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pdfHealth Insurance (HX) Section
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Throughout the specifications for this CAPI section, for screens that
specify the reference period {END DATE} as part of the context header,
CAPI displays the {END DATE} only for Round 5. In any other round, CAPI
does not display the {END DATE} in the context header. For most
persons, the end date for Round 5 will be December 31 of the second
year of the panel.
HX01
Help Enabled
Comment Enabled
Jump Back Enabled
{STR-DT} {END-DT}
Now I’d like to talk with you about health insurance, an important topic for
most persons. We want to know about all the health coverage that anyone in
the family may have had to help pay the costs of medical care at any time
{since (START DATE)/between (START DATE) and (END DATE)}.
{ASK RESPONDENT TO GET INSURANCE CARDS/IDENTIFYING
INFORMATION IF NOT ALREADY AVAILABLE.}
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
DISPLAY INSTRUCTIONS:
DISPLAY ‘ASK....AVAILABLE.’ IF ROUND 1.
NULL DISPLAY.
OTHERWISE, USE A
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY
'between (START DATE) and (END DATE)' IF ROUND 5.
ROUTING INSTRUCTION:
IF ROUND 1, GO TO BOX_03
OTHERWISE, CONTINUE WITH BOX_01
Context Header Display Instructions:
For month display 3 char month (eg. JAN, FEB)
BOX_01
ASK THE OLD EMPLOYMENT AND PRIVATE RELATED INSURANCE (OE) SECTION.
AT COMPLETION OF OE SECTION, CONTINUE WITH BOX_02
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Health Insurance (HX) Section
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BOX_02
ASK THE OLD PUBLIC RELATED INSURANCE (PR) SECTION.
AT COMPLETION OF PR SECTION, CONTINUE WITH BOX_03
BOX_03
IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS PROVIDING HEALTH
INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS 'NOT SELF-EMPLOYED' OR IS FLAGGED AS
'SELF-EMPLOYED' WITH A FIRM-SIZE-GREATER-THAN 1,
CONTINUE WITH LOOP_01
OTHERWISE, GO TO BOX_05
LOOP_01
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK HX02 END_LP01
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT PRIVATE HEALTH
INSURANCE OBTAINED THROUGH AN EMPLOYER. THIS LOOP CYCLES ON ESTABLISHMENTPERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS PROVIDING HEALTH
INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS ‘NOT SELF-EMPLOYED’ OR IS FLAGGED AS
‘SELF-EMPLOYED’ WITH A FIRM-SIZE-GREATER-THAN-1.
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Health Insurance (HX) Section
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HX02
Help Enabled
Variable Name
EPRS.VERCOVR
Comment Enabled
Jump Back Enabled
Label
VERIFY HEALTH INS THROUGH ESTABLISHMENT
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
You mentioned that (PERSON) (were/was) covered by health insurance from
(ESTABLISHMENT) at some point after (START DATE).
SELECT 'HAS/HAD HEALTH INSURANCE' UNLESS RESPONDENT
VOLUNTEERS REPORTED IN ERROR.
HAS/HAD HEALTH INSURANCE
THROUGH (ESTABLISHMENT) AT SOME
POINT AFTER (START DATE)
DOES NOT HAVE HEALTH INSURANCE
THROUGH (ESTABLISHMENT)
1
{BOX_04}
2
{END_LP01}
ROUTING INSTRUCTION:
IF CODED ‘2’ (DOES NOT HAVE HEALTH INSURANCE THROUGH
(ESTABLISHMENT)), FLAG THIS ESTABLISHMENT-PERSON-PAIR AS ‘NOT
SEPARATE SOURCE OF INSURANCE’ AND GO TO END_LP01
OTHERWISE, CONTINUE WITH BOX_04
Context Header Display Instructions:
Rounds 1-4, just display the begin date rather than both the
begin and end date.
If Round 5 then display both the begin and end date.
BOX_04
ASK THE PRIVATE HEALTH INSURANCE DETAIL (HP) SECTION FOR THIS
ESTABLISHMENT-PERSON-PAIR.
AT COMPLETION OF HP SECTION, CONTINUE WITH END_LP01
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Health Insurance (HX) Section
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END_LP01
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS THE
CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH
BOX_05.
BOX_05
IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS PROVIDING
HEALTH INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS 'SELF-EMPLOYED'
AND
- FIRM SIZE OF ESTABLISHMENT = 1,
CONTINUE WITH LOOP_02
OTHERWISE, GO TO BOX_07
LOOP_02
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK LOOP_03 END_LP02
LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION ABOUT THE SOURCES OF
DIRECTLY PURCHASED HEALTH INSURANCE ASSOCIATED WITH A SELF-EMPLOYED JOB
WHERE FIRM SIZE = 1. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT
MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS PROVIDING HEALTH INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS ‘SELF-EMPLOYED’
- FIRM SIZE OF ESTABLISHMENT = 1
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Health Insurance (HX) Section
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LOOP_03
FOR EACH OF THE FOLLOWING:
INSURANCE
INSURANCE
INSURANCE
INSURANCE
INSURANCE
INSURANCE
ASK HX03 -
CATEGORY
CATEGORY
CATEGORY
CATEGORY
CATEGORY
CATEGORY
1
2
3
4
5
6
END_LP03
LOOP DEFINITION: LOOP_03 COLLECTS INFORMATION ABOUT THE WAYS PERSON
PURCHASED HEALTH INSURANCE (INSURANCE CATEGORIES AT HX03) ASSOCIATED WITH
A SELF-EMPLOYED JOB WITH FIRM-SIZE = 1. THE FIRST CYCLE OF THIS LOOP
COLLECTS THE MAIN WAY PERSON PURCHASES INSURANCE. SUBSEQUENT CYCLES
COLLECT ADDITIONAL WAYS PERSON PURCHASES INSURANCE.
THE RESPONSE AT HX04 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF HX04 IS
CODED ‘1’ (YES), THE LOOP CYCLES TO COLLECT THE NEXT INSURANCE CATEGORY.
IF HX04 IS CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW), THE LOOP
ENDS.
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Health Insurance (HX) Section
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HX03
Help Enabled (INSCATGRY)
Variable Name
EPRS.PURCHTYP
Comment Enabled
Jump Back Enabled
Label
MAIN CATEGORY OF PURCHASING INSURANCE
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
SHOW CARD HX-1.
{You mentioned that (PERSON) {(are/is)/(were/was)} self-employed and had
health insurance through that business.} Which category on this card comes
closest to {the main/another} way (PERSON) (purchase/purchases) this
insurance?
FROM A PROFESSIONAL ASSOCIATION
FROM A SMALL BUSINESS GROUP
1
2
{BOX_06}
{BOX_06}
FROM A UNION
FROM A HEALTH INSURANCE
PURCHASING ALLIANCE
3
4
{BOX_06}
{BOX_06}
DIRECTLY FROM AN INSURANCE
AGENT
5
{BOX_06}
DIRECTLY FROM INSURANCE
COMPANY
DIRECTLY FROM AN HMO
6
{BOX_06}
7
{BOX_06}
FROM A PREVIOUS EMPLOYER
FROM A PREVIOUS EMPLOYER
(COBRA)
8
9
{BOX_06}
{BOX_06}
OTHER
91
{HX03OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
RF
{BOX_06}
Don't Know
DK
{BOX_06}
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
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Health Insurance (HX) Section
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DISPLAY INSTRUCTIONS:
DISPLAY ‘You mentioned that (PERSON) {(are/is)/(were/was)}
self-employed and had health insurance through that business.’
IF FIRST CYCLE THROUGH LOOP_03. OTHERWISE USE A NULL
DISPLAY.
DISPLAY ‘(are/is)’ IF ESTABLISHMENT IS FLAGGED AS A CURRENT
EMPLOYER. DISPLAY ‘(were/was)’ IF ESTABLISHMENT IS NOT
FLAGGED AS A CURRENT EMPLOYER, OR IF CURRENT ROUND IS ROUND 5.
DISPLAY ‘the main’ IF FIRST CYCLE THROUGH LOOP_03. OTHERWISE
(I.E., NOT FIRST CYCLE), DISPLAY ‘another’.
HX03OV
Help Enabled
Variable Name
EPRS.PURCHOS
Comment Enabled
Jump Back Enabled
Label
GET INS FROM OTHER SOURCE-SPECIFIED
Size
25
OTHER SPECIFY: _______________________
{BOX_06}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_06}
{BOX_06}
BOX_06
ASK PRIVATE HEALTH INSURANCE DETAIL (HP) SECTION FOR THE RESPONSE CATEGORY
SELECTED AT HX03.
AT COMPLETION OF HP SECTION, CONTINUE WITH HX04
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Health Insurance (HX) Section
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HX04
Help Enabled (INSCATGRY)
Comment Enabled
Variable Name
EPRS.bw_HX04
Jump Back Enabled
Label
Size
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
SHOW CARD HX-1.
Aside from what you already told me about, is there another category on this
card which describes the way (PERSON) (purchase/purchases) health
insurance for (ESTABLISHMENT)?
YES
1
{END_LP03}
NO
2
{END_LP03}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP03}
{END_LP03}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
END_LP03
IF HX04 IS CODED ‘1’ (YES), CYCLE TO COLLECT THE NEXT WAY OF PURCHASING
INSURANCE.
OTHERWISE, END LOOP_03 AND CONTINUE WITH END_LP02
END_LP02
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON-PAIRS ROSTER THAT MEETS THE
CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS,
WITH BOX_07
8
END LOOP_02 AND CONTINUE
Health Insurance (HX) Section
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BOX_07
IF ROUND 1, GO TO HX06
OTHERWISE, CONTINUE WITH BOX_08
BOX_08
IF:
ANY NEW RU MEMBERS ADDED TO RU THIS ROUND,
OR
ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE TURNED 65 SINCE
START DATE (USE REAL DATE OF BIRTH ONLY),
OR
ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE WERE = OR > 65
(OR IN AGE CATEGORY 9) IN PREVIOUS ROUND,
CONTINUE WITH HX05
OTHERWISE, GO TO BOX_12
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Health Insurance (HX) Section
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HX05
Help Enabled (MEDICARE)
Comment Enabled
Jump Back Enabled
Variable Name
EPRS.MCARE
PERSON IS COVERED BY MEDICARE
Label
Size
2
EPRS.EPRSRURN
EPRS.EPRSID
ROUND STAMP: RU LETTER + ROUND NUMBER
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
2
20
EPCP.EPCPRURN
EPCP.EPCPID
ROUND STAMP: RU LETTER + ROUND NUMBER
EPCP ID KEY: EPRSID + PERSID
2
28
EPRS.CREATEQ
QUESTION THAT CREATED EPRS RECORD
6
EPCP.CREATEQ
HOME.MEDICARE
CREATION STAMP
ANYONE IN THE FAMILY COVERED BY MEDICARE
2
2
ESTB.ESTBID
ESTB ID KEY: RUNTID + COUNTER(3) + CD
11
ESTB.ESTBRURN
ESTB.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED ESTB SEGMENT
2
6
ESTB.ESTBNAME
ESTB.TYPEFLAG
NAME OF EMPLOYER OR BUSINESS
TYPE OF ESTABLISHMENT
30
2
{STR-DT} {END-DT}
My records indicate that (READ NAMES BELOW) {(are/is)} {either} {65 years
old or older} {or} {joined the household since our last interview}.
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
{First Name, [Middle Name], Last Name}
(Has (READ NAME ABOVE)/Have any of these people) been covered by
Medicare since {(START DATE)/between (START DATE) and (END DATE)}?
YES
1
NO
2
{LOOP_04}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{LOOP_04}
{LOOP_04}
HELP AVAILABLE FOR DEFINITION OF MEDICARE.
10
Health Insurance (HX) Section
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DISPLAY INSTRUCTIONS:
DISPLAY ‘(are/is)’ AND ‘65 years old’ IF ANY RU MEMBERS NOT
ALREADY FLAGGED AS RECEIVING MEDICARE TURNED 65 SINCE START
DATE OR IF ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING
MEDICARE WERE = OR > 65 PREVIOUS ROUND.
DISPLAY ‘joined the household since our last interview’ IF ANY
NEW RU MEMBERS ADDED TO THE RU THIS ROUND.
DISPLAY ‘either’ AND ‘or’ IF ANY NEW RU MEMBERS ADDED TO THE
RU THIS ROUND AND IF ANY RU MEMBERS NOT ALREADY FLAGGED AS
RECEIVING MEDICARE TURNED 65 SINCE START DATE OR ANY RU
MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE WERE = OR >
65 PREVIOUS ROUND.
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY
'between (START DATE) and (END DATE)' IF ROUND 5.
ROUTING INSTRUCTION:
IF HX05 IS CODED ‘1’ (YES) AND ONLY ONE RU MEMBER ELIGIBLE FOR
HX05, SELECT THAT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO
TO LOOP_04
IF HX05 IS CODED ‘1’ (YES) AND MORE THAN ONE RU MEMBER
ELIGIBLE FOR HX05, GO TO HX07
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for display of RU-members.
Roster Behavior:
1. Select, add, delete, and edit disallowed.
Roster Filter:
Otherwise, display RU-Members who meet one of the following
conditions:
1. Person is a new RU member this round,
2. Person turned 65 years old this round and is not
flagged as covered by Medicare during any round,
3. Or person >= 65 (or in age category 9) last round
and not flagged as covered by Medicare during any round.
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Health Insurance (HX) Section
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HX06
Help Enabled (MEDICARE)
Comment Enabled
Jump Back Enabled
Variable Name
HOME.MEDICARE
Label
ANYONE IN THE FAMILY COVERED BY MEDICARE
Size
2
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.MCARE
QUESTION THAT CREATED EPRS RECORD
PERSON IS COVERED BY MEDICARE
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
ESTB.ESTBID
ESTB ID KEY: RUNTID + COUNTER(3) + CD
11
ESTB.ESTBRURN
ESTB.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED ESTB SEGMENT
2
6
ESTB.ESTBNAME
ESTB.TYPEFLAG
NAME OF EMPLOYER OR BUSINESS
TYPE OF ESTABLISHMENT
30
2
{STR-DT}
There are several large public health insurance programs {with similar names}
that are easily confused.
Medicare is a health insurance program for persons 65 years or over and for
disabled persons. Other programs, such as {Medicaid/{STATE NAME FOR
MEDICAID} or {STATE CHIP NAME} are state programs which cover low
income families and individuals or children who do not have private health
insurance.
SHOW CARD HX-2.
Let me first ask about Medicare. People covered by Medicare usually have a
card that looks like this.
At any time since (START DATE), has anyone in the family been covered by
Medicare?
YES
1
NO
2
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
12
Health Insurance (HX) Section
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HELP AVAILABLE FOR DEFINITION OF MEDICARE.
13
Health Insurance (HX) Section
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DISPLAY INSTRUCTIONS:
DISPLAY ‘or KidsCare’ FOR ‘STATE CHIP NAME’ IF STATE IN WHICH
INTERVIEW IS BEING CONDUCTED IS ARIZONA.
DISPLAY ‘or ARKids First’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS ARKANSAS.
DISPLAY ‘or Healthy Families’ FOR ‘STATE CHIP NAME’ IF STATE
IN WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.
DISPLAY ‘or Child Health Plan Plus (CHP+) FOR ‘STATE CHIP
NAME’ IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS
COLORADO.
DISPLAY ‘or Husky Plan or Husky Plus’ FOR ‘STATE CHIP NAME’ IF
STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS CONNECTICUT.
DISPLAY ‘or DC Healthy Families or FOR ‘STATE CHIP NAME’ IF
STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS WASHINGTON, DC.
DISPLAY ‘or Delaware Healthy Children Program’ FOR ‘STATE CHIP
NAME’ IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS
DELAWARE.
DISPLAY ‘or Florida KidCare’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS FLORIDA.
DISPLAY ‘or PeachCare for Kids’ FOR ‘STATE CHIP NAME’ IF STATE
IN WHICH INTERVIEW IS BEING CONDUCTED IS GEORGIA.
DISPLAY ‘or hawk-i’ (Healthy and weell kids in Iowa) FOR
‘STATE CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS IOWA.
DISPLAY ‘or Idaho Children's Health Insurance Program’ FOR
‘STATE CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS IDAHO.
DISPLAY ‘or KidCare’ FOR ‘STATE CHIP NAME’ IF STATE IN WHICH
INTERVIEW IS BEING CONDUCTED IS ILLINOIS.
DISPLAY ‘or Hoosier Healthwise’ FOR ‘STATE CHIP NAME’ IF STATE
IN WHICH INTERVIEW IS BEING CONDUCTED IS INDIANA.
DISPLAY ‘or HealthWave’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS KANSAS.
DISPLAY ‘or Kentucky Children's Health Insurance Program’ FOR
‘STATE CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS KENTUCKY.
DISPLAY ‘or LaCHIP’ FOR ‘STATE CHIP NAME’ IF STATE IN WHICH
INTERVIEW IS BEING CONDUCTED IS LOUISIANA.
DISPLAY ‘or State Children is Health Insurance Program (SCHIP)
’ FOR ‘STATE CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS MAINE.
DISPLAY ‘or Maryland Children’s Health Program’ FOR ‘STATE
CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS
MARYLAND.
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Health Insurance (HX) Section
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DISPLAY 'or MA Children's Health Insurance Program' FOR 'STATE
CHIP NAME' IF STATE IN WHICH INTERVIEW BEING CONDUCTED IS
MASSACHUSETTS.
DISPLAY ‘MIChild’ FOR ‘STATE CHIP NAME’ IF STATE IN WHICH
INTERVIEW IS BEING CONDUCTED IS MICHIGAN.
DISPLAY ‘or MinnesotaCare’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS MINNESOTA.
DISPLAY ‘or MC+ for Kids’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS MISSOURI.
DISPLAY ‘or Mississippi Health Benefits Program' FOR ‘STATE
CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS
MISSISSIPPI.
DISPLAY ‘or Montana Children's Health Insurance Plan' FOR
‘STATE CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS MONTANA.
DISPLAY ‘or Kids Connection’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS NEBRASKA.
DISPLAY ‘or Nevada Check Up’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS NEVADA.
DISPLAY ‘or Healthy Kids’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS
NEW HAMPSHIRE.
DISPLAY ‘or NJ Family Care’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS NEW JERSEY.
DISPLAY ‘or New MexiKids’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS NEW MEXICO.
DISPLAY ‘or Child Health Plus (CHPlus)’ FOR ‘STATE CHIP NAME’
IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS
NEW YORK.
DISPLAY ‘or NC Health Choice for Children’ FOR ‘STATE CHIP
NAME’ IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS NORTH
CAROLINA.
DISPLAY ‘or Healthy Steps Program’ FOR ‘STATE CHIP NAME’ IF
STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS NORTH DAKOTA.
DISPLAY ‘or Healthy Start’ FOR ‘STATE CHIP NAME’
WHICH INTERVIEW IS BEING CONDUCTED IS OHIO.
IF STATE IN
DISPLAY ‘or State Children's Health Insurance Program
(SCHIP)' FOR ‘STATE CHIP NAME’ IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED IS OKLAHOMA.
DISPLAY ‘or State Children's Health Insurance Program (SCHIP)’
FOR ‘STATE CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS OREGON.
DISPLAY ‘or Pennsylvania Children's Health Insurance Program’
15
Health Insurance (HX) Section
Beta
FOR ‘STATE CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS PENNSYLVANIA.
DISPLAY ‘or RIte Care’ FOR ‘STATE CHIP NAME’ IF STATE IN WHICH
INTERVIEW IS BEING CONDUCTED IS RHODE ISLAND.
DISPLAY ‘or Partners for Healthy Children (PHC)' FOR ‘STATE
CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS
SOUTH CAROLINA.
DISPLAY ‘or Children's Health Insurance Program’ FOR ‘STATE
CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS
SOUTH DAKOTA.
DISPLAY ‘or TexCare' FOR ‘STATE CHIP NAME’ IF STATE IN WHICH
INTERVIEW IS BEING CONDUCTED IS
TEXAS.
DISPLAY ‘or Children's Health Insurance Program (CHIP)' FOR
‘STATE CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS UTAH.
DISPLAY ‘or Dr. Dynasaur’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS VERMONT.
DISPLAY ‘or Family Access to Medical Insurance Security
(FAMIS) Plan’ FOR ‘STATE CHIP NAME’ IF STATE IN WHICH
INTERVIEW IS BEING CONDUCTED IS VIRGINIA.
DISPLAY ‘or Children's Health Insurance Program' FOR ‘STATE
CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS
WASHINGTON.
DISPLAY ‘or West Virginia Children's Health Insurance Program'
FOR 'STATE CHIP NAME’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS WEST VIRGINIA.
DISPLAY ‘or BadgerCare’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS WISCONSIN.
DISPLAY ‘or KidCare CHIP’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS WYOMING.
OTHERWISE, DISPLAY ‘or State Children’s Health Insurance
Program (CHIP)’ FOR ‘STATE CHIP NAME.’
16
Health Insurance (HX) Section
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PROGRAMMER NOTES:
DISPLAY ‘with similar names’ IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED USES ‘MEDICAID’ OR A NAME SIMILAR TO MEDICARE
(SUCH AS MEDI-CAL).
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS ONE OF THE FOLLOWING:
ALABAMA, ARKANSAS, COLORADO, CONNECTICUT, FLORIDA, GEORGIA,
IDAHO, ILLINOIS, INDIANA, IOWA, KANSAS, KENTUCKY, LOUISIANA,
MICHIGAN, MISSISSIPPI, MONTANA, NEBRASKA, NEVADA, NEW
HAMPSHIRE, NEW JERSEY, NEW MEXICO, NEW YORK, NORTH CAROLINA,
NORTH DAKOTA, OHIO, SOUTH CAROLINA, TEXAS, UTAH, VERMONT,
VIRGINIA, WEST VIRGINIA,WISCONSIN, WYOMING
DISPLAY ‘Medical Assistance’ FOR ‘STATE NAME FOR MEDICAID’
STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS ONE OF THE
FOLLOWING:
ALASKA, DISTRICT OF COLUMBIA, HAWAII, IOWA, MARYLAND,
MINNESOTA, PENNSYLVANIA, SOUTH DAKOTA, WASHINGTON
IF
DISPLAY ‘Arizona Health Care Cost Containment System’ FOR
‘STATE NAME FOR MEDICAID’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS ARIZONA.
DISPLAY ‘Medi-Cal’ FOR ‘STATE NAME FOR MEDICAID’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS CALIFORNIA.
DISPLAY ‘Delaware Medical Assistance Program (DMAP)’ FOR
‘STATE NAME FOR MEDICAID’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED IS DELAWARE.
DISPLAY ‘MaineCare’ FOR ‘STATE NAME FOR MEDICAID’
WHICH INTERVIEW IS BEING CONDUCTED IS
MAINE.
IF STATE IN
DISPLAY ‘MassHealth’ FOR ‘STATE NAME FOR MEDICAID’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS MASSACHUSETTS.
DISPLAY ‘Medicaid/MC+’ FOR ‘STATE NAME FOR MEDICAID’ IF STATE
IN WHICH INTERVIEW IS BEING CONDUCTED IS MISSOURI.
DISPLAY ‘SoonerCare' FOR ‘STATE NAME FOR MEDICAID’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS OKLAHOMA.
DISPLAY ‘Oregon Health Plan’ FOR ‘STATE NAME FOR MEDICAID’ IF
STATE IN WHICH INTERVIEW IS BEING CONDUCTED IS OREGON.
DISPLAY ‘TennCare’ FOR ‘STATE NAME FOR MEDICAID’
WHICH INTERVIEW IS BEING CONDUCTED IS TENNESSEE.
IF STATE IN
DISPLAY ‘or Denali KidCare’ FOR ‘STATE CHIP NAME’ IF STATE IN
WHICH INTERVIEW IS BEING CONDUCTED IS ALASKA.
DISPLAY ‘or ALL Kids’ FOR ‘STATE CHIP NAME’ IF STATE IN WHICH
INTERVIEW IS BEING CONDUCTED IS ALABAMA.
17
Health Insurance (HX) Section
Beta
ROUTING INSTRUCTION:
IF CODED ‘1’ (YES) AND SINGLE-PERSON RU, SELECT PERSON
AUTOMATICALLY BY CAPI AT HX07 AND GO TO
LOOP_04
IF CODED ‘1’ (YES) AND MULTI-PERSON RU, CONTINUE WITH HX07
IF CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW) AND
ONE OR MORE RU MEMBER = > 65 YEARS OLD, GO TO LOOP_04
IF CODED ‘2’ (NO), ‘RF’ (REFUSED), OR ‘DK’ (DON’T KNOW) AND NO
RU MEMBER = > 65 YEARS OLD, GO TO BOX_12
18
Health Insurance (HX) Section
Beta
HX07
Help Enabled
Comment Enabled
Variable Name
HOME.bw_HX07
Jump Back Enabled
Label
Size
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPRS.MCARE
QUESTION THAT CREATED EPRS RECORD
PERSON IS COVERED BY MEDICARE
6
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_04}
Roster Details
Title:
RU_MEMBERS_SelectOne
Col #
Header
Instructions
PERSON-TYPEPROVIDER
Display RU members’ first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection of RUmembers.
Roster Behavior:
1. Multiple select allowed. Interviewer may select one
or more from the listed members.
2. Add, delete, and edit disallowed.
Roster Filter:
19
Health Insurance (HX) Section
Beta
In Round 1, none. Display all.
In Rounds 2-5, display RU-Members who meet one of the
following conditions:
1. Person is a new RU member this round,
2. Person turned 65 years old this round and is not flagged
as covered by Medicare during any round,
3. Or person >= 65 (or in age category 9) last round and
not flagged as covered by Medicare during any round.
LOOP_04
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK BOX_09-END_LP04
LOOP DEFINITION: LOOP_04 DETERMINES IF REASON FOR MEDICARE IS
CONDITION/DISABILITY FOR PERSONS < 65 WHO RECEIVE MEDICARE AND COLLECTS
SOCIAL SECURITY STATUS FOR PERSONS = > 65 WHO ARE NOT COVERED BY
MEDICARE. THIS LOOP CYCLES ON PERSONS WHO MEET ANY OF THE FOLLOWING
CONDITIONS:
- IF ROUND 1: ALL CURRENT RU MEMBERS
- IF NOT ROUND 1: ALL CURRENT RU MEMBERS WHO MEET ONE OF THE FOLLOWING
CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND,
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED
BY MEDICARE DURING ANY ROUND
OR
- PERSON => 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT
FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
BOX_09
IF ROUND 1, GO TO BOX_11
OTHERWISE, CONTINUE WITH BOX_10
BOX_10
IF PERSON ADDED THIS ROUND, CONTINUE WITH BOX_11
IF HX05 IS CODED '2' (NO), 'RF' (REFUSED), OR 'DK' (DON'T KNOW) AND RU
MEMBER TURNED 65 THIS ROUND, GO TO HX09
OTHERWISE, GO TO END_LP04
NOTE: HX09 IS NOT RE-ASKED OF PERSONS WHO WERE OVER 65 DURING THE
PREVIOUS ROUND AND DID NOT RECEIVE MEDICARE AND WHO CONTINUE NOT RECEIVING
MEDICARE DURING THE CURRENT ROUND.
20
Health Insurance (HX) Section
Beta
BOX_11
IF PERSON IS SELECTED AT HX07 AND IS < 65 YEARS OLD (OR IN AGE CATEGORIES
1-8), CONTINUE WITH HX08
IF PERSON IS SELECTED AT HX07 AND IS = > 65 YEARS OLD (OR IN AGE CATEGORY
9), GO TO END_LP04
IF PERSON IS NOT SELECTED AT HX07 AND IS < 65 YEARS OLD (OR IN AGE
CATEGORIES 1-8), GO TO END_LP04
IF PERSON IS NOT SELECTED AT HX07 AND IS = > 65 YEARS OLD (OR IN AGE
CATEGORY 9), GO TO HX09
IF HX07 IS NOT ASKED (I.E., HX05 OR HX06 IS CODED '2' (NO), 'RF'
(REFUSED), OR 'DK' (DON'T KNOW)) AND PERSON IS < 65 YEARS OLD (OR IN AGE
CATEGORIES 1-8), GO TO END_LP04
IF HX07 IS NOT ASKED (I.E., HX05 OR HX06 IS CODED '2' (NO), 'RF'
(REFUSED), OR 'DK' (DON'T KNOW)) AND PERSON IS = > 65 YEARS OLD (OR IN AGE
CATEGORY 9), GO TO HX09
HX08
Help Enabled (HX08Help)
Variable Name
EPRS.MCAREREA
Comment Enabled
Jump Back Enabled
Label
RECEIVE MEDICARE FOR COND/DISABILITY
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
(Do/Does) (PERSON) receive Medicare because of a medical condition or a
disability?
YES
NO
1
2
{END_LP04}
{END_LP04}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP04}
{END_LP04}
HELP AVAILABLE FOR DEFINITION OF CONDITION/DISABILITY.
21
Health Insurance (HX) Section
Beta
HX09
Help Enabled (HX09Help)
Variable Name
PRND.SOCSEC
Comment Enabled
Jump Back Enabled
Label
DOES PERSON RECEIVE SOCIAL SECURITY
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
People with Social Security usually get Medicare. (Do/Does) (PERSON)
receive Social Security?
YES
NO
1
2
{END_LP04}
{END_LP04}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP04}
{END_LP04}
HELP AVAILABLE FOR DEFINITION OF SOCIAL SECURITY.
END_LP04
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED
IN THE LOOP DEFINITION
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_04 AND CONTINUE
WITH BOX_12
BOX_12
IF MEDICAID/SCHIP PROVIDED TO ANY RU MEMBER DURING THE PREVIOUS ROUND, GO
TO BOX_14
OTHERWISE, CONTINUE WITH BOX_12A
22
Health Insurance (HX) Section
Beta
BOX_12A
IF GOVT-HOSPITAL/PHYSICIAN IS A SOURCE OF INSURANCE FOR ANY RU MEMBER
DURING THE CURRENT ROUND, GO TO BOX_14
OTHERWISE, CONTINUE WITH HX10
23
Health Insurance (HX) Section
Beta
HX10
Help Enabled (MEDICAT)
Comment Enabled
Jump Back Enabled
Variable Name
HOME.MEDICAID
Label
ANYONE IN FAMILY COVERED BY MEDICAID
Size
2
HOME.MCAIDNUM
ESTB.ESTBID
MEDICAID CARD INFO COLLECTD ON THIS EPRS
ESTB ID KEY: RUNTID + COUNTER(3) + CD
20
11
ESTB.ESTBRURN
ESTB.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED ESTB SEGMENT
2
6
ESTB.ESTBNAME
NAME OF EMPLOYER OR BUSINESS
30
ESTB.TYPEFLAG
EPRS.EPRSID
TYPE OF ESTABLISHMENT
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
2
20
EPRS.EPRSRURN
ROUND STAMP: RU LETTER + ROUND NUMBER
2
EPRS.CREATEQ
EPRS.MCAID
QUESTION THAT CREATED EPRS RECORD
PERSON COVERED BY MEDICAID
6
2
EPCP.EPCPID
EPCP.EPCPRURN
EPCP ID KEY: EPRSID + PERSID
ROUND STAMP: RU LETTER + ROUND NUMBER
28
2
EPCP.CREATEQ
CREATION STAMP
2
{STR-DT} {END-DT}
{Some people are covered by programs called {Medicaid/{STATE NAME
FOR MEDICAID}} or {STATE CHIP NAME}. These are state programs for
low income families and individuals or children who do not have private health
insurance. They sometimes cover persons with very large medical bills or
those in nursing homes.}
{SHOW CARD HX-3.}
{People covered by {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE
CHIP NAME} usually have a (piece of paper/card) that looks something like
this.}
{During the last interview, we recorded that no one in the family was covered
by {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}.}
Has anyone in the family been covered by {Medicaid/{STATE NAME FOR
MEDICAID}} or {STATE CHIP NAME} at any time {since (START
DATE)/between (START DATE) and (END DATE)}?
YES
1
NO
2
24
{BOX_14}
Health Insurance (HX) Section
Beta
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_14}
{BOX_14}
HELP AVAILABLE FOR DEFINITION OF MEDICAID.
DISPLAY INSTRUCTIONS:
DISPLAY FIRST PARAGRAPH (‘Some .... homes.’) ONLY IF ROUND 1.
OTHERWISE, USE A NULL DISPLAY.
DISPLAY SECOND PARAGRAPH (INCLUDING REFERENCE TO SHOW CARD)
ONLY IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED ISSUES A
CARD OR PIECE OF PAPER TO MEDICAID RECIPIENTS. THIS INCLUDES
ALL STATES EXCEPT TENNESSEE. IF THE INTERVIEW IS BEING
CONDUCTED IN TENNESSEE, USE A NULL DISPLAY.
DISPLAY THIRD PARAGRAPH (‘During... CHIP NAME}}.’)ONLY IF NOT
ROUND 1. OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF
THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE
THE NAME ‘MEDICAID.’ FOR THE SPECIFIC NAME TO USE BY STATE,
SEE BOX ON HX06.
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS SUBSTITUTING
THE REAL STATE NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE
BY STATE, SEE BOX ON HX06.
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY
'between (START DATE) and (END DATE)' IF ROUND 5.
ROUTING INSTRUCTION:
IF CODED ‘1’ (YES) AND SINGLE-PERSON RU, SELECT PERSON
AUTOMATICALLY BY CAPI AT HX11 AND GO TO LOOP_05
IF CODED ‘1’ (YES) AND MULTI-PERSON RU, CONTINUE WITH HX11
25
Health Insurance (HX) Section
Beta
HX11
Help Enabled
Comment Enabled
Variable Name
ESTB.bw_HX11
Jump Back Enabled
Label
Size
ESTB.TYPEFLAG
ESTB.ESTBRURN
TYPE OF ESTABLISHMENT
ROUND STAMP: RU LETTER + ROUND NUMBER
2
2
ESTB.ESTBNAME
ESTB.ESTBID
NAME OF EMPLOYER OR BUSINESS
ESTB ID KEY: RUNTID + COUNTER(3) + CD
30
11
ESTB.CREATEQ
QUESTION THAT CREATED ESTB SEGMENT
6
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
QUESTION THAT CREATED EPRS RECORD
6
EPRS.MCAID
EPCP.EPCPID
PERSON COVERED BY MEDICAID
EPCP ID KEY: EPRSID + PERSID
2
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT} {END-DT}
Who is covered by {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE
CHIP NAME}?
PROBE: Who else is covered by {Medicaid/{STATE NAME FOR
MEDICAID}}or {STATE CHIP NAME}?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_05}
DISPLAY INSTRUCTIONS:
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF
THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE
THE NAME ‘MEDICAID.’ FOR THE SPECIFIC NAME TO USE BY STATE,
SEE BOX ON HX06.
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS SUBSTITUTING
THE REAL STATE NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE
BY STATE, SEE BOX ON HX06.
26
Health Insurance (HX) Section
Beta
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection of RUmembers.
Roster Behavior:
1. Multiple select allowed. Interviewer may select from the
listed members.
2. Add, delete, and edit disallowed.
Roster Filter:
None, Display All.
LOOP_05
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON-PAIRS ROSTER, ASK BOX_13 END_LP05
LOOP DEFINITION: LOOP_05 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU
MEMBERS COVERED BY MEDICAID/SCHIP. THIS LOOP CYCLES ON ESTABLISHMENTPERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS MEDICAID/SCHIP
AND
- PERSON IS FLAGGED AS COVERED BY MEDICAID/SCHIP
DURING THE CURRENT ROUND (I.E., SELECTED IN HX11)
BOX_13
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PERSON.
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP05
END_LP05
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS
THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_05 AND CONTINUE WITH
BOX_14
27
Health Insurance (HX) Section
Beta
BOX_14
IF TRICARE/CHAMPVA PROVIDED TO ANY RU MEMBER DURING THE PREVIOUS ROUND, GO
TO BOX_16
OTHERWISE, CONTINUE WITH HX12
HX12
Help Enabled (CHAMPTRI)
Variable Name
HOME.CHAMP
Comment Enabled
Jump Back Enabled
Label
ANY IN FAMILY COVERED BY CHAMPUS/CHAMPVA
Size
2
{STR-DT} {END-DT}
{During the last interview, we recorded that no one in the family was covered
by TRICARE or CHAMPVA.}
At any time {since (START DATE)/between (START DATE) and (END
DATE)}, has anyone in the family been covered by TRICARE or CHAMPVA?
YES
1
{HX12A}
NO
2
{BOX_16}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_16}
{BOX_16}
HELP AVAILABLE FOR DEFINITION OF TRICARE/CHAMPVA.
DISPLAY INSTRUCTIONS:
DISPLAY FIRST PARAGRAPH (‘During .... TRICARE or CHAMPVA.’) IF
NOT ROUND1. OTHERWISE, USE A NULL DISPLAY.
DISPLAY 'since (START DATE)' IF NOT ROUND 5. DISPLAY 'between
(START DATE) and (END DATE)' IF ROUND 5.
28
Health Insurance (HX) Section
Beta
HX12A
Help Enabled
Comment Enabled
Variable Name
HOME.HX12ABLSWVS
Jump Back Enabled
Label
Size
HOME.CHAMPVA
HOME.TRISTAND
SOMEONE IN RU HAS TRICARE STANDARD
2
HOME.TRIPRIME
HOME.TRIEXTRA
SOMEONE IN RU HAS TRICARE PRIME
SOMEONE IN RU HAS TRICARE EXTRA
2
2
HOME.TRILIFE
HX12A/PR19A/21A MEMBER HAS TRICARE(LIFE)
2
{STR-DT}{END-DT}
Which plan is it? Is it …
INTERVIEWER: CODE MORE THAN ONE PLAN ONLY IF DIFFERENT RU
MEMBERS HAVE DIFFERENT PLANS.
CHECK ALL THAT APPLY.
TRICARE Standard;
TRICARE Prime;
1
2
TRICARE Extra;
TRICARE for Life; or
3
4
CHAMPVA?
5
PROGRAMMER NOTES:
IF HX12 IS CODED ‘1’ (YES) AND SINGLE-PERSON RU, SELECT PERSON
AT HX13 AUTOMATICALLY BY CAPI AND GO TO LOOP_06
ROUTING INSTRUCTION:
IF HX12 IS CODED ‘1’ (YES) AND MULTI-PERSON RU, CONTINUE WITH
HX13
29
Health Insurance (HX) Section
Beta
HX13
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
EPRS.CHAMP
Label
PERSON COVERED BY CHAMPUS/CHAMPVA
Size
2
EPRS.EPRSID
EPRS.EPRSRURN
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
ROUND STAMP: RU LETTER + ROUND NUMBER
20
2
EPRS.CREATEQ
EPCP.EPCPID
QUESTION THAT CREATED EPRS RECORD
EPCP ID KEY: EPRSID + PERSID
6
28
EPCP.EPCPRURN
ROUND STAMP: RU LETTER + ROUND NUMBER
2
EPCP.CREATEQ
CREATION STAMP
2
{STR-DT}{END-DT}
Who is covered by TRICARE or CHAMPVA?
PROBE: Who else is covered by TRICARE or CHAMPVA?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_06}
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection of RUmembers.
Roster Behavior:
1. Multiple select allowed. Interviewer may select from
the listed members.
2. Add, delete, and edit disallowed.
Roster Filter:
None, Display All.
30
Health Insurance (HX) Section
Beta
LOOP_06
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK BOX_15END_LP06
LOOP DEFINITION: LOOP_06 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU
MEMBERS COVERED BY TRICARE OR CHAMPVA. THIS LOOP CYCLES ON ESTABLISHMENTPERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS TRICARE/CHAMPVA
AND
- PERSON IS FLAGGED AS COVERED BY TRICARE/CHAMPVA DURING THE CURRENT
ROUND (I.E., SELECTED AT HX13)
BOX_15
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PERSON.
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP06
END_LP06
CYCLE ON NEXT PAIR ON RU ESTABLISHMENT-PERSON-PAIRS ROSTER THAT MEETS THE
CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_06 AND CONTINUE WITH
BOX_16
BOX_16
IF MEDICAID/SCHIP IS A SOURCE OF INSURANCE FOR ANY RU MEMBER DURING
CURRENT ROUND, GO TO BOX_19
OTHERWISE, CONTINUE WITH BOX_17
BOX_17
IF GOVT-HOSPITAL/PHYSICIAN PROVIDED TO ANY RU MEMBER DURING THE PREVIOUS
ROUND, GO TO BOX_19
OTHERWISE, CONTINUE WITH HX14
31
Health Insurance (HX) Section
Beta
HX14
Help Enabled (INSTYPES)
Comment Enabled
Jump Back Enabled
Variable Name
HOME.GOVTPROG
Label
ANYONE COVERD BY STATE/LOCAL GOVT AGENCY
Size
2
HOME.MCAIDNUM
EPRS.EPRSID
MEDICAID CARD INFO COLLECTD ON THIS EPRS
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
20
20
EPRS.EPRSRURN
EPRS.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED EPRS RECORD
2
6
EPRS.GOVTPROG
PERSON IS COVERED BY GOVT PROGRAM
2
ESTB.ESTBID
ESTB.ESTBRURN
ESTB ID KEY: RUNTID + COUNTER(3) + CD
ROUND STAMP: RU LETTER + ROUND NUMBER
11
2
ESTB.CREATEQ
QUESTION THAT CREATED ESTB SEGMENT
6
ESTB.ESTBNAME
ESTB.TYPEFLAG
NAME OF EMPLOYER OR BUSINESS
TYPE OF ESTABLISHMENT
30
2
EPCP.EPCPID
EPCP.EPCPRURN
EPCP ID KEY: EPRSID + PERSID
ROUND STAMP: RU LETTER + ROUND NUMBER
28
2
EPCP.CREATEQ
CREATION STAMP
2
{STR-DT}{END-DT}
{During the last interview, we recorded that no one in the family was covered
by any other state sponsored program which provided hospital and
physician benefits.}
At any time {since (START DATE)/between (START DATE) and (END
DATE)}, has anyone in the family had any other type of health insurance
obtained through any state or local government agency which provided
hospital and physician benefits?
YES
NO
1
2
{HX14A}
{BOX_19}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_19}
{BOX_19}
HELP AVAILABLE FOR DESCRIPTION OF INSURANCE TYPES TO
INCLUDE.
32
Health Insurance (HX) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY FIRST PARAGRAPH (‘During .... benefits.’) IF NOT ROUND
1. OTHERWISE, USE A NULL DISPLAY.
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY
'between (START DATE) and (END DATE)' IF ROUND 5.
HX14A
Help Enabled
Variable Name
ESTB.GOVTFLAG
ESTB.ESTBNAME
Comment Enabled
Jump Back Enabled
Label
GOVT HI PLAN NAME COLLECTED FLAG
NAME OF EMPLOYER OR BUSINESS
{STR-DT}
What is the name of the plan?
PLAN NAME: _______________________
PROGRAMMER NOTES:
NOTE: ‘GOVT-HOSPITAL/PHYSICIAN’ SHOULD BE USED FOR THE
ESTABLISHMENT NAME IN THE CONTEXT HEADER(WHERE APPROPRIATE).
ROUTING INSTRUCTION:
IF HX14 IS CODED ‘1’ (YES) AND SINGLE-PERSON RU, SELECT PERSON
AT HX15 AUTOMATICALLY BY CAPI AND GO TO LOOP_07
IF HX14 IS CODED ‘1’ (YES) AND MULTI-PERSON RU, CONTINUE WITH
HX15
33
Size
2
30
Health Insurance (HX) Section
Beta
HX15
Help Enabled
Comment Enabled
Variable Name
ESTB.bw_HX15
Jump Back Enabled
Label
Size
HOME.MCAIDNUM
EPRS.EPRSID
MEDICAID CARD INFO COLLECTD ON THIS EPRS
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
20
20
EPRS.EPRSRURN
EPRS.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED EPRS RECORD
2
6
EPRS.GOVTPROG
PERSON IS COVERED BY GOVT PROGRAM
2
EPCP.EPCPID
EPCP.EPCPRURN
EPCP ID KEY: EPRSID + PERSID
ROUND STAMP: RU LETTER + ROUND NUMBER
28
2
EPCP.CREATEQ
CREATION STAMP
2
{STR-DT} {END-DT}
Who is covered by a program sponsored by a state or local government
agency which provided hospital and physician benefits?
PROBE: Who else is covered by a program sponsored by a state or local
government agency which provided hospital and physician benefits?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_07}
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection of RUmembers.
Roster Behavior:
1. Multiple select allowed. Interviewer may select from
the listed members.
34
Health Insurance (HX) Section
Beta
2. Add, delete, and edit disallowed.
Roster Filter:
None, Display All.
LOOP_07
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON-PAIRS ROSTER, ASK BOX_18END_LP07
LOOP DEFINITION: LOOP_07 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU
MEMBERS COVERED BY GOVT-HOSPITAL/PHYSICIAN. THIS LOOP CYCLES ON
ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN
AND
- PERSON IS FLAGGED AS BEING COVERED BY GOVT-HOSPITAL/PHYSICIAN
DURING THE CURRENT ROUND (I.E., SELECTED AT HX15)
BOX_18
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PERSON.
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP07
END_LP07
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-PERSON-PAIRS ROSTER THAT MEETS
THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_07 AND CONTINUE WITH
BOX_19
BOX_19
IF ANY TYPE OF OTHER PUBLIC INSURANCE PROVIDED TO ANY RU MEMBER AT ANY
TIME DURING THE PREVIOUS ROUND, GO TO HX21
OTHERWISE, CONTINUE WITH HX16
35
Health Insurance (HX) Section
Beta
HX16
Help Enabled (HX16Help)
Variable Name
HOME.STATPROG
Comment Enabled
Jump Back Enabled
Label
ANYONE COVERED BY A STATE PROGRAM
Size
2
{STR-DT} {END-DT}
{During the last interview, we recorded that no one in the family/Some people}
receive{d} health benefits from other state programs {such as (READ
PROGRAM NAMES BELOW) or other public programs} that provide coverage
for health care services.
{STATE NAME FOR PROGRAM #1}
{STATE NAME FOR PROGRAM #2}
{STATE NAME FOR PROGRAM #3}
{STATE NAME FOR PROGRAM #4}
At any time {since (START DATE)/between (START DATE) and (END
DATE)}, has anyone in the family been covered by any program like this?
YES
NO
1
2
{LOOP_08}
{HX21}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{HX21}
{HX21}
HELP AVAILABLE FOR A LIST OF OTHER STATE PROGRAMS.
DISPLAY INSTRUCTIONS:
DISPLAY ‘During the last interview, we recorded that no one in
the family’ AND THE ‘d’ ON ‘receive’ IF NOT ROUND 1.
OTHERWISE, DISPLAY ‘Some people’.
DISPLAY THE LIST OF UP TO FOUR ACTUAL NAMES OF STATE PROGRAMS
(AS LISTED IN NEXT BOX) FOR ‘STATE NAME FOR PROGRAM #N’ IF
STATE HAS OTHER STATE PROGRAMS. OTHERWISE, USE A NULL DISPLAY.
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY
'between (START DATE) and (END DATE)' IF ROUND 5.
36
Health Insurance (HX) Section
Beta
PROGRAMMER NOTES:
STATE OTHER PUBLIC PROGRAM(S)
ALASKA - Chronic and Acute Medical Assistance (CAMA), AK AIDS
Drug Assistance Program (ADAP)
ALABAMA - Hypertension Program, Senior Rx, AIDS Drug
Assistance Program (ADAP), Alabama Breast and Cervical Cancer
Early Detection Program
ARIZONA - Primary Care Programs, Copper Rx Card, Non-Renal
Transplant Medications Program, AZ AIDS Drug Assistance
Program (ADAP)
ARKANSAS - Arkansas Kidney Disease Commission, AR AIDS Drug
DDS Children's Services
CALIFORNIA - AIDS Drug Assistance Program (ADAP), CA Breast
and Cervical Cancer Early Detection Program, Discount
Prescription Medication Program, Healthy Families
COLORADO - Colorado Breast and Cervical Cancer Early Detection
Program, Colorado AIDS Drug Asistance Program, Colorado
Indigent Care Program (CICP)
CONNECTICUT - ConnPACE, CT AIDS Drug Assistance Program
(ADAP), Healthy Start, CT Pharmaceutical Assist. Contract
DELAWARE - Delaware Prescription Drug Assist. Program, DE AIDS
Drug Assistance Program (ADAP), Nemours Pharmaceutical
Assistance Program, Chronic Renal Disease Program
DISTRICT OF COLUMBIA - DC AIDS Drug Assistance Program (ADAP),
Medical Charities Program, DC Healthcare Alliance, DC Breast
and Cervical Cancer Early Detection Program
FLORIDA - Florida Statewide Kidney Disease Program, Silver
Saver Program, Prescription Discount Program, AIDS Drug
Assistance Program (ADAP)
GEORGIA - AIDS Drug Assistance Program (ADAP), GA Breast and
Cervical Cancer Early Detection Program
HAWAII - Hawaii Chronic Renal Disease Program, AIDS Drug
Assistance Program (ADAP), Hawaii Rx Discount Program, Breast
and Cervical Cancer Early Detection Program
IDAHO - Catastrophic Fund, ID AIDS Drug Assistance Program
(ADAP), Family Support Program
ILLINOIS - CircuitBreaker Pharmacy Assist. Program, IL Rx
Buying Club, ILBreast and Cervical Cancer Early Detection
Program, IL AIDS Drug Assistance Program (ADAP)
INDIANA - Hoosier Rx, Children's Special Health Care Services,
IN AIDS Drug Assistance Program (ADAP), IN Breast and Cervical
Cancer Early Detection Program
IOWA - Iowa Priority Prescription Savings Program, AIDS Drug
Assistance Program (ADAP)
37
Health Insurance (HX) Section
Beta
KANSAS - KS AIDS Drug Assistance Program (ADAP), MediKan,
Kansas Breast and Cervical Cancer Early Detection Program,
Kansas Senior Pharmacy Assistance Program
KENTUCKY - KY AIDS Drug Assistance Program (ADAP), Healthy
Kentucky, Kentucky Pharmaceutical Assistance Program, Kentucky
Access
LOUISIANA - LA AIDS Drug Assistance Program (ADAP), LA Breast
and Cervical Cancer Early Detection Program
MAINE - Elderly Low Cost Drug Program, Maine AIDS Drug
Assistance Program (ADAP), Maine Breast and Cervical Cancer
Early Detection Program, Maine Rx and Rx + Program
MARYLAND - Kidney Disease Program, Maryland Pharmacy Discount
Program, Maryland State Family Planning Program, MD AIDS Drug
Assistance Program (ADAP)
MASSACHUSETTS - CenterCare Program, Children’s Medical
Security Plan, Prescription Advantage Plan, MA AIDS Drug
Assistance Program (ADAP)
MICHIGAN - Michigan AIDS Drug Assistance Program (ADAP), Adult
Medical Program, EPIC (Elderly Prescription Insurance
Coverage), MI Rx Prescription Savings Program
MINNESOTA - The Prescription Drug Program, MN AIDS Drug
Assistance Program (ADAP), General Assistance Medical Care,
MinnesotaCare
MISSISSIPPI - MS AIDS Drug Assistance Program (ADAP),
Mississippi Breast and Cervical Cancer Early Detection
Program, Mississippi Children's Medical Program, First Steps:
Early Intervention Program
MISSOURI - Missouri Kidney Program (MoKP), Missouri Senior Rx
Program, Missouri General Relief, MO AIDS Drug Assistance
Program (ADAP)
MONTANA - End-Stage Renal Disease Program, Prescription Drug
Plus Program, MT AIDS Drug Assistance Program (ADAP)
NEBRASKA - Chronic Renal Disease Program, Nebraska AIDS Drug
Assistance Program (ADAP), Nebraska Breast and Cervical Cancer
Early Detection Program, Perinatal and Child Health Program
NEW HAMPSHIRE - Catastrophic Illness Program, New Hampshire
Breast and Cervical Cancer Early Detection Program, RX Drug
Discount Program for Seniors, NH AIDS Drug Assistance Program
(ADAP)
NEVADA - Senior Rx Insurance Subsidy for Prescription Drugs,
NV AIDS Drug Assistance Program (ADAP), Womens Health
Connection, Children with Special Health Care Needs (CSHCN)
NEW JERSEY - Pharmaceutical Assistance for the Aged and
Disabled (PAAD), Chronic Renal Disease Services, Senior Gold
Prescription Discount Program, NJ AIDS Drug Assistance Program
(ADAP)
38
Health Insurance (HX) Section
Beta
NEW MEXICO -New Mexico AIDS Drug Assistance Program (ADAP),
Prescription Drug Discount Program for Seniors, Family Infant
Toddler Program, Breast and Cervical Cancer Early Detection
Program
NEW YORK - Elderly Pharmaceutical Insure Program (EPIC), NY
AIDS Drug Assistance Program (ADAP), APIC Primary Care, Family
Health Plus
NORTH CAROLINA - State Kidney Program, NC AIDS Drug Assistance
Program (ADAP), Caring Program for Children, Prescription Drug
Assistance Program
NORTH DAKOTA - ND Breast and Cervical Cancer Early Detection
Program, ND AIDS Drug Assistance Program (ADAP)< Health
Tracks, Children's Special Health Services (CSHS)
OHIO - Ohio Disability Assistance Medical Program, Ohio AIDS
Drug Assistance Program (ADAP), Healthy Start, Healthy
Families, Golden Buckeye Prescription Drug Savings Program
OKLAHOMA - AIDS Drug Assistance Programs (ADAP), Oklahoma
Prescription Drug Discount Program, Oklahoma Breast and
Cervical Cancer Early Detection Program, Maternal and Child
Health Services
OREGON - Senior Prescription Drug Assistance Program Discounts, Oregon Breast and Cervical Cancer Early Detection
Program, AIDS Drug Assistance Program (ADAP)
PENNSYLVANIA - Adult Basics, Pharmacy Assistance Contract for
Elderly (PACE/PACE NET), The Healthy Woman Program, Special
Pharmacy Benefits Program-AIDS/HIV Waiver (SPBP)
RHODE ISLAND - General Public Assistance Medical Program,
Rhode Island Pharmacy Assistance for Elderly (RIPAE), Rhode
Island Women's Cancer Screening Program, RI AIDS Drug
Assistance Program (ADAP)
SOUTH CAROLINA - Silverx Card Seniors’ Prescription Drug
Program, SC AIDS Drug Assistance Program (ADAP), SC Breast
and Cervical Cancer Early Detection Program, Communicare
SOUTH DAKOTA - All Woment Count! Program, Children's Special
Health Services (CSHS), SD Ryan White Title II Care Program,
SD Chronic Renal Disease Program
TENNESSEE - Tennessee Renal Disease Program, TN AIDS Drug
Assistance Program (ADAP), Tennessee Breast and Cervical
Cancer Early Detection Program, Children's Special Services
(CSS)
TEXAS - Division of Kidney Health Care Program, Texas HIV
Medication Program (THMP), Community Alzheimer's Resources and
Education (CARE), Breast and Cervical Cancer Control
UTAH - Utah Children with Special Health Care Needs (CSHCN),
Utah AIDS Drug Assistance Program (ADAP), Utah Cancer Control
Program
VIRGINIA - VA AIDS Drug Assistance Program (ADAP), Every
39
Health Insurance (HX) Section
Beta
Woman's Life, Child Development Services Program
VERMONT - Vermont Health Access Plan (VHAP), VT AIDS Insurance
Continuation Coverage Program, Children With Special Needs,
Ladies First
WASHINGTON - WA State Kidney Disease Program, WA AIDS Drug
Assistance Program (ADAP), Rx Washington Discount Plan,
Children with Special Health Care Needs (CSHCN)
WEST VIRGINIA - Golden Mountaineer Discount Card Program, WV
AIDS Drug Assistance Program (ADAP), Children with
SpecialHealth Care Needs (CSHCN)
WISCONSIN - WisconCare Program, Wisconsin SeniorCare
Prescription Drug Assistance Program, WI AIDS Drug Assistance
Program (ADAP), WI Chronic Disease Program
WYOMING - Minimum Medical Program (MMP), Prescription Drug
Assistance Program, WY HIV/AIDS/Hepatitis Program, WY End
Stage Renal Disease Program
LOOP_08
FOR EACH OF THE FOLLOWING:
GROUP 1
GROUP 2
ASK BOX_20 - END_LP08
LOOP DEFINITION: LOOP_08 COLLECTS INFORMATION ON OTHER STATE OR PUBLIC
PROGRAMS. THE FIRST CYCLE OF THIS LOOP COLLECTS GROUP 1 OTHER PUBLIC
INSURANCE PROGRAMS OR, IF NO GROUP 1, GROUP 2 OTHER PUBLIC INSURANCE
PROGRAMS.
THIS LOOP CAN CYCLE A MAXIMUM OF TWICE. THE SUBSEQUENT CYCLE OF THE LOOP
IS DETERMINED BY THE RESPONSE AT HX20. IF HX20 IS CODED ‘1’ (YES),THE
LOOP CYCLES AGAIN TO COLLECT GROUP 2 PUBLIC INSURANCE INFORMATION. IF HX20
IS CODED ‘2’ (NO), ‘RF’ (REFUSED), ‘DK’ (DON’T KNOW), OR IS NOT ASKED, THE
LOOP ENDS.
BOX_20
IF FIRST CYCLE OF LOOP_08, CONTINUE WITH HX17
OTHERWISE (I.E., IF SECOND CYCLE OF LOOP_08), GO TO HX18
40
Health Insurance (HX) Section
Beta
HX17
Help Enabled (STATEPRGM)
Comment Enabled
Jump Back Enabled
Variable Name
ESTB.ESTBID
Label
ESTB ID KEY: RUNTID + COUNTER(3) + CD
Size
11
ESTB.ESTBRURN
ESTB.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED ESTB SEGMENT
2
6
ESTB.TYPEFLAG
ESTB.ESTBNAME
TYPE OF ESTABLISHMENT
NAME OF EMPLOYER OR BUSINESS
2
30
ESTB.STPROG1
RECEIVE BENEFITS FROM STATE PROGRAM #1
2
ESTB.STPROG2
ESTB.STPROG3
RECEIVE BENEFITS FROM STATE PROGRAM #2
RECEIVE BENEFITS FROM STATE PROGRAM #3
2
2
ESTB.STPROG4
RECEIVE BENEFITS FROM STATE PROGRAM #4
2
ESTB.STPRGOTH
ESTB.STPRGNOT
RECEIVE BENEFITS FR OTHER STAE PROGRAM
NO BENEFITS RECEIVED FROM LISTED ST PROG
2
2
{STR-DT} {END-DT}
What is the name of the program?
PROBE: Any other state program?
NOTE: IF ONLY TANF/AFDC, SSI, WIC, IHS, PUBLIC HEALTH CLINIC OR
VA IS MENTIONED, CODE 95.
CHECK ALL THAT APPLY.
{STATE SPECIFIC PLAN 1}
{STATE SPECIFIC PLAN 2}
1
2
{STATE SPECIFIC PLAN 3}
3
{STATE SPECIFIC PLAN 4}
OTHER
4
91
{HX17OV}
NONE OF THESE
95
{HX18}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_21}
{BOX_21}
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
41
Health Insurance (HX) Section
Beta
DISPLAY INSTRUCTIONS:
FOR ‘STATE SPECIFIC PLAN N’, DISPLAY AN ACTUAL NAME OF A STATE
PLAN WHEN INTERVIEW IS BEING CONDUCTED IN A STATE THAT HAS
OTHER STATE PROGRAMS. FOR THE SPECIFIC NAMES OF PROGRAMS BY
STATE, SEE BOX ON HX16.
PROGRAMMER NOTES:
ANY PROGRAM SELECTED IN HX17 IS CONSIDERED A GROUP 1 PROGRAM
AND WILL BE GROUPED TOGETHER WHEN ASKED ABOUT IN HX19.
CODES ‘1’, ‘2’, ‘3’, ‘4’, ‘5’, AND ‘6’ ARE RESERVED FOR STATE
SPECIFIC PLANS. IF THE STATE HAS LESS THAN 6 PLANS, DO NOT
ADJUST THE OTHER CODES. (I.E., FOR A STATE WITH NO STATESPECIFIC PLANS, CODES WOULD START WITH ‘91’ AT HX17 OR ‘7’ AT
HX18.)
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW 'RF' OR
'DK' IN COMBINATION WITH ANY OTHER CODE.
ROUTING INSTRUCTION:
IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER
CODE, CONTINUE WITH HX17OV
IF CODED ‘95’ (NONE OF THESE), GO TO HX18
OTHERWISE, GO TO BOX_21
Hard CHECK:
EDIT: CODE ‘95’ (NONE OF THESE) CANNOT BE ENTERED WITH ANY OTHER CODES.
CODED ‘95’ (NONE OF THESE) WITH ANY OTHER CODES, DISPLAY THE FOLLOWING
MESSAGE: ‘95 CANNOT BE CODED WITH ANY OTHER RESPONSES. VERIFY AND REENTER. CONTINUE.'
42
IF
Health Insurance (HX) Section
Beta
HX17OV
Help Enabled
Variable Name
ESTB.STPRGOS
Comment Enabled
Jump Back Enabled
Label
RECEIVE BENEFITS FR ST PROG-SPECIFIED
Size
25
OTHER SPECIFY: _______________________
{BOX_21}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
43
{BOX_21}
{BOX_21}
Health Insurance (HX) Section
Beta
HX18
Help Enabled (OTHSTPRGM)
Comment Enabled
Variable Name
ESTB.bw_HX18
Jump Back Enabled
Label
Size
ESTB.ESTBID
ESTB.ESTBRURN
ESTB ID KEY: RUNTID + COUNTER(3) + CD
ROUND STAMP: RU LETTER + ROUND NUMBER
11
2
ESTB.CREATEQ
ESTB.ESTBNAME
QUESTION THAT CREATED ESTB SEGMENT
NAME OF EMPLOYER OR BUSINESS
6
30
ESTB.TYPEFLAG
TYPE OF ESTABLISHMENT
2
ESTB.AFDCPROG
ESTB.SSIPROG
RECEIVE BENEFITS FROM AFDC
RECEIVE BENEFITS FROM SSI
2
2
ESTB.WICPROG
RECIEVE BENEFITS FROM WIC
2
ESTB.IHSPROG
ESTB.PHCPROG
RECEIVE BENEFITS FR IHS-INDIAN HLTH SERV
RECEIVE BENEFITS FR PUBLIC HEALTH CLINIC
2
2
ESTB.VAPROG
RECEIVE BENEFITS FR VA (VETERANS ADM)
2
{STR-DT} {END-DT}
What is the name of the program?
PROBE: Any other state program?
CHECK ALL THAT APPLY.
TANF (TEMPORARY ASSISTANCE FOR
NEEDY FAMILIES) OR AFDC (AID TO
FAMILIES WITH DEPENDENT
CHILDREN)
7
SSI (SUPPLEMENTAL SECURITY
8
INCOME)
WIC (WOMEN, INFANTS AND CHILDREN) 9
IHS (INDIAN HEALTH SERVICE)
PUBLIC HEALTH CLINIC
10
11
VA (VETERANS ADMINISTRATION)
12
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP08}
{END_LP08}
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
44
Health Insurance (HX) Section
Beta
PROGRAMMER NOTES:
ANY PROGRAM SELECTED IN HX18 IS CONSIDERED A GROUP 2 PROGRAM
AND WILL BE GROUPED TOGETHER WHEN ASKED ABOUT IN HX19
ROUTING INSTRUCTION:
IF:
NO CURRENT RU MEMBER COVERED BY MEDICAID OR GOVTHOSPITAL/PHYSICIAN DURING CURRENT ROUND
AND
HX18 IS CODED ‘7’ (AFDC), ‘8’ (SSI), OR ‘9’ (WIC), ALONE OR
WITH ANY OTHER COMBINATION OF CODES, CONTINUE WITH BOX_21
OTHERWISE, GO TO END_LP08
BOX_21
IF SINGLE-PERSON RU, SELECT PERSON AT HX19 AUTOMATICALLY BY CAPI AND GO TO
LOOP_09
IF MULTI-PERSON RU, CONTINUE WITH HX19
45
Health Insurance (HX) Section
Beta
HX19
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
EPRS.EPRSID
Label
EPRS ID KEY: ESTBID + PERSID + ROUND NUM
Size
20
EPRS.EPRSRURN
EPRS.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED EPRS RECORD
2
6
EPRS.STSPEC
EPRS.AFDCGRP
PERSON COVERED BY STATE SPECIFIC PLAN
PERS COVERED BY AFDC/WIC/SSI/IHS/PHC/VA
2
2
EPCP.EPCPID
EPCP ID KEY: EPRSID + PERSID
28
EPCP.EPCPRURN
EPCP.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
{STR-DT}{END-DT}
PROGRAM:
{STATE PROGRAM PROVIDING COVERAGE}
{STATE PROGRAM PROVIDING COVERAGE}
{STATE PROGRAM PROVIDING COVERAGE}
{STATE PROGRAM PROVIDING COVERAGE}
Who is covered by (READ PROGRAMS ABOVE)?
PROBE: Who else is covered by (READ PROGRAMS ABOVE)?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_09}
DISPLAY INSTRUCTIONS:
IF COMING FROM HX17, DISPLAY ALL PROGRAMS SELECTED AT HX17.
IF COMING FROM HX18, DISPLAY ALL PROGRAMS SELECTED AT HX18.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
46
Health Insurance (HX) Section
Beta
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection of RUmembers.
Roster Behavior:
1. Multiple select allowed. Interviewer may select from
the listed members.
2. Add, delete, and edit disallowed.
Roster Filter:
None, Display All.
LOOP_09
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON-PAIRS ROSTER, ASK BOX_22END_LP09
LOOP DEFINITION: LOOP_09 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU
MEMBERS COVERED BY OTHER PUBLIC PROGRAMS. THIS LOOP CYCLES ON
ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GROUP 1 OR GROUP 2 OTHER PUBLIC PROGRAM
AND
- PERSON IS FLAGGED AS BEING COVERED BY GROUP 1 OR GROUP 2 OTHER PUBLIC
PROGRAM DURING THE CURRENT ROUND (I.E., SELECTED IN HX19)
IF FIRST TIME THROUGH LOOP_08 AND HX17 IS NOT CODED ‘95’ (NONE OF THESE),
THIS LOOP CYCLES ON A ESTABLISHMENT-PERSON-PAIR WHERE ESTABLISHMENT IS A
GROUP 1 OTHER PUBLIC PROGRAM.
IF HX17 IS CODED ‘95’ (NONE OF THESE) OR IF SECOND CYCLE OF LOOP_08, THEN
THE ESTABLISHMENT IS A GROUP 2 OTHER PUBLIC PROGRAM.
BOX_22
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PERSON.
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP09
END_LP09
CYCLE ON NEXT PAIR ON RU ESTABLISHMENT-PERSON-PAIRS ROSTER THAT MEETS THE
CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_09 AND CONTINUE WITH
BOX_23
47
Health Insurance (HX) Section
Beta
BOX_23
IF HX17 IS CODED '95' (NONE OF THESE) OR IF ON SECOND CYCLE OF LOOP_08, GO
TO END_LP08
OTHERWISE, CONTINUE WITH HX20
HX20
Help Enabled
Comment Enabled
Variable Name
HOME.bw_HX20
Jump Back Enabled
Label
Size
{STR-DT} {END-DT}
Are there any other state programs that provide coverage for health care
services to anyone else in the family?
YES
NO
1
2
{END_LP08}
{END_LP08}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP08}
{END_LP08}
END_LP08
IF HX20 IS CODED ‘1’ (YES), CYCLE TO COLLECT GROUP 2 PUBLIC INSURANCE
INFORMATION.
IF HX20 IS CODED ‘2’ (NO), ‘RF’ (REFUSED), ‘DK’ (DON’T KNOW), OR IS NOT
ASKED, END LOOP_08 AND CONTINUE WITH HX21
48
Health Insurance (HX) Section
Beta
HX21
Help Enabled
Comment Enabled
Variable Name
HOME.bw_HX21
Jump Back Enabled
Label
Size
{STR-DT} {END-DT}
Next, I have some questions about other sources of health insurance anyone
in the family may have had {since (START DATE)/between (START DATE)
and (END DATE)} to help pay hospital and doctor bills and other health
expenses such as nursing home care or prescribed medicines. {This includes
Medigap or Medicare Supplements, plans through a private insurance carrier,
which some people who are eligible for Medicare have as additional
coverage.}
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
DISPLAY INSTRUCTIONS:
DISPLAY ‘This includes...coverage.’ IF ANYONE IN RU HAS
MEDICARE AS A SOURCE OF INSURANCE DURING THE CURRENT ROUND.
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY
'between (START DATE) and (END DATE)' IF ROUND 5.
49
Health Insurance (HX) Section
Beta
HX22
Help Enabled (OTHINS)
Variable Name
HOME.HILIST
Comment Enabled
Jump Back Enabled
Label
ANYONE COVERD BY ANY OTHER HI SOURCE
Size
2
{STR-DT} {END-DT}
SHOW CARD HX-4.
Please look at this card. It lists various ways people can obtain insurance.
{Not counting insurance you already told me about, at/At} any time {since
(START DATE)/between (START DATE) and (END DATE)}, was anyone in
the family covered by health insurance from any {other} source, such as those
listed on the card?
YES
1
{LOOP_10}
NO
2
{BOX_25}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_25}
{BOX_25}
HELP AVAILABLE FOR DEFINITIONS OF ITEMS ON SHOW CARD.
DISPLAY INSTRUCTIONS:
DISPLAY ‘Not counting insurance you already told me about, at’
AND ‘other’ IF ANY SOURCES OF INSURANCE ARE RECORDED FOR THIS
RU.
IF NO SOURCES OF INSURANCE ARE RECORDED FOR THIS RU, DISPLAY
‘At’.
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY
'between (START DATE) and (END DATE)' IF ROUND 5.
50
Health Insurance (HX) Section
Beta
LOOP_10
FOR EACH OF THE FOLLOWING:
PRIVATELY
PRIVATELY
PRIVATELY
PRIVATELY
PRIVATELY
PRIVATELY
PURCHASED
PURCHASED
PURCHASED
PURCHASED
PURCHASED
PURCHASED
INSURANCE
INSURANCE
INSURANCE
INSURANCE
INSURANCE
INSURANCE
CATEGORY
CATEGORY
CATEGORY
CATEGORY
CATEGORY
CATEGORY
1
2
3
4
5
6
ASK HX23 - END_LP10
LOOP DEFINITION: LOOP_10 COLLECTS INFORMATION ABOUT PRIVATELY PURCHASED
HEALTH INSURANCE OBTAINED FROM SOURCES OTHER THAN EMPLOYERS MENTIONED IN
THE EMPLOYMENT SECTION OF THE INTERVIEW. THIS LOOP CYCLES ON SOURCES OF
PRIVATELY PURCHASED INSURANCE LISTED AT HX23. THE FIRST CYCLE OF THIS
LOOP COLLECTS THE FIRST SOURCE OF PRIVATELY PURCHASED INSURANCE.
SUBSEQUENT CYCLES OF THE LOOP ARE DETERMINED BY THE RESPONSE AT HX24. IF
HX24 IS CODED ‘1’ (YES), THE LOOP CYCLES AGAIN TO COLLECT THE NEXT SOURCE
OF PRIVATELY PURCHASED INSURANCE. IF HX24 IS CODED ‘2’ (NO), ‘RF’
(REFUSED), OR ‘DK’ (DON’T KNOW), THE LOOP ENDS.
51
Health Insurance (HX) Section
Beta
HX23
Help Enabled (OTHINS)
Variable Name
EPRS.PRIVINS
Comment Enabled
Jump Back Enabled
Label
PURCHASE SOURCE FOR HEALTH INSURANCE
Size
2
{STR-DT} {END-DT}
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase
health insurance?
FROM A GROUP OR ASSOCIATION
1
{BOX_24}
FROM A HEALTH INSURANCE
PURCHASING ALLIANCE
2
{BOX_24}
DIRECTLY THROUGH A SCHOOL
DIRECTLY FROM AN INSURANCE
AGENT
3
4
{BOX_24}
{BOX_24}
DIRECTLY FROM INSURANCE
COMPANY
DIRECTLY FROM AN HMO
5
{BOX_24}
6
{BOX_24}
FROM A UNION
FROM ANYONE'S PREVIOUS
EMPLOYER (COBRA)
7
8
{BOX_24}
{BOX_24}
FROM ANYONE'S PREVIOUS
EMPLOYER (NOT COBRA)
9
{BOX_24}
FROM SPOUSE'S/DECEASED
SPOUSE'S PREVIOUS EMPLOYER
FROM SOME OTHER EMPLOYER
10
{BOX_24}
11
{BOX_24}
UNDER PLAN OF SOMEONE NOT
LIVING HERE
OTHER SOURCE
12
{BOX_24}
91
{HX23OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_24}
{BOX_24}
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
52
Health Insurance (HX) Section
Beta
HX23OV
Help Enabled
Variable Name
EPRS.PRIVINOS
Comment Enabled
Jump Back Enabled
Label
PURCHASE SOURCE FOR HEALTH INSURANCE OS
Size
25
ENTER OTHER: _______________________
{BOX_24}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_24}
{BOX_24}
BOX_24
ASK PRIVATE HEALTH INSURANCE DETAIL (HP) SECTION FOR THE RESPONSE CATEGORY
SELECTED AT HX23 AND FLAGGED THIS ROUND AS PROVIDING HEALTH INSURANCE.
AT COMPLETION OF THE HP SECTION, CONTINUE WITH HX24
53
Health Insurance (HX) Section
Beta
HX24
Help Enabled (OTHINS)
Comment Enabled
Variable Name
HOME.bw_HX24
Jump Back Enabled
Label
Size
{STR-DT} {END-DT}
SHOW CARD HX-4.
Aside from what you already told me about, at any time {since (START
DATE)/between (START DATE) and (END DATE)}, was anyone in the family
covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is
covered by which has not been discussed yet. This includes health insurance
that was obtained from a source not listed on this card.
YES
1
{END_LP10}
NO
2
{END_LP10}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP10}
{END_LP10}
HELP AVAILABLE FOR DEFINITIONS OF ITEMS ON SHOW CARD.
DISPLAY INSTRUCTIONS:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY
'between (START DATE) and (END DATE)' IF ROUND 5.
END_LP10
IF HX24 IS CODED ‘1’ (YES), CYCLE TO COLLECT THE NEXT INSURANCE CATEGORY.
OTHERWISE END LOOP_10, AND CONTINUE WITH BOX_25
54
Health Insurance (HX) Section
Beta
BOX_25
IF NO PUBLIC OR PRIVATE INSURANCE RECORDED FOR ANY CURRENT RU MEMBER, GO
TO BOX_45
OTHERWISE, CONTINUE WITH BOX_26
BOX_26
IF ANY RU MEMBER HAS MEDICARE AS A SOURCE OF INSURANCE DURING THE CURRENT
ROUND, CONTINUE WITH BOX_27
OTHERWISE, GO TO BOX_29
BOX_27
IF ROUND 1, GO TO LOOP_11
OTHERWISE, CONTINUE WITH BOX_28
BOX_28
IF NOT ROUND 1, CONTINUE WITH LOOP_11 ONLY FOR RU MEMBERS WHERE MEDICARE
WAS RECORDED AS BEING RECEIVED THIS ROUND. THAT IS, CONTINUE WITH LOOP_11
ONLY IF THERE IS AT LEAST ONE ESTABLISHMENT-PERSON-PAIR WHERE THE
ESTABLISHMENT IS MEDICARE AND THE PAIR WAS CREATED THIS ROUND.
OTHERWISE, GO TO BOX_29
LOOP_11
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK HX25END_LP11
LOOP DEFINITION: LOOP_11 COLLECTS MEDICARE CARD AND MANAGED CARE
INFORMATION FOR RU MEMBERS COVERED BY MEDICARE. THIS LOOP CYCLES ON
ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
IF ROUND 1:
- ESTABLISHMENT IS MEDICARE
AND
- PERSON IS AN RU MEMBER FLAGGED AS COVERED BY MEDICARE DURING THE ROUND
IF NOT ROUND 1:
- ESTABLISHMENT IS MEDICARE
AND
- PERSON IS AN RU MEMBER
AND
- ESTABLISHMENT-PERSON-PAIR WAS CREATED THIS ROUND
55
Health Insurance (HX) Section
Beta
HX25
Help Enabled
Variable Name
EPRS.CARECARD
Comment Enabled
Jump Back Enabled
Label
Size
2
WAS MEDICARE CARD AVAILABLE
{PERSON’S FIRST MIDDLE AND LAST NAME}
In this study, we are asking the participants for their Medicare numbers, so
that their Medicare records can be easily and accurately located and identified
for statistical research purposes. Under Section 903(c) of the Public Health
Service Act, providing us with the number is a voluntary decision and the
benefits (PERSON) may be receiving under this program will not be affected
by your decision. This study is being conducted under the authority of Section
902(a) of the Public Health Service Act.
CODE WITHOUT ASKING IF ANSWER IS KNOWN.
May I please see (PERSON)’s Medicare card?
CARD AVAILABLE
1
{HX26}
CARD NOT AVAILABLE
2
{HX29}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
56
{HX29}
{HX29}
Health Insurance (HX) Section
Beta
HX26
Help Enabled
Comment Enabled
Variable Name
EPRS.bw_HX26
Jump Back Enabled
Label
Size
EPRS.SAWOTHER
EPRS.SAWRRB
OTHER CARD SHOWN
RAILROAD RETIREMENT CARD SHOWN
2
2
EPRS.SAWMCARE
MEDICARE CARD SHOWN
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
INTERVIEWER:
CODE MEDICARE CARD(S) SHOWN/AVAILABLE.
MEDICARE CARD (RED, WHITE AND
BLUE)
RAILROAD RETIREMENT BOARD CARD
(RED, WHITE AND BLUE)
1
{HX27}
2
{HX27}
SOME OTHER CARD
3
{HX28}
PROGRAMMER NOTES:
INTERVIEWERS WILL BE TRAINED TO CODE ANY TYPE OF MANAGED CARE
CARD COLLECTED HERE AS SOME OTHER CARD. THE NAME OF THE
MANAGED CARE ORGANIZATION WILL BE COLLECTED AT HX28.
ROUTING INSTRUCTION:
IF CODED ‘1’ (MEDICARE CARD) OR ‘2’ (RAILROAD RETIREMENT BOARD
CARD), CONTINUE WITH HX27
IF CODED ‘3’ (SOME OTHER CARD) ONLY, GO TO HX28
57
Health Insurance (HX) Section
Beta
HX27
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
CARD.CARDID
CARD ID KEY: EPRSID + COUNTER(2)
Label
Size
22
CARD.CARDRURN
CARD.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
CARD.CLAIMNUM
CARD.CLAIMNU2
MEDICARE CLAIM NUMBER
MEDICARE CLAIM NUM (ADDITIONAL DIGITS)
9
2
CARD.CLAIMNU3
MEDICARE CLAIM NUM (ADDITIONAL DIGITS)
2
CARD.EFFMM
CARD.EFFDD
CARD EFFECTIVE DATE - MONTH
CARD EFFECTIVE DATE - DAY
2
2
CARD.EFFYY
CARD EFFECTIVE DATE - YEAR
4
CARD.COVRTYPE
CARD.CARDTYPE
TYPE OF MEDICARE COVERAGE ENTITLED
TYPE OF MEDICARE CARD AVAILABLE
2
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
INTERVIEWER:
RECORD THE FOLLOWING INFORMATION FROM THE CARD:
{MEDICARE} CLAIM NUMBER: ____________________
Refused
RF
Don't know
DK
-----------------------------EFFECTIVE DATE: __/__/____
MM DD YYYY
-----------------------------TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY
1
MEDICAL AND HOSPITAL
2
MEDICAL ONLY
3
DISPLAY INSTRUCTIONS:
DISPLAY ‘MEDICARE’ IF HX26 IS CODED ‘1’ (MEDICARE CARD).
58
Health Insurance (HX) Section
Beta
ROUTING INSTRUCTION:
IF HX26 IS CODED ‘3’ (SOME OTHER CARD), CONTINUE WITH HX28
OTHERWISE, GO TO BOX_28A
Hard CHECK:
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., < OR =) THE
INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, {YEAR},WHERE
'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, FLAG RU MEMBER AS ‘WITH
HEALTH INSURANCE COVERAGE ON JAN 1, {YEAR}’.
Soft CHECK:
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR > BIRTH DATE OF
PERSON.
59
Health Insurance (HX) Section
Beta
HX28
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
CARD.CARDID
CARD ID KEY: EPRSID + COUNTER(2)
Label
CARD.CARDRURN
CARD.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
CARD.CARDINF1
CARD.CARDINF2
INFORMATION FROM CARD - VERBATIM 1
INFORMATION FROM THE CARD - VERBATIM 2
45
45
CARD.CARDINF3
INFORMATION FROM THE CARD - VERBATIM 3
45
CARD.CARDINF4
INFORMATION FROM THE CARD - VERBATIM 4
45
{PERSON'S FIRST MIDDLE AND LAST NAME}
INTERVIEWER:
RECORD THE INFORMATION FROM {THE OTHER} CARD:
Information From _______________________
Card:
DISPLAY INSTRUCTIONS:
DISPLAY THE ‘OTHER’ IF HX26 IS CODED ‘1’ (MEDICARE CARD) OR
‘2’ (RAILROAD RETIREMENT BOARD CARD).
ROUTING INSTRUCTION:
IF HX26 IS CODED ‘3’ (SOME OTHER CARD) ONLY, CONTINUE WITH HX29
IF HX26 IS CODED ‘1’ (MEDICARE CARD) OR ‘2’ (RAILROAD
RETIREMENT BOARD CARD) (IN ADDITION TO ‘3’ (SOME OTHER CARD)),
GO TO H30A
60
Size
22
Health Insurance (HX) Section
Beta
HX29
Help Enabled
Comment Enabled
Variable Name
EPCP.MCAREBMM
Label
DATE MEDICARE COVERAGE STARTED - MONTH
EPCP.MCAREBYY
DATE MEDICARE COVERAGE STARTED - YEAR
Jump Back Enabled
Size
2
4
{PERSON’S FIRST MIDDLE AND LAST NAME}
When did (PERSON)’s Medicare coverage start?
_____/______/__________
MM YYYY
{HX30}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{HX29OV}
{HX29OV}
PROGRAMMER NOTES:
IF EFFECTIVE DATE IS NOT '-7' (REFUSED) OR '-8' (DON'T KNOW)
IN THE MONTH AND /OR YEAR FIELDS) AND IS A VALID DATE (I.E.,
ON OR BEFORE JANUARY 1, {YEAR}, WHERE 'YEAR' IS THE FIRST
CALENDAR YEAR OF THE PANEL, FLAG RU MEMBER AS ‘WITH HEALTH
INSURANCE COVERAGE ON JAN 1, {YEAR}’.
ROUTING INSTRUCTION:
IF CODED 'RF' (REFUSED) OR 'DK' (DON'T KNOW), CONTINUE WITH
HX29OV
OTHERWISE (I.E., A DATE IS ENTERED), GO TO HX30
Hard CHECK:
DATE MUST BE ON OR BEFORE (I.E., < OR =) INTERVIEW DATE OR 12/31/{YEAR},
WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, IF ROUND 5. ‘RF’
(REFUSED) AND ‘DK’ (DON’T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
MEDICARE EFFECTIVE DATE MUST BE = OR > BIRTH DATE OF PERSON.
Soft CHECK:
61
Health Insurance (HX) Section
Beta
HX29OV
Help Enabled
Variable Name
EPCP.MCAREJAN
Comment Enabled
Jump Back Enabled
Label
Size
2
MEDICARE COVERAGE ON 1/1/96
Did (PERSON) have Medicare coverage on January 1, {YEAR}?
YES
1
{HX30}
NO
2
{HX30}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{HX30}
{HX30}
PROGRAMMER NOTES:
IF HX29OV CODED ‘1’ (YES), FLAG PERSON AS ‘WITH HEALTH
INSURANCE COVERAGE ON JAN 1, {YEAR}’, WHERE 'YEAR' IS THE
FIRST CALENDAR YEAR OF THE PANEL.
62
Health Insurance (HX) Section
Beta
HX30
Help Enabled
Variable Name
EPRS.CARDCONF
Comment Enabled
Jump Back Enabled
Label
DOES MEDICARE CARD LOOK LIKE SHOW CARD
Size
2
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD HX-2.
(Do/Does) (PERSON) have a Medicare card that looks like this?
YES
NO
1
2
{HX30A}
{HX30A}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
63
{HX30A}
{HX30A}
Health Insurance (HX) Section
Beta
HX30A
Help Enabled
Variable Name
PRND.PREG1231
Comment Enabled
Jump Back Enabled
Label
WAS (PERSON) PREGNANT ON DEC 31ST
Size
2
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
{At any time since (Start Date)/Between (Start Date) and (End Date)},
(have/has)(were/was) (PERSON) {been} covered by the new Medicare
prescribed drug coverage (also called Part D)?
YES
NO
1
2
{BOX_28A}
{BOX_28A}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_28A}
{BOX_28A}
DISPLAY INSTRUCTIONS:
DISPLAY 'At any time since (START DATE)' AND '(have/has)' IF
NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' AND '(were/was)'
IF ROUND 5.
DISPLAY 'been' IF NOT ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
BOX_28A
NOTE: STATES THAT DO NOT OFFER MEDICARE MANAGED CARE PLANS INCLUDE THE
FOLLOWING:
ALASKA, ARKANSAS, DELAWARE, MAINE, MISSISSIPPI, MONTANA, VERMONT, WYOMING
IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT OFFER A MEDICARE
MANAGED CARE PLAN, CODE HX31 AND HX32 AS '2' (NO) AUTOMATICALLY BY CAPI
AND GO TO END_LP11.
OTHERWISE, CONTINUE WITH HX31
64
Health Insurance (HX) Section
Beta
HX31
Help Enabled
Variable Name
EPRS.MCARELST
Comment Enabled
Jump Back Enabled
Label
MEDICARE INSUR LISTED ON THIS CARD
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME}{STR-DT}{END-DT}
SHOW CARD HX-5.
As you may know, Medicare allows beneficiaries in certain parts of the country
to enroll in managed care plans, such as HMOs (Health Maintenance
Organizations) or PPOs (Preferred Provider Organizations) to receive their
Medicare-funded health care. These plans have names like those listed on
this card.
Is the name of (PERSON)’s insurance through Medicare {, between (START
DATE) and (END DATE),} listed on this card?
YES
1
{HX31OV}
NO
2
{HX32}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{HX32}
{HX32}
HELP AVAILABLE FOR DEFINITION OF MEDICARE MANAGED CARE.
DISPLAY INSTRUCTIONS:
DISPLAY ', between (START DATE) and (END DATE),' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
65
Health Insurance (HX) Section
Beta
HX31OV
Help Enabled
Variable Name
EPRS.MCARELET
Comment Enabled
Jump Back Enabled
Label
PLAN LETTER OF MEDICARE INSURANCE
Which insurance plan is (PERSON)’s Medicare managed care plan?
LETTER OF PLAN FROM SHOW CARD:
_______________________
DISPLAY INSTRUCTIONS:
WHEN INTERVIEWER ENTERS LETTER OF PLAN, DISPLAY THE FOLLOWING
MESSAGE: ‘PLEASE VERIFY PLAN SELECTED: {DISPLAY PLAN NAME
SELECTED}.’ WHEN INTERVIEWER PRESSES ENTER TO CLEAR THE
MESSAGE, PROCEED TO THE NEXT LOGICAL SCREEN.
FOR ‘DISPLAY PLAN NAME SELECTED’, DISPLAY THE ACTUAL PLAN NAME
THAT CORRESPONDS TO THE LETTER ENTERED FOR THIS STATE.
PROGRAMMER NOTES:
FLAG INSURER CODED ABOVE AS ‘CURRENT ROUND’S MEDICARE INSURER’
FOR THIS ESTABLISHMENT-PERSON-PAIR.
ROUTING INSTRUCTION:
IF ROUND 1, GO TO HX34
OTHERWISE, GO TO END_LP11
66
Size
4
Health Insurance (HX) Section
Beta
HX32
Help Enabled (HMO)
Variable Name
EPRS.MCAREHMO
Comment Enabled
Jump Back Enabled
Label
MEDICARE: PERSON SIGNED WITH HMO
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Even though (PERSON)’s Medicare plan was not listed on the card, {(is/are)
(PERSON) currently/between (START DATE) and (END DATE), (were/was)
(PERSON)} enrolled in a Medicare managed care plan such as an HMO
(Health Maintenance Organization) or PPO (Preferred Provider Organization)?
(When answering this question, please include only insurance from Medicare,
not any privately purchased insurance.)
YES
NO
1
2
{HX33}
{END_LP11}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP11}
{END_LP11}
HELP AVAILABLE FOR DEFINITION OF MEDICARE MANAGED CARE.
DISPLAY INSTRUCTIONS:
DISPLAY '(is/are) (PERSON) currently' IF NOT ROUND 5. DISPLAY
'between (START DATE) and (END DATE), (were/was) (PERSON)' IF
ROUND 5.
67
Health Insurance (HX) Section
Beta
HX33
Help Enabled
Variable Name
EPRS.MCARENAM
Comment Enabled
Jump Back Enabled
Label
Size
25
NAME OF MEDICARE HMO
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
What is the name of the (PERSON)’s Medicare managed care plan?
PLAN NAME: _______________________
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
PROGRAMMER NOTES:
FLAG INSURER CODED ABOVE AS ‘CURRENT ROUND’S MEDICARE INSURER’
FOR THIS ESTABLISHMENT-PERSON-PAIR.
ROUTING INSTRUCTION:
IF ROUND 1, CONTINUE WITH HX34
OTHERWISE, GO TO END_LP11
68
Health Insurance (HX) Section
Beta
HX34
Help Enabled (PREMPAY)
Variable Name
EPRS.PREMPAY
Comment Enabled
Jump Back Enabled
Label
Size
2
DOES PERSON PAY A PREMIUM
{PERSON’S FIRST MIDDLE AND LAST NAME}
PLAN NAME: {{PLAN NAME ENTERED AT HX31OV}/{NAME OF PLAN
FROM HX33}}
Medicare beneficiaries pay their Part B premiums through their Social Security
checks. In addition, (do/does) (PERSON) (or anyone in the family) pay
anything directly to (PLAN NAME) for this coverage?
[Do not include the cost of any copayments, coinsurance or deductibles
anyone in the family may have had to pay.]
YES
1
{HX35}
NO
2
{END_LP11}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP11}
{END_LP11}
HELP AVAILABLE FOR DEFINITION OF
PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
DISPLAY INSTRUCTIONS:
DISPLAY ‘{PLAN NAME ENTERED AT HX31OV}’ IF A PLAN LETTER WAS
ENTERED AT HX31OV. DISPLAY THE ACTUAL PLAN NAME THAT
CORRESPONDS TO THE LETTER ENTERED AT HX31OV FOR THIS STATE.
DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR ‘NAME OF PLAN
FROM HX33’ IF A PLAN NAME WAS ENTERED.
69
Health Insurance (HX) Section
Beta
HX35
Help Enabled
Variable Name
EPRS.COVRAMT
Comment Enabled
Jump Back Enabled
Label
HOW MUCH PAID FOR COVERAGE-AMT
Size
12
{PERSON’S FIRST MIDDLE AND LAST NAME}
PLAN NAME: {{PLAN NAME ENTERED AT HX31OV}/{NAME OF PLAN
FROM HX33}}
How much (do/does) (PERSON) pay for the (PLAN NAME) coverage?
AMOUNT: $ _______
{HX35OV1}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP11}
{END_LP11}
DISPLAY INSTRUCTIONS:
DISPLAY ‘{PLAN NAME ENTERED AT HX31OV}’ IF A PLAN LETTER WAS
ENTERED AT HX31OV. DISPLAY THE ACTUAL PLAN NAME THAT
CORRESPONDS TO THE LETTER ENTERED AT HX31OV FOR THIS STATE.
DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR ‘NAME OF PLAN
FROM HX33’ IF A PLAN NAME WAS ENTERED.
70
Health Insurance (HX) Section
Beta
HX35OV1
Help Enabled
Variable Name
EPRS.COVRUNIT
Comment Enabled
Jump Back Enabled
Label
HOW MUCH PAID FORCOVERAGE-UNIT
Size
2
Is that per year, per month, per week, or what?
UNIT OF COVERAGE:
PER YEAR
QUARTERLY/EVERY 3 MONTHS
1
2
{END_LP11}
{END_LP11}
BIMONTHLY/EVERY 2 MONTHS
PER MONTH
3
4
{END_LP11}
{END_LP11}
PER WEEK
BIWEEKLY/EVERY 2 WEEKS
5
6
{END_LP11}
{END_LP11}
SEMI-ANNUALLY/2 TIMES PER YEAR
7
{END_LP11}
SEMI-MONTHLY/2 TIMES PER MONTH
OTHER
8
91
{END_LP11}
{HX35OV2}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
71
{END_LP11}
{END_LP11}
Health Insurance (HX) Section
Beta
HX35OV2
Help Enabled
Variable Name
EPRS.COVRUNOS
Comment Enabled
Jump Back Enabled
Label
HOW MUCH PAID: COV UNIT OTH SPEC
Size
25
OTHER SPECIFY: _______________________
{END_LP11}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP11}
{END_LP11}
END_LP11
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS THE
CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_11 AND CONTINUE WITH
BOX_29
BOX_29
IF ANY RU MEMBER HAS MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN AS A SOURCE
OF INSURANCE DURING THE CURRENT ROUND, CONTINUE WITH BOX_30
OTHERWISE, GO TO BOX_32
72
Health Insurance (HX) Section
Beta
BOX_30
IF NO ONE IN THE RU WAS COVERED BY MEDICAID/SCHIP OR GOVTHOSPITAL/PHYSICIAN DURING THE PREVIOUS ROUND AND AT LEAST ONE RU MEMBER IS
COVERED BY MEDICAID/SCHIP DURING THE CURRENT ROUND
OR
IF NO ONE IN THE RU WAS COVERED BY MEDICAID/SCHIP OR GOVTHOSPITAL/PHYSICIAN DURING THE PREVIOUS ROUND AND AT LEAST ONE RU MEMBER IS
COVERED BY GOVT-HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND, GO TO
BOX_31AA
OTHERWISE, GO TO BOX_32
NOTE: SINCE AN RU CANNOT HAVE BOTH MEDICAID/SCHIP AND GOVTHOSPITAL/PHYSICIAN, HX41-HX47OV WILL BE ASKED ONLY ONCE; EITHER FOR A
‘YES’ TO HX10 (MEDICAID/SCHIP) OR A ‘YES’ TO HX14 (GOVTHOSPITAL/PHYSICIAN).
BOX_31AA
NOTE: STATES THAT DO NOT OFFER MEDICAID MANAGED CARE PLANS INCLUDE THE
FOLLOWING:
ALASKA, MISSISSIPPI,NEW HAMPSHIRE, WYOMING
IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT OFFER A MEDICAID
MANAGED CARE PLAN, CODE HX41 '2' (NO) AUTOMATICALLY BY CAPI AND GO TO HX42
OTHERWISE, CONTINUE WITH HX41
73
Health Insurance (HX) Section
Beta
HX41
Help Enabled
Variable Name
HOME.PROGLIST
Comment Enabled
Jump Back Enabled
Label
NAME OF HI FROM MEDICAID/GOVT IS LISTED
Size
2
{STR-DT} {END-DT}
{Some people on {Medicaid/{STATE NAME FOR MEDICAID} or {STATE CHIP
NAME} can enroll in plans called HMOs. These plans have names like those
listed on this card.}
SHOW CARD HX-6.
Is the name of the health insurance through {{Medicaid/{STATE NAME FOR
MEDICAID} or {STATE CHIP NAME}}/the program sponsored by a state or
local government agency which provides hospital and physician benefits} {,
between (START DATE) and (END DATE),} listed on this card?
YES
NO
1
2
{HX41OV}
{HX42}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
74
{HX42}
{HX42}
Health Insurance (HX) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘Some people on...on this card.’ IF ASKING ABOUT
MEDICAID/SCHIP. OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}/or {STATE CHIP
NAME}}’ IF ASKING ABOUT MEDICAID/SCHIP. DISPLAY ‘the
program....benefits’ IF ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR THE PROGRAM)
IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT
USE THE NAME ‘MEDICAID.’ FOR THE SPECIFIC NAME TO USE BY
STATE, SEE BOX ON HX06.
DISPLAY ‘or STATE CHIP NAME’ (SUBSTITUTING THE REAL STATE NAME
FOR PROGRAM). FOR THE SPECIFIC NAME TO USE BY STATE, SEE BOX
ON HX06.
75
Health Insurance (HX) Section
Beta
HX41OV
Help Enabled
Variable Name
HOME.PROGLETT
Comment Enabled
Jump Back Enabled
Label
PLAN LETTER OF MEDICAID/GOVT INSURANCE
Which plan is the health insurance through {{Medicaid/{STATE NAME FOR
MEDICAID}} or {STATE CHIP NAME}}/that program)?
LETTER OF PLAN FROM SHOW CARD:
_______________________
DISPLAY INSTRUCTIONS:
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID} or {STATE CHIP
NAME}}’ IF ASKING ABOUT MEDICAID/SCHIP. DISPLAY ‘that
program’ IF ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN.
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR THE PROGRAM)
IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT
USE THE NAME ‘MEDICAID.’ FOR THE SPECIFIC NAME TO USE BY
STATE, SEE BOX ON HX06.
DISPLAY ‘or STATE CHIP NAME’ (SUBSTITUTING THE REAL STATE NAME
FOR PROGRAM). FOR THE SPECIFIC NAME TO USE BY STATE, SEE BOX
ON HX06.
WHEN INTERVIEWER ENTERS LETTER OF PLAN, DISPLAY THE FOLLOWING
MESSAGE: ‘PLEASE VERIFY PLAN SELECTED: {DISPLAY PLAN NAME
SELECTED}.’ WHEN INTERVIEWER PRESSES ENTER TO CLEAR THE
MESSAGE, PROCEED TO THE NEXT LOGICAL SCREEN.
FOR ‘DISPLAY PLAN NAME SELECTED’, DISPLAY THE ACTUAL PLAN NAME
THAT CORRESPONDS TO THE LETTER ENTERED FOR THIS STATE.
PROGRAMMER NOTES:
FLAG INSURER CODED ABOVE AS ‘CURRENT ROUND’S INSURER FOR
MEDICAID/SCHIP OR GOVT HOSPITAL/PHYSICIAN’.
ROUTING INSTRUCTION:
IF ASKING ABOUT MEDICAID/SCHIP, GO TO BOX_32
OTHERWISE, GO TO HX45
76
Size
4
Health Insurance (HX) Section
Beta
77
Health Insurance (HX) Section
Beta
HX42
Help Enabled (HMO)
Variable Name
HOME.HMOSIGND
Comment Enabled
Jump Back Enabled
Label
MEDICAID/GOVT PROG REQUIRE SIGNING W/HMO
Size
2
{STR-DT} {END-DT}
Under {{Medicaid/{STATE NAME FOR MEDICAID} or {STATE CHIP
NAME}}/the program sponsored by a state or local government agency which
provides hospital and physician benefits} {(are/is)(was/were)} (READ NAME(S)
FROM BELOW) signed up with an HMO, that is a Health Maintenance
Organization {between (START DATE) and (END DATE)}?
[With an HMO, you must generally receive care from HMO physicians. If
another doctor is seen, the expense is not covered unless you were referred
by the HMO, or there was a medical emergency.]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
YES, ALL ARE
YES, SOME ARE
1
2
{HX44}
{HX44}
NO, NONE ARE
3
{HX43}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{HX43}
{HX43}
HELP AVAILABLE FOR DEFINITION OF HMO.
78
Health Insurance (HX) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID} or {STATE CHIP
NAME}}’ IF ASKING ABOUT MEDICAID/SCHIP. DISPLAY ‘the
program....benefits’ IF ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN.
DISPLAY '(are/is)' IF NOT ROUND 5.
ROUND 5.
DISPLAY '(were/was)' IF
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR THE PROGRAM)
IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT
USE THE NAME ‘MEDICAID.’ FOR THE SPECIFIC NAME TO USE BY
STATE, SEE BOX ON HX06.
DISPLAY ‘or STATE CHIP NAME’ (SUBSTITUTING THE REAL STATE NAME
FOR PROGRAM). FOR THE SPECIFIC NAME TO USE BY STATE, SEE BOX
ON HX06.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
OTHERWISE, USE NULL DISPLAY.
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
selection of RU-members.
Roster Behavior:
1. Select, add, delete, and edit disallowed.
Roster Filter:
1. Establishment is Medicaid/SCHIP or Govt-Hospital/Physician,
and
2. Person is an RU member flagged as covered by Medicaid/SCHIP
or Govt-Hospital/Physician during the current round.
79
Health Insurance (HX) Section
Beta
HX43
Help Enabled (PROGDR)
Variable Name
HOME.PROGDR
Comment Enabled
Jump Back Enabled
Label
MEDICAID/GOVT PROG REQUIRE SIGNING W/DR
Size
2
{STR-DT} {END-DT}
{Does/Between (START DATE) and (END DATE), did} {{Medicaid/{STATE
NAME FOR MEDICAID}} or {STATE CHIP NAME}/the program sponsored by
a state or local government agency which provides hospital and physician
benefits} require (READ NAME(S) BELOW) to sign up with a certain primary
care doctor, group of doctors, or with a certain clinic which they must go to for
all of their routine care?
PROBE: Do not include emergency care or care from a specialist they were
referred to.
{[First Name, [Middle Name], Last Name]}
{[First Name, [Middle Name], Last Name]}
{[First Name, [Middle Name], Last Name]}
YES, ALL REQUIRED
YES, SOME REQUIRED
1
2
NO, NONE REQUIRED
3
{HX44}
{HX44}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
HELP AVAILABLE FOR DEFINITION OF PRIMARY CARE DOCTOR AND
ROUTINE CARE.
80
Health Insurance (HX) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY 'Does' IF NOT ROUND 5.
DISPLAY 'Between (START DATE)
and (END DATE), did' IF ROUND 5.
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP
NAME}’ IF ASKING ABOUT MEDICAID/SCHIP.
DISPLAY ‘the program....benefits’ IF ASKING ABOUT GOVTHOSPITAL/PHYSICIAN.
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR THE PROGRAM)
IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT
USE THE NAME ‘MEDICAID.’ FOR THE SPECIFIC NAME TO USE BY
STATE, SEE BOX ON HX06.
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS SUBSTITUTING
THE REAL STATE NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE
BY STATE, SEE BOX ON HX06.
PROGRAMMER NOTES:
IF CODED '3' (NO, NONE REQUIRED), 'RF' (REFUSED), OR 'DK'
(DON'T KNOW), THERE IS NO INSURER ASSOCIATED WITH THE CURRENT
ROUND FOR MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN.
ROUTING INSTRUCTION:
IF CODED ‘3’ (NO, NONE REQUIRED), ‘RF’ (REFUSED), OR ‘DK’
(DON’T KNOW) AND IF ASKING ABOUT MEDICAID/SCHIP, GO TO BOX_32
IF CODED ‘3’ (NO, NONE REQUIRED), ‘RF’ (REFUSED), OR ‘DK’
(DON’T KNOW) AND ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN, GO TO
HX45
OTHERWISE, (I.E., IF CODED ‘1’ (YES, ALL REQUIRED) OR ‘2’
(YES, SOME REQUIRED)), CONTINUE WITH HX44
Roster Details
Title:
RU_ESTB_PERS_PAIRS_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER for
selection of RU-members.
Roster Behavior:
1. Select, add, delete, and edit disallowed.
Roster Filter:
81
Health Insurance (HX) Section
Beta
1. Establishment is Medicaid/SCHIP or Govt-Hospital/Physician,
and
2. Person is an RU member flagged as covered by Medicaid/SCHIP
or Govt-Hospital/Physician during the current round.
82
Health Insurance (HX) Section
Beta
HX44
Help Enabled
Variable Name
HOME.PROGNAME
Comment Enabled
Jump Back Enabled
Label
Size
25
PROGRAM HMO/INSURANCE NAME
{STR-DT}{END-DT}
What is the name of the {{Medicaid/{STATE NAME FOR MEDICAID}/or
{STATE CHIP NAME}}} {HMO/health insurance} {from the program sponsored
by a state or local government agency which provides hospital and physician
benefits}?
PLAN NAME: _______________________
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
DISPLAY INSTRUCTIONS:
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID} or {STATE CHIP
NAME}}’ IF ASKING ABOUT MEDICAID/SCHIP. IF ASKING ABOUT GOVTHOSPITAL/PHYSICIAN, USE A NULL DISPLAY.
DISPLAY ‘from the....benefits’ IF ASKING ABOUT GOVT
HOSPITAL/PHYSICIAN. IF ASKING ABOUT MEDICAID/SCHIP, USE A NULL
DISPLAY.
DISPLAY ‘HMO’ IF HX42 IS CODED ‘1’ (YES, ALL ARE) OR ‘2’ (YES,
SOME ARE).
DISPLAY ‘health insurance’ IF HX43 IS CODED ‘1’ (YES, ALL
REQUIRED) OR ‘2’ (YES, SOME REQUIRED).
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS BEING
CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY ‘STATE NAME FOR
MEDICAID’ (SUBSTITUTING THE REAL STATE NAME FOR THE PROGRAM)
IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT
USE THE NAME ‘MEDICAID.’ FOR THE SPECIFIC NAME TO USE BY
STATE, SEE BOX ON HX06.
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS SUBSTITUTING
THE REAL STATE NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE
BY STATE, SEE BOX ON HX06.
83
Health Insurance (HX) Section
Beta
PROGRAMMER NOTES:
FLAG INSURER CODED ABOVE AS CURRENT ROUND’S INSURER FOR
MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN.
ROUTING INSTRUCTION:
IF ASKING ABOUT MEDICAID/SCHIP, GO TO BOX_32
OTHERWISE, CONTINUE WITH HX45
84
Health Insurance (HX) Section
Beta
HX45
Help Enabled (PREMPAY)
Variable Name
HOME.PREMPAY
Comment Enabled
Jump Back Enabled
Label
DOES SOMEONE PAY PREM FOR GOVT SPONS PRG
Size
2
{STR-DT} {END-DT}
{PLAN NAME: {{PLAN NAME ENTERED AT HX41OV}/{NAME OF PLAN
FROM HX44}}}
Does anyone in the family pay anything for the coverage through {(PLAN
NAME)/the program sponsored by a state or local government agency which
provides hospital and physician benefits}?
[Do not include the cost of any copayments, coinsurance or deductibles
anyone in the family may have had to pay.]
YES
1
{HX46}
NO
2
{HX47}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_32}
{BOX_32}
HELP AVAILABLE FOR DEFINITION OF
PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ...’ IF THERE IS A CURRENT ROUND INSURER
ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN INSURANCE.
OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘{PLAN NAME ENTERED IN HX41OV}’ IF A PLAN LETTER WAS
ENTERED AT HX41OV. DISPLAY THE ACTUAL PLAN NAME THAT
CORRESPONDS TO THE LETTER ENTERED AT HX41OV FOR THIS STATE.
DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX44 FOR ‘NAME OF PLAN
FROM HX44’ IF A PLAN NAME WAS ENTERED.
DISPLAY ‘(PLAN NAME)’ IF THERE IS A CURRENT ROUND INSURER
ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN INSURANCE.
OTHERWISE, DISPLAY, ‘the program sponsored ...’.
85
Health Insurance (HX) Section
Beta
HX46
Help Enabled
Variable Name
HOME.COVRAMT
Comment Enabled
Jump Back Enabled
Label
MEDICAID/GOVT: AMOUNT FAMILY PAID
Size
12
{STR-DT} {END-DT}
{PLAN NAME: {{PLAN NAME ENTERED AT HX41OV}/{NAME OF PLAN
FROM HX44}}}
How much does anyone in the family pay for {the (PLAN NAME)/that}
coverage?
Amount: $ _______
{HX46OV1}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{HX47}
{HX47}
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ...’ IF THERE IS A CURRENT ROUND INSURER
ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN INSURANCE.
OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘{PLAN NAME ENTERED IN HX41OV}’ IF A PLAN LETTER WAS
ENTERED AT HX41OV. DISPLAY THE ACTUAL PLAN NAME THAT
CORRESPONDS TO THE LETTER ENTERED AT HX41OV FOR THIS STATE.
DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX44 FOR ‘NAME OF PLAN
FROM HX44’ IF A PLAN NAME WAS ENTERED.
DISPLAY ‘(PLAN NAME)’ IF THERE IS A CURRENT ROUND INSURER
ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN INSURANCE.
OTHERWISE, DISPLAY, ‘that’.
86
Health Insurance (HX) Section
Beta
HX46OV1
Help Enabled
Variable Name
HOME.COVRUNIT
Comment Enabled
Jump Back Enabled
Label
Size
2
MEDICAID/GOVT: UNIT OF PAYMENT
Is that per year, per month, per week, or what?
UNIT OF COVERAGE:
PER YEAR
1
{HX47}
QUARTERLY/EVERY 3 MONTHS
BIMONTHLY/EVERY 2 MONTHS
2
3
{HX47}
{HX47}
PER MONTH
PER WEEK
4
5
{HX47}
{HX47}
BIWEEKLY/EVERY 2 WEEKS
SEMI-ANNUALLY/2 TIMES PER YEAR
SEMI-MONTHLY/2 TIMES PER MONTH
6
7
8
{HX47}
{HX47}
{HX47}
OTHER
91
{HX46OV2}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
87
{HX47}
{HX47}
Health Insurance (HX) Section
Beta
HX46OV2
Help Enabled
Variable Name
HOME.COVRUNOS
Comment Enabled
Jump Back Enabled
Label
MEDICAID/GOVT: UNIT OF PAYMENT OTH SPEC
Size
25
OTHER SPECIFY: _______________________
{HX47}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
88
{HX47}
{HX47}
Health Insurance (HX) Section
Beta
HX47
Help Enabled
Comment Enabled
Variable Name
HOME.HX47BLSWVS
Jump Back Enabled
Label
Size
HOME.BYFED
HOME.BYSTATE
FEDERAL GOVT PAID MEDICAID/GOVT PREMIUM
STATE GOVT PAID MEDICAID/GOVT PREMIUM
2
2
HOME.BYLOCAL
HOME.BYSOMGOV
LOCAL GOVT PAID MEDICAID/GOVT PREMIUM
SOME GOVT PAID MEDICAID/GOVT PREMIUM
2
2
HOME.BYOTHER
OTHER PAID MEDICAID/GOVT PREMIUM
2
{STR-DT}{END-DT}
{PLAN NAME: {{PLAN NAME ENTERED AT HX41OV}/{NAME OF PLAN
FROM HX44}}}
Who {else} pays {some of/for} the premium or cost of this insurance?
FEDERAL GOVERNMENT
STATE GOVERNMENT
1
2
LOCAL GOVERNMENT
SOME GOVERNMENT
3
4
OTHER
91
{HX47OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_32}
{BOX_32}
DISPLAY INSTRUCTIONS:
DISPLAY ‘PLAN NAME: ...’ IF THERE IS A CURRENT ROUND INSURER
ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN INSURANCE.
OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘{PLAN NAME ENTERED IN HX41OV}’ IF A PLAN LETTER WAS
ENTERED AT HX41OV. DISPLAY THE ACTUAL PLAN NAME THAT
CORRESPONDS TO THE LETTER ENTERED AT HX41OV FOR THIS STATE.
DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX44 FOR ‘NAME OF PLAN
FROM HX44’ IF A PLAN NAME WAS ENTERED.
DISPLAY ‘else’ IF HX45 IS CODED ‘1’ (YES). OTHERWISE, USE A
NULL DISPLAY.
DISPLAY ‘some of’ IF HX45 IS CODED ‘1’ (YES).
DISPLAY ‘for’ IF HX45 IS CODED ‘2’ (NO).
89
Health Insurance (HX) Section
Beta
PROGRAMMER NOTES:
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW 'RF' OR
'DK' IN COMBINATION WITH ANY OTHER CODE.
ROUTING INSTRUCTION:
IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER
CODE, CONTINUE WITH HX47OV
OTHERWISE, GO TO BOX_32
HX47OV
Help Enabled
Variable Name
HOME.BYOTHOS
Comment Enabled
Jump Back Enabled
Label
OTH SPEC OF WHO PAID SOME/ALL MEDICAID/G
Size
25
OTHER SPECIFY: _______________________
{BOX_32}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_32}
{BOX_32}
BOX_32
IF ANY ESTABLISHMENT RECORDED AS PROVIDING PRIVATE INSURANCE (THAT WAS
CREATED DURING THE CURRENT ROUND) TO A CURRENT RU MEMBER, CONTINUE WITH
LOOP_12
OTHERWISE, GO TO BOX_45
90
Health Insurance (HX) Section
Beta
LOOP_12
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK HX48END_LP12
LOOP DEFINITION: LOOP_12 COLLECTS PRIVATE HEALTH INSURANCE INFORMATION.
THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING
CONDITIONS:
- ESTABLISHMENT IS PROVIDER OF PRIVATE HEALTH INSURANCE TO A CURRENT
RU MEMBER
AND
- THE INSURANCE COVERAGE PROVIDED BY THE ESTABLISHMENT IS CREATED DURING
THE CURRENT ROUND
91
Health Insurance (HX) Section
Beta
HX48
Help Enabled (TYPEINS)
Comment Enabled
Variable Name
EPRS.HX48BLSWVS
Jump Back Enabled
Label
Size
EPRS.HOSPINS
EPRS.DENTLINS
TYPE OF HI GOTTEN: HOSPITAL/HMO
TYPE OF HI GOTTEN: DENTAL
2
2
EPRS.PMEDINS
EPRS.VISIONIN
TYPE OF HI GOTTEN: PRESCRIPTION DRUG
TYPE OF HI GOTTEN: VISION
2
2
EPRS.MSUPINS
TYPE OF HI GOTTEN: MEDIGAP
2
EPRS.LTCINS
EPRS.CASHINS
TYPE OF HI GOTTEN: LTC-NURSING HOME
TYPE OF HI GOTTEN: EXTRA CASH
2
2
EPRS.DREADINS
TYPE OF HI GOTTEN: DREAD DISEASE
2
EPRS.DISABINS
EPRS.WCOMPINS
TYPE OF HI GOTTEN: DISABILITY
TYPE OF HI GOTTEN: WORKER'S COMP
2
2
EPRS.ACCDINS
EPRS.OTHINS
TYPE OF HI GOTTEN: ACCIDENT
TYPE OF HI GOTTEN: OTHER
2
2
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
SHOW CARD HX-7.
Now I’d like to ask a few questions about (POLICYHOLDER)’s health
insurance through (ESTABLISHMENT). What type of health insurance
{(do/does)/did} (POLICYHOLDER) get through (ESTABLISHMENT) {on (END
DATE)}?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS,
INCLUDING COVERAGE THROUGH AN
HMO
1
DENTAL
PRESCRIPTION DRUGS
2
3
VISION
MEDICARE SUPPLEMENT/MEDIGAP
4
5
LONG TERM CARE IN A NURSING HOME 6
EXTRA CASH FOR HOSPITAL STAYS
7
SERIOUS DISEASE OR DREAD DISEASE 8
DISABILITY
WORKER'S COMPENSATION
92
9
10
Health Insurance (HX) Section
Beta
ACCIDENT
11
OTHER
91
{HX48OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_33}
{BOX_33}
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
DISPLAY INSTRUCTIONS:
DISPLAY ‘(do/does)’ IF INSURANCE BEING ASKED ABOUT IS CURRENT
(I.E., HQ02 IS CODED ‘1’ (YES, COVERED NOW) FOR THE
POLICYHOLDER, AND THE CURRENT ROUND IS NOT ROUND 5.
OTHERWISE, DISPLAY ‘did’.
DISPLAY 'on (END DATE)' IF ROUND 5.
DISPLAY.
OTHERWISE, USE A NULL
PROGRAMMER NOTES:
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW 'RF' OR
'DK' IN COMBINATION WITH ANY OTHER CODE.
ROUTING INSTRUCTION:
IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER
CODE, CONTINUE WITH HX48OV
OTHERWISE, GO TO BOX_33
93
Health Insurance (HX) Section
Beta
HX48OV
Help Enabled
Variable Name
EPRS.OTHINSOS
Comment Enabled
Jump Back Enabled
Label
Size
25
TYPE OF HI GOTTEN: OTH SPECIFY
OTHER SPECIFY: _______________________
{BOX_33}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_33}
{BOX_33}
BOX_33
IF ESTABLISHMENT TYPE IS NOT INSURANCE CO. OR HMO AND HX48 IS CODED '5'
(MEDICARE SUPPLEMENT OR MEDIGAP) ONLY OR '5' AND ANY OTHER CODES, CONTINUE
WITH HX49
IF ESTABLISHMENT TYPE IS INSURANCE CO. OR HMO AND HX48 IS CODED '5'
(MEDICARE SUPPLEMENT OR MEDIGAP) ONLY OR '5' AND ANY OTHER CODES,
AUTOMATICALLY CODE HX49 WITH APPROPRIATE RESPONSES BY CAPI AND THEN GO TO
LOOP_13
OTHERWISE (I.E., HX48 IS NOT CODED '5' (MEDICARE SUPPLEMENT OR MEDIGAP)),
GO TO BOX_35
94
Health Insurance (HX) Section
Beta
HX49
Help Enabled (INSHMO)
Comment Enabled
Jump Back Enabled
Variable Name
EPIN.EPINID
EPIN ID KEY: EPRSID + COUNTER(2)
Label
Size
22
EPIN.EPINRURN
EPIN.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
EPIN.INSNAME
EPIN.INSTYPE
HX41/43/46 NAME OF INSURANCE CO OR HMO
HX41/43/46 TYPE OF INSURER
25
2
EPIN.MSUPFLG
FLAG-PROVIDE MEDICARE SUPPLEMENT/MEDIGAP
2
EPIN.MAJORMED
FLAG EPIN AS PROVIDING MAJOR MEDICAL COV
2
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
What is the name of the insurance company or HMO from which
(POLICYHOLDER) receives the Medicare Supplement or Medigap benefits?
IF MORE THAN ONE NAME, PROBE: What is the main insurance company
or HMO from which (POLICYHOLDER) receives the Medicare Supplement
or Medigap benefits?
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO,
SELECT 'HMO'.
NAME OF INSURER:_______________
-----------------------------TYPE:
INSURANCE COMPANY
HMO
1
2
{LOOP_13}
{LOOP_13}
SELF-INSURED COMPANY
3
{LOOP_13}
HELP AVAILABLE FOR DEFINITION OF INSURANCE CO/HMO/SELFINSURED CO.
PROGRAMMER NOTES:
FLAG INSURANCE CO./HMO AS ‘SUPPLYING MEDICARE
SUPPLEMENT/MEDIGAP BENEFITS’. ALSO FLAG AS CURRENT ROUND’S
INSURER(S) FOR THIS ESTABLISHMENT-PERSON-PAIR.
95
Health Insurance (HX) Section
Beta
LOOP_13
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON-INSURER-TRIPLES-ROSTER, ASK
HX50-END_LP13
LOOP DEFINITION: LOOP_13 COLLECTS OTHER POLICY NAMES FOR THE HEALTH
INSURANCE COMPANIES OR HMOs PROVIDING MEDICARE SUPPLEMENT/MEDIGAP BENEFITS
(THAT IS, INSURERS ENUMERATED AT HX49).
THIS LOOP CYCLES ON TRIPLES THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS PROVIDER OF PRIVATE INSURANCE WHICH PROVIDES MEDICARE
SUPPLEMENT/MEDIGAP BENEFITS
AND
- PERSON IS THE POLICYHOLDER FOR THE INSURANCE PROVIDED THROUGH THIS
ESTABLISHMENT
AND
- INSURER IS THE SOURCE OF THE BENEFITS PROVIDED TO PERSON THROUGH
THE ESTABLISHMENT (I.E., THE INSURANCE COMPANY, HMO, OR SELF-INSURED
COMPANY)
96
Health Insurance (HX) Section
Beta
HX50
Help Enabled (OPTION)
Variable Name
EPIN.OTHNAME
Comment Enabled
Jump Back Enabled
Label
HX42/44/47 ANOTHER NAME FOR POLICY
Size
2
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-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
NO OTHER NAMES
1
2
{HX50OV}
{END_LP13}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP13}
{END_LP13}
HELP AVAILABLE FOR DEFINITION OF LOW OPTION/HIGH OPTION.
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THE INSURANCE CO/HMO RECORDED IN HX49_01
WHICH IS BEING LOOPED ON FOR ‘INSURANCE...NAME.’
97
Health Insurance (HX) Section
Beta
HX50OV
Help Enabled
Variable Name
EPIN.OTHNAMOS
Comment Enabled
Jump Back Enabled
Label
HX42/44/47 OTH NAME FOR INSURANCE POLICY
Size
25
OTHER NAME: _______________________
{END_LP13}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP13}
{END_LP13}
END_LP13
CYCLE ON NEXT TRIPLE ON THE RU-ESTABLISHMENT-PERSON-INSURER-TRIPLES-ROSTER
THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO MORE TRIPLES MEET THE STATED CONDITIONS, END LOOP_13 AND CONTINUE
WITH BOX_35
98
Health Insurance (HX) Section
Beta
BOX_35
IF ESTABLISHMENT TYPE IS INSURANCE COMPANY, INSURANCE COMPANY - FROM
AGENT, OR HMO, AND HX48 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS,
INCLUDING COVERAGE THROUGH AN HMO) (BUT NOT '5' (MEDIGAP)), FLAG INSURANCE
COMPANY/HMO AS 'SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS' AND
AUTOMATICALLY CODE HX51 WITH APPROPRIATE RESPONSES BY CAPI AND GO TO
LOOP_14.
IF ESTABLISHMENT TYPE IS NOT INSURANCE COMPANY, INSURANCE COMPANY - FROM
AGENT, OR HMO, AND HX48 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS,
INCLUDING COVERAGE THROUGH AN HMO) AND NOT ALSO CODED '5' (MEDICARE
SUPPLEMENT/MEDIGAP), CONTINUE WITH HX51
IF ROUND 1 AND HX48 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS,
INCLUDING COVERAGE THROUGH AN HMO) AND '5' (MEDICARE SUPPLEMENT/MEDIGAP)
(IN COMBINATION WITH ANY OTHER CODES), GO TO BOX_38
IF ROUND 2, 3, 4 OR 5 AND HX48 IS NOT CODED '1' (HOSPITAL AND PHYSICIAN
BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) BUT IS CODED '2' (DENTAL),
'3' (PRESCRIPTION DRUGS), '4' (VISION), '5' (MEDICARE SUPPLEMENT/MEDIGAP),
'6' (LONG TERM CARE IN A NURSING HOME), '7' (EXTRA CASH FOR HOSPITAL
STAYS), '8' (SERIOUS DISEASE OR DREAD DISEASE), OR '91' (OTHER), GO TO
BOX_38
IF HX48 IS CODED ANY COMBINATION OF ONLY CODES '9' (DISABILITY), '10'
(WORKER'S COMPENSATION) OR '11' (ACCIDENT), GO TO END_LP12
IF ROUND 1 AND HX48 IS CODED 'RF' (REFUSED) OR 'DK' (DON'T KNOW), GO TO
BOX_39
IF ROUND 2, 3, 4, OR 5 AND HX48 IS CODED 'RF' (REFUSED) OR DK (DON'T
KNOW), GO TO BOX_38
99
Health Insurance (HX) Section
Beta
HX51
Help Enabled (INSHMO)
Comment Enabled
Jump Back Enabled
Variable Name
EPIN.EPINID
EPIN ID KEY: EPRSID + COUNTER(2)
Label
Size
22
EPIN.EPINRURN
EPIN.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
CREATION STAMP
2
2
EPIN.INSNAME
EPIN.INSTYPE
HX41/43/46 NAME OF INSURANCE CO OR HMO
HX41/43/46 TYPE OF INSURER
25
2
EPIN.MAJORMED
FLAG EPIN AS PROVIDING MAJOR MEDICAL COV
2
EPIN.MSUPFLG
FLAG-PROVIDE MEDICARE SUPPLEMENT/MEDIGAP
2
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
What is the name of the insurance company or HMO from which
(POLICYHOLDER) receives hospital and physician benefits?
IF MORE THAN ONE NAME, PROBE: What is the main insurance company
or HMO from which (POLICYHOLDER) receives hospital and physician
benefits?
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO,
SELECT 'HMO'.
NAME OF INSURER:_______________
-------------------------------------------TYPE:
INSURANCE COMPANY
HMO
1
2
{LOOP_14}
{LOOP_14}
SELF-INSURED COMPANY
3
{LOOP_14}
HELP AVAILABLE FOR DEFINITION OF INSURANCE CO/HMO/SELFINSURED CO.
PROGRAMMER NOTES:
FLAG INSURANCE CO./HMO AS ‘SUPPLYING HOSPITAL ANDPHYSICIAN
BENEFITS’. ALSO FLAG AS CURRENT ROUND’S INSURER(S) FOR THIS
ESTABLISHMENT-PERSON-PAIR.
100
Health Insurance (HX) Section
Beta
LOOP_14
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON-INSURER-TRIPLES-ROSTER, ASK
HX52-END_LP14
LOOP DEFINITION: LOOP_14 COLLECTS OTHER POLICY NAMES FOR THE HEALTH
INSURANCE COMPANIES OR HMOS PROVIDING HOSPITAL/PHYSICIAN BENEFITS BUT NOT
MEDICARE SUPPLEMENT OR MEDIGAP. THIS LOOP CYCLES ON TRIPLES THAT MEET THE
FOLLOWING CONDITIONS:
- ESTABLISHMENT IS PROVIDER OF PRIVATE INSURANCE WHICH PROVIDES
HOSPITAL/PHYSICIAN BENEFITS BUT NOT MEDICARE SUPPLEMENT OR
MEDIGAP
AND
- PERSON IS THE POLICYHOLDER FOR THE INSURANCE PROVIDED THROUGH THIS
ESTABLISHMENT
AND
- INSURER IS THE SOURCE OF THE BENEFITS PROVIDED TO PERSON THROUGH THE
ESTABLISHMENT (I.E., THE INSURANCE COMPANY, HMO OR SELF-INSURED
COMPANY)
101
Health Insurance (HX) Section
Beta
HX52
Help Enabled (OPTION)
Variable Name
EPIN.OTHNAME
Comment Enabled
Jump Back Enabled
Label
HX42/44/47 ANOTHER NAME FOR POLICY
Size
2
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-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
NO OTHER NAMES
1
2
{HX52OV}
{END_LP14}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP14}
{END_LP14}
HELP AVAILABLE FOR DEFINITION OF LOW OPTION/HIGH OPTION.
DISPLAY INSTRUCTIONS:
DISPLAY THE NAME OF THE INSURANCE CO/HMO RECORDED IN HX51_01
WHICH IS BEING LOOPED ON FOR ‘INSURANCE...NAME.’
102
Health Insurance (HX) Section
Beta
HX52OV
Help Enabled
Variable Name
EPIN.OTHNAMOS
Comment Enabled
Jump Back Enabled
Label
HX42/44/47 OTH NAME FOR INSURANCE POLICY
Size
25
OTHER NAME: _______________________
{END_LP14}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP14}
{END_LP14}
END_LP14
CYCLE ON NEXT TRIPLE ON RU-ESTABLISHMENT-PERSON-INSURER-TRIPLES-ROSTER
THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO MORE TRIPLES MEET THE STATED CONDITIONS, END LOOP_14 AND CONTINUE
WITH BOX_38
BOX_39
IF ESTABLISHMENT-PERSON-PAIR BEING ASKED ABOUT IS FLAGGED AS THROUGH THE
FEDERAL GOVERNMENT (EM96 IS CODED '2' (THE FEDERAL GOVERNMENT) OR HP13 IS
CODED '1' (YES)), CONTINUE WITH HX59
OTHERWISE, GO TO BOX_40
103
Health Insurance (HX) Section
Beta
HX59
Help Enabled
Variable Name
EPRS.PLANLIST
Comment Enabled
Jump Back Enabled
Label
NAME OF POLICYHOLDERS PLAN LISTED ON CRD
Size
2
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
SHOW CARD HX-8.
Is the name of (POLICYHOLDER)’s insurance plan through
(ESTABLISHMENT) listed on this card?
YES
1
{HX59OV}
NO
2
{BOX_40}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
104
{BOX_40}
{BOX_40}
Health Insurance (HX) Section
Beta
HX59OV
Help Enabled
Variable Name
EPRS.INSRLETT
Comment Enabled
Jump Back Enabled
Label
LETTER CODE OF PLAN FROM SHOW CARD
Size
4
Which insurance plan is (POLICYHOLDER)’s (ESTABLISHMENT)
insurance?
LETTER OF PLAN FROM SHOW CARD:
_______________________
{BOX_40}
DISPLAY INSTRUCTIONS:
WHEN INTERVIEWER ENTERS LETTER OF PLAN, DISPLAY THE FOLLOWING
MESSAGE: ‘PLEASE VERIFY PLAN ENTERED.’ WHEN INTERVIEWER
CLEARS THE MESSAGE, PROCEED TO THE NEXT LOGICAL SCREEN.
BOX_40
IF THIS ESTABLISHMENT-PERSON-PAIR HAS AT LEAST ONE INSURER THAT PROVIDES
HOSPITAL AND PHYSICIAN BENEFITS OR THAT PROVIDES MEDICARE SUPPLEMENT/
MEDIGAP COVERAGE AND THE POLICYHOLDER IS NOT LISTED AS A COVERED PERSON
WITH MEDICAID OR GOVT-HOSPITAL/PHYSICIAN FOR THE CURRENT ROUND, CONTINUE
WITH LOOP_17
OTHERWISE, GO TO BOX_42
105
Health Insurance (HX) Section
Beta
LOOP_17
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON-INSURER-TRIPLES-ROSTER, ASK
BOX_41 - END_LP17
LOOP DEFINITION: LOOP_17 COLLECTS INFORMATION ON PLANS THAT PROVIDE
HOSPITAL/PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT/MEDIGAP COVERAGE TO
EACH POLICYHOLDER NOT ALSO COVERED BY MEDICAID OR GOVT-HOSPITAL/PHYSICIAN
TO DETERMINE IF THAT PLAN IS AN HMO/MANAGED CARE PLAN. THIS LOOP CYCLES
ON TRIPLES THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS PROVIDER OF HOSPITAL/PHYSICIAN BENEFITS OR MEDICARE
SUPPLEMENT/MEDIGAP COVERAGE
AND
- PERSON IS NOT LISTED AS A COVERED PERSON WITH MEDICAID OR
GOVT-HOSPITAL/PHYSICIAN
AND
- INSURER IS THE SOURCE OF THE HOSPITAL AND PHYSICIAN BENEFITS PROVIDED
TO PERSON THROUGH THE ESTABLISHMENT (I.E., THE INSURANCE COMPANY OR
SELF-INSURED COMPANY)
BOX_40A
IF INSURER IS AN HMO (EPIN.INSTYPE = 2), CONTINUE WITH HX60A
OTHERWISE (I.E., IF INSURER IS NOT AN HMO), GO TO BOX_41
106
Health Insurance (HX) Section
Beta
HX60A
Help Enabled
Variable Name
EPIN.VISITPAY
Comment Enabled
Jump Back Enabled
Label
PLAN PAY FOR NON-HMO, NON-REFER DR VISIT
Size
2
{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
NO
1
2
{END_LP17}
{END_LP17}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP17}
{END_LP17}
BOX_41
PRESENT MANAGED CARE (MC) SECTION FOR THIS INSURER
AT COMPLETION OF THE MC SECTION, CONTINUE WITH END_LP17
END_LP17
CYCLE ON NEXT TRIPLE ON RU-ESTABLISHMENT-PERSON-INSURER-TRIPLES-ROSTER
THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE TRIPLES MEET THE STATED CONDITIONS, END LOOP_17 AND CONTINUE
WITH BOX_42
107
Health Insurance (HX) Section
Beta
BOX_42
IF ROUND 1 OR ROUND 3 AND IF HX48 IS CODED '5' (MEDICARE
SUPPLEMENT/MEDIGAP), CONTINUE WITH HX60
OTHERWISE, GO TO BOX_43
HX60
Help Enabled (HX60Help)
Variable Name
EPRS.PLANLETT
Comment Enabled
Jump Back Enabled
Label
MEDICARE SUPP/MEDIGAP PLAN LETTER
Size
4
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
CODE WITHOUT ASKING IF ANSWER IS KNOWN.
Many Medicare Supplemental or Medigap Plans are referred to by a Plan
Letter. Do you know the Plan Letter for (PERSON)’s plan?
PROBE: What is it?
PLAN LETTER: _______________________
{BOX_43}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_43}
{BOX_43}
HELP AVAILABLE FOR DEFINITION OF PLAN LETTER.
BOX_43
IF ROUND 1 OR ROUND 3, CONTINUE WITH HX61
OTHERWISE (I.E., IF ROUND 2, 4, OR 5), GO TO END_LP12
108
Health Insurance (HX) Section
Beta
HX61
Help Enabled (PREMPAY)
Variable Name
EPRS.PREMLEVL
Comment Enabled
Jump Back Enabled
Label
HOW MUCH OF PREMIUM PAID BY FAM
Size
2
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-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
YES, PAY SOME OF PREMIUM/COST
1
2
{HX62}
{HX62}
YES, BUT DON'T KNOW IF PAY ALL OR
SOME OF PREMIUM/COST
NO, DO NOT PAY
3
{HX62}
4
{HX63}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP12}
{END_LP12}
HELP AVAILABLE FOR DEFINITION OF
PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
PROGRAMMER NOTES:
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.
109
Health Insurance (HX) Section
Beta
HX62
Help Enabled
Variable Name
EPRS.COVRAMT
Comment Enabled
Jump Back Enabled
Label
HOW MUCH PAID FOR COVERAGE-AMT
Size
12
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT}{END-DT}
How much {(do/does)/did} (POLICYHOLDER) pay for the (ESTABLISHMENT)
coverage?
AMOUNT: $ _______________________
{HX62OV1}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_44A}
{BOX_44A}
DISPLAY INSTRUCTIONS:
DISPLAY ‘(do/does)’ IF INSURANCE BEING ASKED ABOUT IS CURRENT
(I.E., HQ02 IS CODED ‘1’ (YES, COVERED NOW)) FOR THE
POLICYHOLDER.
OTHERWISE, DISPLAY ‘did’.
PROGRAMMER NOTES:
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.
110
Health Insurance (HX) Section
Beta
HX62OV1
Help Enabled
Variable Name
EPRS.COVRUNIT
Comment Enabled
Jump Back Enabled
Label
HOW MUCH PAID FORCOVERAGE-UNIT
Size
2
{Is/Was} that per year, per month, per week, or what?
UNIT OF COVERAGE:
PER YEAR
QUARTERLY/EVERY 3 MONTHS
1
2
{BOX_44A}
{BOX_44A}
BIMONTHLY/EVERY 2 MONTHS
PER MONTH
3
4
{BOX_44A}
{BOX_44A}
PER WEEK
BIWEEKLY/EVERY 2 WEEKS
5
6
{BOX_44A}
{BOX_44A}
SEMI-ANNUALLY/2 TIMES PER YEAR
7
{BOX_44A}
SEMI-MONTHLY/2 TIMES PER MONTH
OTHER
8
91
{BOX_44A}
{HX62OV2}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_44A}
{BOX_44A}
DISPLAY INSTRUCTIONS:
DISPLAY ‘Is' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E.,
HQ02 IS CODED ‘1’ (YES, COVERED NOW)) FOR THE POLICYHOLDER.
OTHERWISE, DISPLAY ‘Was’.
111
Health Insurance (HX) Section
Beta
HX62OV2
Help Enabled
Variable Name
EPRS.COVRUNOS
Comment Enabled
Jump Back Enabled
Label
HOW MUCH PAID: COV UNIT OTH SPEC
Size
25
OTHER SPECIFY: _______________________
{BOX_44A}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_44A}
{BOX_44A}
BOX_44A
IF HX61 IS CODED '1' (YES, PAY ALL OF PREMIUM/COST), GO TO END_LP12
OTHERWISE, CONTINUE WITH HX63
112
Health Insurance (HX) Section
Beta
HX63
Help Enabled
Comment Enabled
Variable Name
EPRS.HX63BLSWVS
Jump Back Enabled
Label
Size
EPRS.BYFED
EPRS.BYSTATE
FEDERAL GOVT PAID FOR PRIV PLAN PREMIUM
STATE GOVT PAID FOR PRIV PLAN PREMIUM
2
2
EPRS.BYLOCAL
EPRS.BYSOMGOV
LOCAL GOVT PAID FOR PRIV PLAN PREMIUM
SOME GOVT PAID FOR PRIV PLAN PREMIUM
2
2
EPRS.BYEMPL
EMPLOYER PAID FOR PRIV PLAN PREMIUM
2
EPRS.BYUNION
EPRS.BYOTHER
UNION PAID FOR PRIV PLAN PREMIUM
OTHER PAID FOR PRIV PLAN PREMIUM
2
2
HOME.PLANFLAG
RU PLAN FLAG-HOSP/PHYS INSR + HMO STATUS
2
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
Who {else} pays {some of/for} the premium or cost of this insurance?
CHECK ALL THAT APPLY.
FEDERAL GOVERNMENT
STATE GOVERNMENT
1
2
LOCAL GOVERNMENT
3
SOME GOVERNMENT
EMPLOYER
4
5
UNION
OTHER
6
91
{HX63OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP12}
{END_LP12}
DISPLAY INSTRUCTIONS:
DISPLAY ‘else’ IF HX61 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 HX61 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 HX61 IS CODED ‘4’ (NO, DO
NOT PAY).
113
Health Insurance (HX) Section
Beta
PROGRAMMER NOTES:
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW 'RF' OR
'DK' IN COMBINATION WITH ANY OTHER CODE.
ROUTING INSTRUCTION:
IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER
CODE, CONTINUE WITH HX63OV
OTHERWISE, GO TO END_LP12
HX63OV
Help Enabled
Variable Name
EPRS.BYOTHOS
Comment Enabled
Jump Back Enabled
Label
OTHER SPECIFY OF WHO PAID PRIV PLAN PREM
Size
25
OTHER SPECIFY: _______________________
{END_LP12}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP12}
{END_LP12}
END_LP12
CYCLE ON NEXT PAIR IN RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS THE
CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_12 AND CONTINUE WITH
BOX_45
BOX_45
IF ROUND 1, CONTINUE WITH BOX_46
OTHERWISE, GO TO BOX_50
114
Health Insurance (HX) Section
Beta
BOX_46
IF ALL PERSONS IN RU HAVE HEALTH INSURANCE (I.E., FLAGGED AS HAVING
MEDICARE, MEDICAID, GOVT-HOSPITAL/PHYSICIAN, TRICARE/CHAMPVA, OTHER PUBLIC
OR PRIVATE INSURANCE) COVERAGE ON JANUARY 1,{YEAR}, WHERE 'YEAR' IS THE
FIRST CALENDAR YEAR OF THE PANEL, GO TO BOX_48
OTHERWISE (AT LEAST ONE RU MEMBER BORN BEFORE 12/31/{YEAR} WHERE 'YEAR'
PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, IS WITHOUT HEALTH INSURANCE
ON JANUARY 1, {YEAR}, WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE
PANEL), CONTINUE WITH LOOP_18
LOOP_18
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK HX64-END_LP18
LOOP DEFINITION: LOOP_18 COLLECTS INFORMATION ABOUT RU MEMBERS WITH NO
HEALTH INSURANCE ON JANUARY 1, {YEAR}, WHERE 'YEAR' IS THE FIRST CALENDAR
YEAR OF THE PANEL. THIS LOOP CYCLES ON RU MEMBERS WHO ARE NOT A COVERED
PERSON IN ANY ESTABLISHMENT-POLICYHOLDER-COVERED-PERSON-TRIPLE THAT MEETS
THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS MEDICARE, MEDICAID/SCHIP, GOVT-HOSPITAL/PHYSICIAN,
OTHER PUBLIC, TRICARE/CHAMPVA, OR PRIVATE INSURANCE
AND
- PERSON IS A CURRENT RU MEMBER (PART OF THE RU ON 1/1/{YEAR}, WHERE
'YEAR' IS THEYEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL WITH A
BIRTH DATE PRIOR TO DECEMBER 31, {YEAR}, WHERE 'YEAR' IS THE FIRST
CALENDAR YEAR OF THE PANEL (OR AGE CATEGORY > 1)
AND
- PERIOD OF COVERAGE INCLUDES JANUARY 1,{YEAR}, WHERE 'YEAR' IS THE FIRST
CALENDAR YEAR OF THE PANEL.
115
Health Insurance (HX) Section
Beta
HX64
Help Enabled
Variable Name
PERS.PREVCOVR
Comment Enabled
Jump Back Enabled
Label
WAS PERSON COVERED BY INS IN 1993 OR 94
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
I have recorded that (PERSON) (were/was) without insurance on January 1,
{YEAR}. (Were/Was) (PERSON) covered by a health insurance plan or
program at any time in the years {YEAR} or {YEAR}?
YES
NO
1
2
{HX65}
{END_LP18}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP18}
{END_LP18}
DISPLAY INSTRUCTIONS:
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY:) IN THE QUESTION TEXT, "… ON JANUARY 1,
{YEAR}," 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL. IN
THE QUESTION TEXT, "… at any times in the years {YEAR} or
{YEAR}?. " CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST
CALENDAR YEAR OF THE PANEL. (FOR PANEL 12 FOR EXAMPLE, THIS
WOULD BE '2005 OR 2006?')
116
Health Insurance (HX) Section
Beta
HX65
Help Enabled
Comment Enabled
Variable Name
PERS.COVRMM
Label
MONTH MOST RECENTLY COVERED BY INS
PERS.COVRYY
YEAR MOST RECENTLY COVERED BY INS
Jump Back Enabled
Size
2
4
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
When (were/was) (PERSON) most recently covered by health insurance?
That is, in what month and year did that health insurance end for the last
time in 2005 or 2006?
_____/______/__________
MM DD YYYY
{HX66}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{HX66}
{HX66}
DISPLAY INSTRUCTIONS:
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY:) CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST
CALENDAR YEAR OF THE PANEL FOR "'YEAR' OR 'YEAR'?". (FOR
PANEL 12 FOR EXAMPLE, THIS WOULD BE '2005 OR 2006?')
PROGRAMMER NOTES:
‘RF’ (REFUSED) AND ‘DK’ (DON’T KNOW) ARE ALLOWED ON THE MONTH
AND YEAR FIELDS.
117
Health Insurance (HX) Section
Beta
HX66
Help Enabled (PREVINSTYPE)
Comment Enabled
Variable Name
PERS.HX66BLSWVS
Jump Back Enabled
Label
Size
PERS.WASESTB
PERS.WASMCARE
WAS PREV INS BY UNION OR EMPLOYER
WAS PREV INS BY MEDICARE
2
2
PERS.WASMCAID
PERS.WASCHAMP
WAS PREV INS BY MEDICAID
WAS PREV INS BY CHAMPUS/CHAMPVA
2
2
PERS.WASVA
WAS PREV INS BY VA/MILITARY CARE
2
PERS.WASPRIV
PERS.WASOTGOV
WAS PREV INS BY GROUP/ASSOC/INS CO
INSURANCE THAT ENDED WAS OTHER GOVT PROG
2
2
PERS.WASAFDC
WAS PREV INS BY PUBLIC AFDC
2
PERS.WASSSI
PERS.WASSTAT1
WAS PREV INS BY SSI PROGRAM
WAS PREV INS BY STATE PROGRAM 1
2
2
PERS.WASSTAT2
PERS.WASSTAT3
WAS PREV INS BY STATE PROGRAM 2
WAS PREV INS BY STATE PROGRAM 3
2
2
PERS.WASSTAT4
WAS PREV INS BY STATE PROGRAM 4
2
PERS.WASSTAT5
PERS.WASSTAT6
WAS PREV INS BY STATE PROGRAM 5
WAS PREV INS BY STATE PROGRAM 6
2
2
PERS.WASOTHER
WAS PREV INS BY SOME OTHER SOURCE
2
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Was (PERSON)’s health insurance that ended in {MONTH AND YEAR
FROM HX65/ {YEAR} or {YEAR} obtained through an employer or a
union, was it a government program such as Medicaid, or what?
CHECK ALL THAT APPLY.
OBTAINED THROUGH UNION, PRIVATE
EMPLOYER OR PUBLIC EMPLOYER
(FEDERAL, STATE, OR LOCAL GOVT.)
1
MEDICARE
2
MEDICAID
TRICARE/CHAMPVA
VA OR MILITARY HEALTH CARE
PURCHASED DIRECTLY FROM GROUP,
ASSOC., OR INS. AGENT, INS. CO. OR
HMO
3
4
5
6
OTHER TYPE OF GOVERNMENT
SPONSORED PROGRAM
7
OTHER PUBLIC PROGRAM:
118
Health Insurance (HX) Section
Beta
TANF/AFDC
8
SSI
{STATE PROGRAM 1}
{STATE PROGRAM 2}
{STATE PROGRAM 3}
9
10
11
12
{STATE PROGRAM 4}
13
OTHER
91
{HX66OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP18}
{END_LP18}
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
DISPLAY INSTRUCTIONS:
IF HX65 IS NOT CODED ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW),
DISPLAY THE DATE ENTERED AT HX65 FOR ‘MONTH AND YEAR FROM
HX65’. DISPLAY ‘in {YEAR} or {YEAR}’ IF HX65 IS CODED ‘RF’
(REFUSED) OR ‘DK’ (DON’T KNOW), WHERE "'YEAR' OR 'YEAR'
" DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF
THE PANEL. FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE '2005' OR
'2006'.
FOR ‘STATE PROGRAM N’, DISPLAY AN ACTUAL NAME OF STATE PLAN.
FOR THE SPECIFIC NAMES OF PROGRAMS BY STATE, SEE BOX ON HX16.
PROGRAMMER NOTES:
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW 'RF' OR
'DK' IN COMBINATION WITH ANY OTHER CODE.
ROUTING INSTRUCTION:
IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION WITH OTHER
CODES, CONTINUE WITH HX66OV
OTHERWISE, GO TO END_LP18
119
Health Insurance (HX) Section
Beta
HX66OV
Help Enabled
Variable Name
PERS.WASOTHOS
Comment Enabled
Jump Back Enabled
Label
PREVIOUS INSURANCE SOURCE SPECIFIED
Size
25
OTHER SPECIFY: _______________________
{END_LP18}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP18}
{END_LP18}
END_LP18
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED
IN THE LOOP DEFINITION
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_18 AND CONTINUE
WITH BOX_48
BOX_48
IF NO CURRENT RU MEMBERS WHO WERE BORN BEFORE DECEMBER 31, {YEAR), WHERE
'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, HAVE ANY
TYPE OF COMPREHENSIVE PUBLIC INSURANCE (I.E., MEDICARE, MEDICAID/SCHIP,
GOVT-HOSPITAL/PHYSICIAN, OR TRICARE/CHAMPVA)
AND
NO CURRENT RU MEMBERS WHO WERE BORN BEFORE DECEMBER 31, {YEAR}, WHERE
'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, HAVE ANY
PRIVATE INSURANCE THAT INCLUDED HOSPITAL AND PHYSICIAN BENEFITS OR
MEDICARE SUPPLEMENT/MEDIGAP BENEFITS ON 1/1/{YEAR}, WHERE 'YEAR' IS THE
YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, GO TO BOX_49
OTHERWISE, CONTINUE WITH LOOP_19
120
Health Insurance (HX) Section
Beta
LOOP_19
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK HX70-END_LP19
LOOP DEFINITION: LOOP_19 COLLECTS INFORMATION ON ALL RU MEMBERS WITH
PUBLIC AND PRIVATE HEALTH INSURANCE PROVIDING HOSPITAL/PHYSICIAN BENEFITS
OR MEDICARE SUPPLEMENT/MEDIGAP BENEFITS ON JANUARY 1, {YEAR}, WHERE 'YEAR'
IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL TO DETERMINE
PERIODS OF COVERAGE IN {YEAR}, WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST
CALENDAR YEAR OF THE PANEL. THIS LOOP CYCLES ON PERSONS THAT MEET THE
FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER
AND
- PERSON WAS PART OF RU ON 1/1/{YEAR}, WHERE 'YEAR' IS THE YEAR PRIOR TO
THE FIRST CALENDAR YEAR OF THE PANEL
AND
- PERSON’S DATE OF BIRTH IS BEFORE 12/31/{YEAR}, WHERE 'YEAR' IS THE YEAR
PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL OR IN AGE CATEGORIES 2-9
AND
- PERSON HAD COMPREHENSIVE HEALTH INSURANCE COVERAGE ON 1/1/{YEAR}, WHERE
'YEAR' IS THE YEAR PRIOR TO THE
FIRST CALENDAR YEAR OF THE PANEL. COMPREHENSIVE HEALTH INSURANCE REFERS
TO THE PERSON BEING A COVERED
PERSON ON AT LEAST ONE OF THE FOLLOWING ESTABLISHMENT- POLICYHOLDERCOVERED PERSON-TRIPLES ON 1/1/{YEAR},
WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL:
- ESTABLISHMENT IS MEDICARE
- ESTABLISHMENT IS MEDICAID
- ESTABLISHMENT IS TRICARE
- ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN
- ESTABLISHMENT IS PRIVATE WITH HOSPITAL AND PHYSICIAN
BENEFITS OR MEDICARE SUPPLEMENT OR MEDIGAP
(I.E., HX48 = 1 OR 5)
121
Health Insurance (HX) Section
Beta
HX70
Help Enabled
Variable Name
PERS.NOINSBEF
Comment Enabled
Jump Back Enabled
Label
EVER W/OUT HEALTH INS IN 95(P1)/96(P2)?
Size
2
{POLICYHOLDER FIRST MIDDLE LAST NAME} {STR-DT} {END-DT}
I have recorded that (PERSON) had health insurance coverage on January 1,
2007. (Were/Was) (PERSON) ever without health insurance coverage at
any time in 2006?
YES
1
{HX71}
NO
2
{END_LP19}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP19}
{END_LP19}
DISPLAY INSTRUCTIONS:
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY:) FOR 'YEAR' IN "…on January1, {YEAR}," DISPLAY
THE FIRST CALENDAR YEAR OF THE PANEL. FOR 'YEAR' in "… at any
time in {YEAR}, DISPLAY THE YEAR PRIOR TO THE FIRST CALENDAR
YEAR OF THE PANEL.
122
Health Insurance (HX) Section
Beta
HX71
Help Enabled
Variable Name
PERS.NOINSTM
Comment Enabled
Jump Back Enabled
Label
# WKS/MNTHS W/OUT INS IN 95(P1)/96(P2)
Size
2
{POLICYHOLDER FIRST MIDDLE LAST NAME} {STR-DT} {END-DT}
Altogether, how many weeks or months (were/was) (PERSON) without health
insurance coverage in the year {YEAR}?
NUMBER: _______
{HX71OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP19}
{END_LP19}
DISPLAY INSTRUCTIONS:
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY:) FOR 'YEAR' IN THE QUESTION TEXT, DISPLAYS THE
YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL.
123
Health Insurance (HX) Section
Beta
HX71OV
Help Enabled
Variable Name
PERS.NOINUNIT
Comment Enabled
Jump Back Enabled
Label
UNIT FOR TIME W/OUT INS IN 95(P1)/96(P2)
Size
2
ENTER UNIT:
WEEKS
MONTHS
1
2
{END_LP19}
{END_LP19}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP19}
{END_LP19}
END_LP19
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED
IN THE LOOP DEFINITION
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_19 AND CONTINUE
WITH BOX_49
BOX_49
IF ALL CURRENT RU MEMBERS WHO WERE BORN BEFORE DECEMBER 31, {YEAR}, WHERE
'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, HAVE
ONLY PRIVATE INSURANCE THAT INCLUDES HOSPITAL AND PHYSICIAN BENEFITS
AND/OR
ALL CURRENT RU MEMBERS HAVE ONLY COMPREHENSIVE PUBLIC INSURANCE ON JANUARY
1,{YEAR},WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, GO TO
BOX_50
OTHERWISE, CONTINUE WITH LOOP_20
124
Health Insurance (HX) Section
Beta
LOOP_20
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK HX76-END_LP20
LOOP DEFINITION: LOOP_20 COLLECTS INFORMATION FOR EACH RU MEMBER WHOSE
DATE OF BIRTH IS PRIOR TO 12/31/{YEAR}, WHERE 'YEAR' IS THE YEAR PRIOR TO
THE FIRST CALENDAR YEAY OF THE PANEL, (OR AGE CATEGORY > 1), AND WHO IS
COVERED BY PRIVATE INSURANCE THAT DOES NOT INCLUDE EITHER
HOSPITAL/PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT/MEDIGAP BENEFITS ON
JANUARY 1,{YEAR}, WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR
YEAY OF THE PANEL. THIS LOOP DETERMINES IF THESE PERSONS WERE EVER COVERED
BY A MORE COMPREHENSIVE PLAN THAT PROVIDED HOSPITAL/PHYSICIAN COVERAGE
DURING {YEAR}, WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAY
OF THE PANEL, OR {YEAR}, WHERE 'YEAR' IS THE TWO YEARS PRIOR TO THE FIRST
CALENDAR YEAY OF THE PANEL. THE LOOP CYCLES ON PERSONS THAT MEET THE
FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER
AND
- PERSON WAS PART OF RU ON 1/1/{YEAR}, WHERE 'YEAR' IS THE FIRST CALENDAR
YEAY OF THE PANEL
AND
- PERSON’S DATE OF BIRTH IS BEFORE 12/31/{YEAR}, WHERE 'YEAR' IS THE YEAR
PRIOR TO THE FIRST CALENDAR YEAY OF THE PANEL, OR IN AGE CATEGORIES 2-9
AND
- PERSON DID NOT HAVE COMPREHENSIVE HEALTH INSURANCE COVERAGE ON
1/1/{YEAR}, WHERE 'YEAR' IS THE FIRST CALENDAR YEAY OF THE PANEL.
COMPREHENSIVE HEALTH INSURANCE REFERS TO THE PERSON BEING A COVERED
PERSON ON AT LEAST ONE OF THE FOLLOWING ESTABLISHMENT-POLICY
HOLDER-COVERED PERSON-TRIPLES ON 1/1/{YEAR}, WHERE 'YEAR' IS THE
FIRST CALENDAR YEAY OF THE PANEL:
- ESTABLISHMENT IS MEDICARE
- ESTABLISHMENT IS MEDICAID
- ESTABLISHMENT IS TRICARE
- ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN
- ESTABLISHMENT IS PRIVATE WITH HOSPITAL AND PHYSICIAN
BENEFITS OR MEDICARE SUPPLEMENT OR MEDIGAP
(I.E., HX48 = 1 OR 5)
AND
- PERSON IS COVERED PERSON ON AT LEAST ONE OF THE FOLLOWING
ESTABLISHMENT-POLICYHOLDER-COVERED-PERSON-TRIPLES ON 1/1/{YEAR},
WHERE 'YEAR' IS THE FIRST CALENDAR YEAY OF THE PANEL,7
- ESTABLISHMENT IS GROUP 1 OR GROUP 2 OTHER PUBLIC
- ESTABLISHMENT IS PRIVATE WITHOUT HOSPITAL AND PHYSICIAN
BENEFITS OR MEDICARE SUPPLEMENT OR MEDIGAP
(I.E., HX48 IS NOT CODED '1' OR '5')
125
Health Insurance (HX) Section
Beta
HX76
Help Enabled
Variable Name
PERS.MORECOVR
Comment Enabled
Jump Back Enabled
Label
COVERED BY MORE COMP PLAN IN PREV 2 YRS
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
I have recorded that (PERSON) {had health insurance coverage for (READ
TYPES OF INSURANCE BELOW) coverage} {and} {was covered by a public
program} on January 1, {YEAR}. (Were/Was) (PERSON) ever covered by a
more comprehensive health insurance plan or program that paid for medical
and doctor’s bills at any time in the years {YEAR} or {YEAR}?
{TYPE OF INSURANCE IN HX48} {TYPE OF INSURANCE IN HX48}
{TYPE OF INSURANCE IN HX48} {TYPE OF INSURANCE IN HX48}
{TYPE OF INSURANCE IN HX48} {TYPE OF INSURANCE IN HX48}
YES
NO
1
2
{HX77}
{END_LP20}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
126
{END_LP20}
{END_LP20}
Health Insurance (HX) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘had health...(BELOW)’ IF PERSON CONFIRMED AS
POLICYHOLDER (HP09 IS CODED ‘1’ (YES)) OR SELECTED AS
POLICYHOLDER (SELECTED AT HP11) OR SELECTED AS A DEPENDENT
(SELECTED AT HP16) FOR ANY PRIVATE ESTABLISHMENT-POLICYHOLDER
PAIR WHERE HX48 IS NOT CODED ‘1’ (HOSPITAL AND PHYSICIAN
BENEFITS) AND NOT CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP)
EITHER ALONE OR WITH ANY COMBINATION OF CODES FOR ALL OF THOSE
PRIVATE ESTABLISHMENT-POLICYHOLDER PAIRS. OTHERWISE, USE A
NULL DISPLAY.
DISPLAY ‘was....program’ IF PERSON SELECTED AT HX19 (FOR
EITHER GROUP 1 OR GROUP 2 PROGRAM).
OTHERWISE, USE A NULL
DISPLAY.
DISPLAY ‘and’ IF PERSON CONFIRMED AS POLICYHOLDER (HP09 IS
CODED ‘1’ (YES)) OR SELECTED AS POLICYHOLDER (SELECTED AT
HP11) OR SELECTED AS A DEPENDENT (SELECTED AT HP16) FOR ANY
PRIVATE ESTABLISHMENT-POLICYHOLDER PAIR WHERE HX48 IS NOT
CODED ‘1’ (HOSPITAL AND PHYSICIAN BENEFITS) AND NOT CODED ‘5’
(MEDICARE SUPPLEMENT/MEDIGAP) EITHER ALONE OR WITH ANY
COMBINATION OF CODES FOR ALL OF THOSE PRIVATE ESTABLISHMENTPOLICYHOLDER PAIRS AND PERSON SELECTED AT HX19 (FOR EITHER
GROUP 1 OR GROUP 2 PROGRAM).
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY:) IN THE QUESTION TEXT, "… ON JANUARY 1,
{YEAR}," 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL. IN
THE QUESTION TEXT, "… at any times in the years {YEAR} or
{YEAR}?. " CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST
CALENDAR YEAR OF THE PANEL. (FOR PANEL 12 FOR EXAMPLE, THIS
WOULD BE '2005 OR 2006?')
127
Health Insurance (HX) Section
Beta
HX77
Help Enabled
Comment Enabled
Variable Name
PERS.INSENDMM
MONTH MOST RECENTLY COVR'D
PERS.INSENDYY
YEAR MOST RECENTLY COVR'D
Jump Back Enabled
Label
Size
2
4
{PERSON’S FIRST MIDDLE AND LAST NAME}
When (were/was) (PERSON) most recently covered by this kind of health
insurance? That is, in what month and year did the health insurance that paid
for medical and doctor’s bills end for the last time in 2005 or 2006?
_____/______/__________
MM DD YYYY
{HX78}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{HX78}
{HX78}
DISPLAY INSTRUCTIONS:
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY:) CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST
CALENDAR YEAR OF THE PANEL FOR "'YEAR' OR 'YEAR'?". (FOR
PANEL 12 FOR EXAMPLE, THIS WOULD BE '2005 OR 2006?')
PROGRAMMER NOTES:
‘RF’ (REFUSED) AND ‘DK’ (DON’T KNOW) ARE ALLOWED ON THE MONTH
AND YEAR FIELDS.
128
Health Insurance (HX) Section
Beta
HX78
Help Enabled (PREVINSTYPE)
Comment Enabled
Jump Back Enabled
Variable Name
PERS.WASSTAT4
Label
WAS PREV INS BY STATE PROGRAM 4
Size
2
PERS.HX78BLSWVS
PERS.WASESTB
WAS PREV INS BY UNION OR EMPLOYER
2
PERS.WASMCARE
PERS.WASMCAID
WAS PREV INS BY MEDICARE
WAS PREV INS BY MEDICAID
2
2
PERS.WASCHAMP
WAS PREV INS BY CHAMPUS/CHAMPVA
2
PERS.WASVA
PERS.WASPRIV
WAS PREV INS BY VA/MILITARY CARE
WAS PREV INS BY GROUP/ASSOC/INS CO
2
2
PERS.WASOTGOV
INSURANCE THAT ENDED WAS OTHER GOVT PROG
2
PERS.WASAFDC
PERS.WASSSI
WAS PREV INS BY PUBLIC AFDC
WAS PREV INS BY SSI PROGRAM
2
2
PERS.WASSTAT1
PERS.WASSTAT2
WAS PREV INS BY STATE PROGRAM 1
WAS PREV INS BY STATE PROGRAM 2
2
2
PERS.WASSTAT3
WAS PREV INS BY STATE PROGRAM 3
2
PERS.WASOTHER
WAS PREV INS BY SOME OTHER SOURCE
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
Was (PERSON)’s health insurance that ended in {DATE FROM HX77/{YEAR}
or {YEAR} obtained through an employer or union, was it a government
program such as Medicare or Medicaid, or what?
CHECK ALL THAT APPLY.
OBTAINED THROUGH UNION, PRIVATE
EMPLOYER OR PUBLIC EMPLOYER
(FEDERAL, STATE, OR LOCAL
GOVERNMENT)
1
MEDICARE
2
MEDICAID
TRICARE/CHAMPVA
3
4
VA OR MILITARY HEALTH CARE
PURCHASED DIRECTLY FROM GROUP,
ASSOCIATION, OR INSURANCE AGENT,
INSURANCE COMPANY OR HMO
5
6
OTHER TYPE OF GOVERNMENT
SPONSORED PROGRAM
7
OTHER PUBLIC PROGRAM:
129
Health Insurance (HX) Section
Beta
TANF/AFDC
8
SSI
{STATE PROGRAM 1}
{STATE PROGRAM 2}
{STATE PROGRAM 3}
9
10
11
12
{STATE PROGRAM 4}
13
OTHER
91
{HX78OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP20}
{END_LP20}
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
DISPLAY INSTRUCTIONS:
IF HX77 IS NOT CODED ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW),
DISPLAY THE DATE ENTERED AT HX77 FOR ‘MONTH AND YEAR FROM
HX77’. DISPLAY ‘in {YEAR} or{YEAR}’ IF HX77 IS CODED ‘RF’
(REFUSED) OR ‘DK’ (DON’T KNOW), WHERE "'YEAR'" DISPLAYS THE
TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. FOR
PANEL 12 FOR EXAMPLE, THIS WOULD BE '2005 OR 2006.'
FOR ‘STATE PROGRAM N’, DISPLAY AN ACTUAL NAME OF STATE PLAN
WHEN INTERVIEW IS BEING CONDUCTED IN A STATE THAT HAS OTHER
STATE PROGRAMS. FOR THE SPECIFIC NAMES OF PROGRAMS BY STATE,
SEE BOX ON HX16.
PROGRAMMER NOTES:
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW 'RF' OR
'DK' IN COMBINATION WITH ANY OTHER CODE.
ROUTING INSTRUCTION:
IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION WITH OTHER
CODES, CONTINUE WITH HX78OV
OTHERWISE, GO TO END_LP20
130
Health Insurance (HX) Section
Beta
HX78OV
Help Enabled
Variable Name
PERS.WASOTHOS
Comment Enabled
Jump Back Enabled
Label
PREVIOUS INSURANCE SOURCE SPECIFIED
Size
25
OTHER SPECIFY: _______________________
{END_LP20}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP20}
{END_LP20}
END_LP20
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED
IN THE LOOP DEFINITION
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_20 AND CONTINUE
WITH BOX_50
BOX_50
IF ROUND 3, CONTINUE WITH LOOP_21
OTHERWISE,
GO TO NEXT QUESTIONNAIRE SECTION.
LOOP_21
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK HX81 – END_LP21
LOOP DEFINITION: LOOP_21 COLLECTS INFORMATION FOR EACH RU MEMBER TO
DETERMINE IF THESE PERSONS HAD ANY COMPREHENSIVE COVERAGE ON DECEMBER 31,
{YEAR}, WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL.
131
Health Insurance (HX) Section
Beta
HX81
Help Enabled
Variable Name
PERS.COMPCOVR
Comment Enabled
Jump Back Enabled
Label
HAS INS THAT PAYS MEDICAL BILLS ON 12/31
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
(Were/Was) (PERSON) covered by a health insurance plan or program that
paid for medical and doctor’s bills on December 31, {YEAR}?
YES
NO
1
2
{END_LP21}
{END_LP21}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP21}
{END_LP21}
DISPLAY INSTRUCTIONS:
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY:) FOR 'YEAR' DISPLAY THE FIRST CALENDAR YEAR OF
THE PANEL.
END_LP21
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED
IN THE LOOP DEFINITION
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_21 AND CONTINUE
WITH BOX_51
BOX_51
GO TO NEXT QUESTIONNAIRE SECTION
132
| File Type | application/pdf |
| File Title | \\rk29\vol2905\MEPSWVS\SpecWriter\BETA\HX (Beta).snp |
| Author | miller_n |
| File Modified | 2005-10-26 |
| File Created | 2005-10-26 |