MEPS-HC Core Interview

MEPS FAMES P12R5/P13R3/P14R1 Managed Care (MC) Section

December 8, 2008

Managed Care (MC) Section

BOX_00

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| CONTEXT HEADER DISPLAY INSTRUCTIONS: |

| DISPLAY PERS.FULLNAME, ESTB.ESTBNAME, |

| PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY, |

| PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY. |

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MC01

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{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

Now I will ask you a few questions about how (POLICYHOLDER)'s

health insurance through (ESTABLISHMENT) {works/worked} for

non-emergency care {on (END DATE)}.

We are interested in knowing if (POLICYHOLDER)'s (ESTABLISHMENT)

plan is an HMO, that is, a Health Maintenance Organization.

With an HMO, you must generally receive care from HMO physicians.

For other doctors, the expense is not covered unless you were

referred by the HMO or there was a medical emergency.

{When answering this question, do not consider (POLICYHOLDER)’s

insurance through Medicare.}

{Is/Was} (POLICYHOLDER)’s (INSURER NAME) an HMO {on (END DATE)}?

YES .................................... 1 {MC05}

NO ..................................... 2 {MC02}

REF ................................... -7 {MC02}

DK .................................... -8 {MC02}

HELP AVAILABLE FOR DEFINITION OF HMO.

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| DISPLAY ‘When answering this question, do not |

| consider (POLICYHOLDER)’s insurance through |

| Medicare.’ IF POLICYHOLDER BEING ASKED ABOUT IS |

| ALSO COVERED BY MEDICARE. OTHERWISE, USE A NULL |

| DISPLAY. |

| |

| DISPLAY ‘works’ AND ‘is’ IF NOT ROUND 5. DISPLAY |

| ‘worked’ AND ‘was’ IF ROUND 5. |

| |

| DISPLAY ‘on (END DATE)’ IF ROUND 5. OTHERWISE, |

| USE A NULL DISPLAY. |

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MC02

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{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

{(Do/Does)/As of (END DATE), did} (POLICYHOLDER)’s insurance

plan require (POLICYHOLDER) to sign up with a certain primary

care doctor, group of doctors, or a certain clinic which

(POLICYHOLDER) must go to for all of (POLICYHOLDER)’s routine

care?

PROBE: Do not include emergency care or care from a specialist

you were referred to.

YES .................................... 1 {MC04}

NO ..................................... 2 {MC03}

REF ................................... -7 {MC03}

DK .................................... -8 {MC03}

HELP AVAILABLE FOR DEFINITION OF PRIMARY CARE DOCTOR AND ROUTINE CARE.

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| DISPLAY ‘(Do/Does)’ IF NOT ROUND 5. DISPLAY ‘As |

| of (END DATE), did’ IF ROUND 5. |

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MC03

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{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

{Is/As of (END DATE), was} there a book or list of doctors

associated with the plan?

YES .................................... 1 {MC04}

NO ..................................... 2 {BOX_01}

REF ................................... -7 {BOX_01}

DK .................................... -8 {BOX_01}

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| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘As of (END |

| DATE), was’ IF ROUND 5. |

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MC04

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{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

{Will/As of (END DATE), would} (POLICYHOLDER)’s plan pay for any

of the costs of visits to doctors who are not associated with

(POLICYHOLDER)’s plan, even if (POLICYHOLDER) {(do/does)/did}

not have a referral?

YES .................................... 1 {BOX_01}

NO ..................................... 2 {BOX_01}

REF ................................... -7 {BOX_01}

DK .................................... -8 {BOX_01}

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| DISPLAY ‘Will’ AND ‘(do/does)’ IF NOT ROUND 5. |

| DISPLAY ‘As of (END DATE), would’ AND ‘did’ IF |

| ROUND 5. |

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MC05

====

{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

{Will/As of (END DATE), would} (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)/did} not

have a referral?

YES .................................... 1 {BOX_01}

NO ..................................... 2 {BOX_01}

REF ................................... -7 {BOX_01}

DK .................................... -8 {BOX_01}

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| DISPLAY ‘Will’ AND ‘(do/does)’ IF NOT ROUND 5. |

| DISPLAY ‘As of (END DATE), would’ AND ‘did’ IF |

| ROUND 5. |

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BOX_01

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| RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN HX OR |

| OE. |

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