 2003. For Panel 6, STATUS13STATUS24 represent
coverage from January 2002 through December 2002, and STATUS1STATUS12
are inapplicable, because this information is in the year 2001. Coverage
is reported only for the interview reference period. For example, if a
person from Panel 7 was first interviewed in February and reported she
was covered in January and February, and then in the second interview in
August she reported she was covered from March through August, then the
PRPL record for the first round will have STATUS1 and STATUS2 set to 1
and the rest set to inapplicable, and the PRPL for the second round will
have STATUS3 through STATUS8 set to 1 and the rest set to inapplicable.
Return To Table Of Contents
3.3 Policyholder Variables
The values of three variables describing the
policyholder do not vary across the records of the persons covered by
the plan, regardless of whether the covered person is the policyholder.
The variable DECPHLDR indicates the policyholder is deceased. The
variable OUTHLDR indicates the policyholder resides outside the RU. In
each case, there are no person-level records on a person-level PUF, even
though the PRPL file has a record for the policyholder as a
covered-person (that is, a record where PHOLDER=1). The variable NOPUFLG
indicates there is another reason the policyholder does not have a
record on a person-level PUF. The purpose of these flags is to explain
any difficulty users may have linking policyholder information onto the
PRPL file. These variables do not, however, measure mortality or
policyholders’ leaving household, which should instead be obtained from
the PSTATUS variables on the person-level files. (For example,
policyholders who die between rounds 1 (Panel 7) or 3 (Panel 6) and the
end of 2002 will have records on HC-053 and HC-062, and PUF53FLG and
PUF62FLG will be set to 1.)
Return To Table Of Contents
3.4 Establishment Variables
The values of establishment-level variables do not
vary across the records of the persons insured through the
policyholder-establishment pair.
3.4.1 Employers and Other Establishments
The type of establishment providing coverage (TYPEFLAG)
is on the record. This variable is the source for types of
establishments providing coverage that is not through an employer (HX03
and HX23). TYPEFLAG reflects the type of establishment when the
establishment was first reported, but it is not necessarily updated. For
example, users must link to the jobs file to obtain information on
employees who left their job since the interview in which the employer
was first reported (see section 3.6). For employment-based coverage
through both an employer and a union (such as insurance through a
labor-management committee), information about only one of the establishments,
usually the employer, is on the record. (These cases are identifiable through
the PROVDINS variable on the JOBS file.)
Return To Table Of Contents
3.4.2 Types of Coverage through the Establishment
The establishments in the PRPL file provide private
health insurance covering hospital/physician, Medicare supplemental
insurance, dental, vision, or prescription medication insurance. The
variable PRIVCAT identifies the type of source for hospital and
physician or
Medicare supplemental insurance. HOSPINSX and MSUPINSX are edited
establishment-policyholder flags for whether the policyholder has
physician/hospital and medigap coverage, respectively, through the
establishment. However, even when PRIVCAT indicates there is either
hospital/physician or medigap coverage, both HOSPINSX and MSUPINSX may
have missing values. Note also that both HOSPINSX and MSUPINSX may be
coded "yes" on the same record. DENTLINS, VISIONIN, and PMEDINS flags
indicate the establishment provides coverage for dental care, vision
care, and prescription medications, respectively. Below are examples of
how to use these variables to identify types of insurance:
Identifying Types of Insurance |
Variable and Values |
Hospital and physician or Medicare supplemental insurance |
PRIVCAT in (1,2,3,4,5,99) |
Medicare supplemental insurance |
MSUPINSX = 1 |
Hospital and physician insurance |
PRIVCAT in (1,2,3,4,5,99) & MSUPINSX ne 1 |
Dental insurance |
DNTLINS = 1 |
The variable COBRA is a flag for whether the
respondent reported the coverage was obtained through the requirements
of the COBRA of 1986. This act requires that certain employers allow
some former employees to continue their employment-based coverage by
paying the employer the premium (U.S. Department of Labor 1999). This
flag does not, however, indicate all the coverage through former
employers, which can be determined using TYPEFLAG and links to former
jobs in the JOBS file. COBRA is set to "yes" if any of the three
following conditions are met:
- The respondent said insurance from
a previous job is the source of coverage and the
respondent answered yes to either HP14 or OE14
(depending on when the job ended):
Some employer insurance can be continued after
leaving the company by continuing to pay the premium. This is sometimes referred to as a COBRA plan.
Is (POLICYHOLDER)’ s (ESTABLISHMENT) insurance like that?
Or
Did that health insurance continue through COBRA?
- The respondent said COBRA is the source of insurance through a
self-insured firm with firm-size one (HX03)
- The respondent said COBRA is the source of insurance not
elsewhere reported (HX23)
COBRA is set to "no" when the insurance was not COBRA
coverage. COBRA is set to "inapplicable" when the coverage was not
employment-based, and when the coverage was through a current job. COBRA
is set to "not ascertained" for retirement jobs first reported in the
employment section in round 1 (EM80), retirement jobs first reported in
the employment section for new RU members (EM80), and insurance through
unions reported in the insurance section (HX23)
2.
In a few cases, self-employed persons with firm size = 1 reported buying
coverage through a previous job, and these cases are coded as yes or no,
while other insurance through self-employment with firm size = 1 is coded
"inapplicable".
The variable COVTYPIN flags whether coverage was
single or family, based on the number of persons covered in the RU,
whether the establishment’s insurance covers someone outside the
household, and whether the policyholder is outside the household. For
Panel 7 rounds 1 and 2, and Panel 6 rounds 3 and 4, the number of
covered persons was measured at the time of the interview (or end of the
reference period). For Panel 7 round 3 and Panel 6 round 5 the number is
as of December 31st.
2
In these three cases, the survey was not designed to ascertain whether the
coverage was COBRA or not, but the variable is coded as "not
ascertained" to help analysts.
Return To Table Of Contents
3.4.3 Out-of-Pocket Premiums
In the 2002 MEPS, questions on out of pocket premiums
were asked of all policyholders with private insurance coverage, for all
establishments. The variable OOPPREM provides the monthly out-of-pocket
premium paid by the policyholder for coverage through the establishment
for Panel 7 as of round 1 and Panel 6 as of round 3. OOPELIG flags these
covered-person-policyholder-establishment triples. OOPPREMX provides an
edited version of OOPPREM and the variable OOPFLAG identifies which
records were edited. OOPX12X is provided as a convenience to researchers
and contains the edited monthly out-of-pocket premium amount multiplied
by 12, representing the annual amount.
The edited variable OOPPREMX includes imputed values for records
which contained missing values as well as for a limited number of
records with values that were implausibly low or high. For policyholders
in Panel 6 Round 3 with missing out-of-pocket premiums, if coverage is
through a continuation job which was originally reported in Panel 6
Round 1 and type of coverage, (COVTYPIN) is the same as in Panel 6 Round
1, then OOPPREMX is set equal to OOPPREMX from Panel 6 Round 1 times the
growth rate in out-of-pocket premiums from 2001 to 2002. The growth rate
is assigned by type of coverage and is based on private sector
out-of-pocket premiums reported in MEPS-Insurance Component in 2001 and
2002. For all other cases, imputed values were assigned by a hotdeck
imputation procedure which accounted for source of insurance (private
employer, state and local government, federal government, medigap, other
non-group policy), age of policyholder, number of persons covered by the
policy, size of employer, region and MSA, presence of supplemental
benefits such as drug, dental and vision, and active or retired job.
Both OOPPREM and OOPREMX are coded as zero for those who reported
paying none of their premium.
OOPPREM was created using the out-of-pocket amount reported and the
frequency of payments (HX61, HX62, and HX620V1):
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 co-payments, coinsurance or deductibles
anyone in the family may have had to pay.]
How much {(do/does)/did} (POLICYHOLDER) pay for the (ESTABLISHMENT) coverage?
PROBE: {Is/Was} that per year, per month, per week, or what?
PREMLEVX shows whether OOPPREM was the full premium or part of it.
When the respondent reported they paid some or none of the premium, the
variables BYFED BYSTATE BYLOCAL BYSOMGOV BYEMPL BYUNION BYOTHER indicate
who paid the rest of the premium.
For the entire set of 13 variables (OOPPREM OOPREMX OOPX12X OOPELIG
OOPFLAG PREMLEVX BYFED BYSTATE BYLOCAL BYSOMGOV BYEMPL BYUNION BYOTHER),
the same values are reported on the records of each dependent person
covered through the policyholder’s establishment, but the policyholder
paid only once per establishment-policyholder.
Return To Table Of Contents
3.5 Plan Variables
The values of plan-level variables do not vary across
the records of the persons insured through the
policyholder-establishment pair. The PRPL file contains managed care and
experience with plan variables for hospital/physician and Medicare
supplemental plans. For all other plans, these variables are set to
"inapplicable."
3.5.1 Household Reports of Managed Care
The variable UPRHMO identifies records for HMO
coverage when the household respondent reported that the insurance was
purchased through an HMO, reported the insurance company was an HMO, or
described the plan as an HMO. In all cases the respondent answered a
question using the term "HMO." UPRHMO is set to "yes" if any of the
three following conditions are met:
-
If the respondent reported purchasing the insurance directly
through an HMO (HX03, HX23)
-
If the respondent identified the type of insurance company as an
HMO (HX49, HX51, HX54)
-
If the respondent answered yes to the following question (MC01):
Now I will ask you a few questions about how (POLICYHOLDER)’s
health insurance through (ESTABLISHMENT) works for non-emergency care.
We are interested in knowing if (POLICYHOLDER)’s (ESTABLISHMENT)
plan is an HMO, that is, a Health Maintenance Organization. With an HMO,
you must generally receive care from HMO physicians. For other doctors,
the expense is not covered unless you were referred by the HMO or
there was a medical emergency. Is (POLICYHOLDER)’s (INSURER NAME)
an HMO?
UPRHMO is set to "no" when the plan was not an HMO.
UPRHMO is set to inapplicable when the plan was not hospital/physician
or Medicare supplemental coverage.
The variable UPRMNC identifies records for gatekeeper
plans. The household respondent has not identified the plan as an HMO
but has identified a characteristic of the plan that requires plan
members to sign up with a gatekeeper for all routine care (the exact
question is given below). In 1998, this gatekeeper feature was
associated with HMO plans and with some Preferred Provider Organization
(PPO) plans. Users of the data can decide how to classify these persons.
UPRMNC is set to "yes" if the following condition is met:
If the respondent answered "no" to the HMO question (MC01)
and "yes" to the following question (MC02):
(Do/Does) (POLICYHOLDER)’s insurance plan
require (POLICYHOLDER) to sign up with a certain primary care doctor,
group of doctors, or a certain clinic which (POLICYHOLDER) must go
to for all of (POLICYHOLDER)’s routine care?
Probe: Do not include emergency care or care from a
specialist you were referred to.
UPRMNC is set to "no" when the plan does not require a gatekeeper and
when the plan is an HMO. UPRMNC is set to "inapplicable" when the plan is not
hospital/physician or Medicare supplemental coverage.
Return To Table Of Contents
For plans other than HMOs and those with gatekeepers, the variable
DRLIST identifies records for plans that the household respondent said
had a book or list of doctors. The household respondent has not
identified the plan as a PPO but has identified a plan characteristic
associated with PPO plans. If both the following conditions were met:
- If the person did not say the plan is an HMO (HX03, HX23, HX49,
HX51, HX54, MC01)
- If the respondent answered "no" to the gatekeeper question
(MC02)
then the respondent was asked MC03:
Is there a book or list of doctors associated with the plan?
DRLIST is set to "inapplicable" when the plan is not
hospital/physician or Medicare supplemental coverage, when the plan is
an HMO, or when the plan requires a gatekeeper.
For HMOs and for plans with gatekeepers and lists of doctors, the
variable VISITPAY identifies records for plans that the household
respondent said paid for out-of-network visits. The household respondent
has not identified the plan as a PPO or a Point of Service (POS) plan
but has identified a plan characteristic associated with PPO and POS
plans. When the respondent answered "yes" to the gatekeeper question
(MC02), or answered "yes" to the list of doctors question (MC03), then
VISITPAY has the responses to MC04:
Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors
who are not associated with (POLICYHOLDER)’s plan, even if (POLICYHOLDER)
(do/does) not have a referral?
When the respondent said the plan is an HMO (HX03, HX23, HX49, HX51,
HX54, MC01), then VISITPAY has the responses to MC05, HX60A, OE11B,
OE25B, and OE38B:
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?
VISITPAY is set to "inapplicable" when the plan is not
hospital/physician or Medicare supplemental coverage, or when the plan
does not require a gatekeeper and does not have a list of doctors.
Return To Table Of Contents
3.5.2 Family Experience with Plan
Experience with plan questions were asked at rounds 2
(Panel 7) and 4 (Panel 6) for families where at least one member was
covered by the plan at the time of the interview. The variable SATELIG
indicates whether the policyholder-establishment was eligible for the
experience with plan questions. Respondents were eligible for the experience with
plan questions if someone in the RU was covered by the plan on the date
of the interview and the insurance was hospital/physician or Medicare
supplemental coverage. Question wording is based on questions in the
Consumer Assessment of Health Plans (CAHPS®), an AHRQ-sponsored family
of survey instruments designed to measure quality from the consumer’s
perspective. In 2002, these questions replaced the satisfaction with
plan questions asked from 1996 through 2001.
The variables address the following topics:
difficulty getting a personal doctor or nurse (GTDOCPRB), delays waiting
for plan approval for care (APRVTRET, APRVDLAY), problems finding or
understanding plan information (LOOKINF, PRBFDINF), problems getting
help from customer service (CUSTSERV, PRBCSTSV), problems with paperwork
(PAPRWRK, PRBPPRWK), and rating of experience with plan (RATEPLAN).
When multiple RU members were covered by the same
private plan, the respondent answered the questions once and described
experiences for the policyholder and family members. These family
(RU)-level responses are on each round 2 or 4 covered
person-policyholder-establishment record for the
policyholder-establishment and do not vary across covered persons.
Return To Table Of Contents
3.5.3 Change in Plan Name
The variable NAMECHNG indicates whether the name of
the plan obtained through the establishment changed from the prior
round. For Panel 7 rounds 2 and 3 and Panel 6 rounds 3, 4 and 5,
NAMECHNG is set to "yes" if someone in the RU had coverage through the
establishment in the prior round and still had coverage at the time of
the interview, and the respondent answered yes to the following question
(OE09, OE23, OE35):
Since (START DATE), has there been any change in the plan name of the
health insurance (POLICYHOLDER) has through (ESTABLISHMENT)?
If the respondent answered no, then NAMECHNG is coded
no. If no one in the RU had coverage through the establishment in the
prior round, no one had coverage at the time of the interview, or it is
a round 1 record, then NAMECHNG is set to "inapplicable."
When the respondent answered yes, then MEPS HC asked about types of
benefits and managed care, which are updated on the PRPL file.
There are two important caveats to this variable.
First, changes in plan name do not necessarily imply the plan itself
changed. For example, the plan may have merely changed its name for
marketing purposes. Second, the variable NAMECHNG pertains only to
changes in plan names at the same establishment; a policyholder may
switch plans if she or he switches the establishment (including
employer) through which he or she obtains insurance. Switches in EPRSIDs
and ESTBIDs between rounds indicate those other types of changes.
Return To Table Of Contents
3.6 Links to Job Providing Insurance
For employment-based insurance, there are two
variables linking the insurance to details about the jobs through which
the insurance was obtained, CMJINS and JOBSIDX.
Most people with employment-based insurance have it
through current main jobs. The variable CMJINS indicates whether the
insurance is through a current main job. When the insurance is not
employment-based, then CMJINS is set to "inapplicable." Generally, many
edited and imputed variables describing policyholders’ current main jobs
are available on HC-053 and HC-062. If CMJINS =1 and the policyholder
has a PUF record (PUF53FLG or PUF62FLG), then edited and imputed current
main jobs variables are available on the indicated PUF.
For other types of jobs (for example, former jobs),
the JOBS files (HC-063 and HC-056) contain edited variables describing
the job. JOBSFILE indicates which jobs file contains information about
the source of coverage. In most cases, information about the job is in
HC-062, but for Panel 6, if the job ended before 2002, information about
the job is contained in HC-056. JOBSIDX is the link to the record for
the job in the JOBS file that is the source of coverage. This link is
slightly complicated, because the variable JOBSINFR indicates links that
were inferred, rather than obtained directly from the respondent. Links
were inferred because when persons reported employment-based health
insurance at the end of the insurance section (HX23), the plan is not
always easily linked to a specific job. Most of these cases were
directly linked by establishment IDs, but others required inferences
based on whether the insurance was through a current or former job (EMPLSTAT),
and some could not be linked at all.
The variable EMPLSTAT contains the answers to
question HP12, which is asked only about the policyholders of
employment-related insurance first mentioned at the end of the insurance
section of the interview (HX23), and it is asked only in the interview
round where the insurance was first reported. Thus, it is useful only
for the cases where links to jobs could not be inferred. Because it does
not contain updated information about the policyholder’s employment at
each interview, the value is set to -2 in subsequent rounds, and users
can link back to the PRPL record from the prior rounds, using the
DUPERSID and EPRSIDX, to get the original information.
Return To Table Of Contents
References
U.S. Department of Labor. Pension and Welfare Benefits Administration. 1999.
Health Benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
Washington, DC. [Available on-line at:
http://www.dol.gov/ebsa/pdf/cobraemployee.pdf]
Return To Table Of Contents
D. Variable Source Crosswalk
VARIABLE TO SOURCE CROSSWALK
FOR MEPS PUBLIC USE FILE HC-066
HEALTH INSURANCE VARIABLES - SOURCE
Variable |
Label |
Source |
EPCPIDX |
UNIQUE RECORD IDENTIFIER (DUPERSID+RN+EPRSIDX) |
CONSTRUCTED |
DUPERSID |
PERSON IDENTIFIER (EITHER DEPENDENT OR POLICYHOLDER) |
CONSTRUCTED |
PHLDRIDX |
PERSON IDENTIFIER OF THE POLICYHOLDER |
CONSTRUCTED |
ESTBIDX |
ESTABLISHMENT ID |
CONSTRUCTED |
EPRSIDX |
UNIQUELY IDENTIFIES INSURANCE COVERAGE THAT A
POLICYHOLDER OBTAINS FROM ESTABLISHMENT (ESTBIDX+PHLDRIDX) |
CONSTRUCTED |
PANEL |
PANEL NUMBER |
CONSTRUCTED |
RN |
ROUND NUMBER |
CONSTRUCTED |
JOBSIDX |
UNIQUELY IDENTIFIES POLICYHOLDER’S JOB AT THE
ESTABLISHMENT THAT PROVIDED INSURANCE |
CONSTRUCTED |
JOBSINFR |
JOBSIDX INFERRED RATHER THAN REPORTED ID |
CONSTRUCTED |
PUF53FLG |
INDICATOR IF PERSON IS IN PUF 53 |
CONSTRUCTED |
PUF62FLG |
INDICATOR IF PERSON IS IN PUF 62 |
CONSTRUCTED |
CMJINS |
CMJ AS THE SOURCE OF PLAN: 1 YES, 2 NO |
PRIVCAT, RJ01A, RJ0189A, EM08, EM14 |
EMPLSTAT |
POLICYHOLDER EMPLOYMENT STATUS |
HP 12 |
PHOLDER |
POLICY HOLDER |
HP 9, 11 |
DEPNDNT |
DEPENDENT OF POLICY HOLDER |
PRIVCAT, PHOLDER |
EVALCOVR |
COVERED @ INTERVIEW OR 12/31 |
HQ1, 2 |
STATUS1 – STATUS24 |
STATUS -MONTH 1 THROUGH STATUS -MONTH 24 |
HQ1, 2, 3, 4, 5 |
DECPHLDR |
DECEASED POLICYHOLDER FLAG |
CONSTRUCTED |
OUTPHLDR |
OUT-OF-RU POLICYHOLDER FLAG |
CONSTRUCTED |
NOPUFLG |
PHLDR NOT IN HC053 OR HC062 |
CONSTRUCTED |
TYPEFLAG |
TYPE OF ESTABLISHMENT |
HX 3, 23; EM 6, 8, 12, 14, 19, 22, 23, 28, 31,
32, 41, 44, 45, 54, 57, 58, 71, 74, 75, 83, 86, 87, 118, 120 |
PRIVCAT |
CATEGORY OF PRIVATE COVERAGE |
HX 2, 3, 23, 48, 61, 63; HP 1, 2, 9, 11, 15, 16;
EM 17, 18, 26, 27, 39, 40, 52, 53, 69, 70, 81, 82, 91, 92, 117 |
HOSPINSX |
TYPE OF HI GOTTEN: HOSPITAL/HMO (EDITED) |
HX48 |
MSUPINSX |
TYPE OF HI GOTTEN: MEDIGAP (EDITED) |
HX48 |
DENTLINS |
TYPE OF HI GOTTEN: DENTAL |
HX48 |
VISIONIN |
TYPE OF HI GOTTEN: VISION |
HX48 |
PMEDINS |
TYPE OF HI GOTTEN: PRESCRIPTION DRUG |
HX48 |
COBRA |
COBRA COVERAGE: 1=YES, 2=NO |
HX 3, 23; HP12, 14 ; OE14; EM 8, 9, 14, 15, 22,
23, 24, 31, 32, 33, 44, 46, 57, 58, 74, 75, 76, 80, 85A, 86, 87, 88; RJ 1A, 189A; PRIVCAT |
COVTYPIN |
COVERAGE @INTVW: 1=SINGLE, 2=FAMILY |
HP 15, 16, 17 |
OOPELIG |
FLAG: POLICYHOLDER ESTB HAS PREMIUM |
RN; TYPEFLAG; HX 3, 23; HP14 |
OOPPREM |
MONTHLY OUT-OF-POCKET PREMIUM |
HX 61, 62 |
OOPPREMX |
MONTHLY OUT-OF-POCKET PREMIUM (ED/IMP) |
CONSTRUCTED |
OOPX12X |
ANNUAL OUT-OF-POCKET PREMIUM (ED/IMP) |
CONSTRUCTED |
OOPFLAG |
OOPPREMX EDIT/IMPUTATION FLAG |
CONSTRUCTED |
PREMLEVX |
HOW MUCH OF PREMIUM PAID BY FAM (ED) |
HX 61, 62 |
BYFED |
FEDERAL GOVT PAID FOR PRIV PLAN PREMIUM |
HX63 |
BYSTATE |
STATE GOVT PAID FOR PRIV PLAN PREMIUM |
HX63 |
BYLOCAL |
LOCAL GOVT PAID FOR PRIV PLAN PREMIUM |
HX63 |
BYSOMGOV |
SOME GOVT PAID FOR PRIV PLAN PREMIUM |
HX63 |
BYEMPL |
EMPLOYER PAID FOR PRIV PLAN PREMIUM |
HX63 |
BYUNION |
UNION PAID FOR PRIV PLAN PREMIUM |
HX63 |
BYOTHER |
OTHER PAID FOR PRIV PLAN PREMIUM |
HX63 |
UPRHMO |
HMO COVERAGE (FROM PRPL) |
HX 3, 23, 49_02.TYPE, 50_02.TYPE, 54_02.TYPE; MC 1 |
UPRMNC |
PLAN REQRD COVRD PERS USE GATEKEEPER |
MC 2 |
DRLIST |
DOES PLAN HAVE A BOOK/LIST OF DOCTORS? |
MC 3 |
VISITPAY |
PLAN PAY FOR NON-REFER DR VISIT |
MC 4 |
NAMECHNG |
HAS THERE BEEN A CHANGE IN PLAN NAME |
OE 9, 23, 35 |
SATELIG |
ELIG. FOR SATIS. PLAN QUEST: 1=YES, 2=NO |
PRIVCAT, RN, EVALCOVR |
GTDOCPRB |
HOW MUCH PROBLEM GETTING PERSONAL DOC |
SP 2 |
APRVTRET |
NEED APPROVAL FOR TREATMENT |
SP 3 |
APRVDLAY |
DELAY WAITING FOR APPROVAL |
SP 4 |
LOOKINF |
INFORMATION ON HOW PLAN WORKS |
SP 5 |
PRBFDINF |
PROBLEM FINDING INFORMATION |
SP 6 |
CUSTSERV |
HAS CALLED CUSTOMER SERVICE/ADMIN OFFICE |
SP 7 |
PRBCSTSV |
PROBLEM GETTING HELP FROM CUST SERVICE |
SP 8 |
PAPRWRK |
FILL OUT ANY PAPERWORK FOR PLAN |
SP 9 |
PRBPPRWK |
PROBLEM WITH PLAN PAPERWORK |
SP 10 |
RATEPLAN |
RATE EXPERIENCE WITH PLAN |
SP 11 |
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