MEPS-HC Core Interview

Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC through 2009)

Attachment 50 -- HC Old Employment & Private Related Insurance Section

MEPS-HC Core Interview

OMB: 0935-0118

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0935-0118 can be found here:

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MEPS FAMES P12R5/P13R3/P14R1 Old Empl and Private Related Insurance (OE) Section

December 8, 2008

Old Employment and Private Related Insurance (OE) Section

----------------------------------------------------

| 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} FOR ROUNDS 2-5. FOR |

| MOST PERSONS, THE END DATE FOR ROUNDS 2-4 WILL BE |

| THE INTERVIEW DATE. FOR MOST PERSONS, THE END |

| FOR ROUND 5 WILL BE DECEMBER 31 OF THE SECOND |

| YEAR OF THE PANEL. |

----------------------------------------------------

BOX_00

======

----------------------------------------------------

| CONTEXT HEADER DISPLAY INSTRUCTIONS: |

| DISPLAY PERS.FULLNAME, ESTB.ESTBNAME, |

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

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

----------------------------------------------------

BOX_01

======

----------------------------------------------------

| IF ONE OR MORE RU MEMBERS STILL HOLDS A ‘CURRENT |

| MAIN’ OR ‘CURRENT MISCELLANEOUS’ JOB THIS ROUND |

| THAT WAS REPORTED DURING THE PREVIOUS ROUND AS |

| PROVIDING HEALTH INSURANCE ON THE DATE OF THE |

| PREVIOUS ROUND’S INTERVIEW, THAT IS: |

| |

| IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE |

| RU MEET THE FOLLOWING CONDITIONS: |

| - RJ01 OR RJ06 WAS CODED ‘1’ (YES) DURING THIS |

| ROUND FOR THIS PAIR, AND |

| - PERSON IS A JOBHOLDER AT ESTABLISHMENT, AND |

| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |

| INSURANCE, AND |

| - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING |

| THE PREVIOUS ROUND AS ‘PROVIDES HEALTH |

| INSURANCE’ AND, |

| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT |

| COVERED PERSON ON THE DATE OF THE PREVIOUS |

| ROUND’S INTERVIEW (HQ01 WAS CODED ‘1’ (WHOLE |

| TIME) OR HQ02 WAS CODED ‘1’ (YES) IN THE |

| PREVIOUS ROUND), AND |

| - JOB AT ESTABLISHMENT IS NOT FLAGGED AS ‘SELF- |

| EMPLOYED’ WITH A FIRM-SIZE-1, |

| |

| CONTINUE WITH LOOP_01 |

----------------------------------------------------

| NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT |

| IN THE RU ON THE PREVIOUS ROUND’S INTERVIEW DATE, |

| THE FIFTH CONDITION ABOVE CAN BE MET IF AT LEAST |

| ONE DEPENDENT WAS COVERED BY POLICYHOLDER’S |

| INSURANCE ON THE PREVIOUS ROUND’S INTERVIEW DATE. |

| THE LOOP WILL CYCLE ON THE POLICYHOLDER’S NAME. |

----------------------------------------------------

| OTHERWISE, GO TO BOX_10 |

----------------------------------------------------

| NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE |

| POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, |

| INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT |

| ROUND’S INTERVIEW DATE, BUT WHERE THE |

| ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO |

| ARE STILL RU MEMBERS MAY STILL QUALIFY FOR |

| LOOP_01. |

----------------------------------------------------

LOOP_01

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- |

| PAIRS-ROSTER, ASK OE01 - END_LP01. |

----------------------------------------------------

| LOOP DEFINITION: |

| |

| LOOP_01 COLLECTS INFORMATION ABOUT THE |

| CONTINUATION OF INSURANCE COVERAGE THROUGH A |

| ‘CURRENT MAIN’ OR ‘CURRENT MISCELLANEOUS’ JOB THAT|

| WAS COLLECTED IN THE PREVIOUS ROUND. THIS LOOP |

| CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE|

| FOLLOWING CONDITIONS: |

| |

| - RJ01 OR RJ06 WAS CODED ‘1’ (YES) DURING THIS |

| ROUND FOR THIS PAIR, AND |

| - PERSON IS A JOBHOLDER AT ESTABLISHMENT, AND |

| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |

| INSURANCE, AND |

| - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING |

| THE PREVIOUS ROUND AS ‘PROVIDES HEALTH |

| INSURANCE’ AND, |

| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT |

| COVERED PERSON ON THE DATE OF THE PREVIOUS |

| ROUND’S INTERVIEW (HQ01 WAS CODED ‘1’ (WHOLE |

| TIME) OR HQ02 WAS CODED ‘1’ (YES) IN THE |

| PREVIOUS ROUND), AND |

| - JOB AT ESTABLISHMENT IS NOT FLAGGED AS ‘SELF- |

| EMPLOYED’ WITH A FIRM-SIZE-1 |

-----------------------------------------------------

OE01

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

During the last interview, we recorded that someone in the

family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health

insurance. {(Are/Is)/(Were/Was)} (POLICYHOLDER) or anyone in

the family covered by (POLICYHOLDER)’s health insurance through

(ESTABLISHMENT) as of {today,} (END DATE)?

YES ................................... 1 {BOX_02}

NO .................................... 2 {OE02}

REF ................................... -7 {END_LP01}

DK .................................... -8 {END_LP01}

----------------------------------------------------

| DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY |

| ‘(Was/Were)’ IF ROUND 5. |

| |

| DISPLAY ‘today,’ IF NOT ROUND 5. OTHERWISE, USE A|

| NULL DISPLAY. |

----------------------------------------------------

OE02

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did (POLICYHOLDER)’s health insurance through

(ESTABLISHMENT) end?

{IF INSURANCE ENDED AFTER 12/31/{YEAR}, BACK-UP TO OE01

AND SELECT ‘YES’.}

[Enter Month-2, Day-2, Year-4] .........

REF ................................... -7 {BOX_02}

DK .................................... -8 {BOX_02}

----------------------------------------------------

| DISPLAY ‘IF INSURANCE ENDED... SELECT ‘YES’.’ IF |

| ROUND 5. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|

| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE02OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_02 |

----------------------------------------------------

OE02OV

======

Can you just tell me if (POLICYHOLDER) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 {BOX_02}

PART OF THE MONTH ..................... 2 {BOX_02}

REF ................................... -7 {BOX_02}

DK .................................... -8 {BOX_02}

[Code One]

BOX_02

======

----------------------------------------------------

| IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT |

| THE PREVIOUS ROUND’S INTERVIEW DATE BY THE |

| INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, |

| AUTOMATICALLY CODE OE03 AS ‘1’ (YES) AND GO TO |

| BOX_03 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH OE03 |

----------------------------------------------------

OE03

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

During the last interview, we recorded that (READ NAMES BELOW)

(were/was) covered by (POLICYHOLDER)’s health insurance

through (ESTABLISHMENT).

{Are/Were} they all covered by this health insurance {until

{{OE02 DATE}/it ended}/on (END DATE)}?

{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}

YES ................................... 1 {BOX_03}

NO .................................... 2 {BOX_03}

REF ................................... -7 {BOX_03}

DK .................................... -8 {BOX_03}

----------------------------------------------------

| DISPLAY ‘Are’ IF OE01 IS CODED ‘1’ (YES). |

| DISPLAY ‘Were’ IF OE01 IS CODED ‘2’ (NO) OR IF |

| CURRENT ROUND IS ROUND 5. |

| |

| DISPLAY ‘until {OE02 DATE}’ IF OE01 IS CODED ‘2’ |

| (NO). |

| DISPLAY ‘on (END DATE)’ IF OE01 IS CODED ‘1’ |

| (YES). |

| |

| DISPLAY THE DATE RECORDED AT OE02 FOR ‘OE02 DATE’.|

| IF THE MONTH OR YEAR FIELD AT OE02 IS CODED ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|

| FOR ‘OE02 DATE’. |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY COVERED PERSONS’ NAMES |

| (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER FOR DISPLAY. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. DISPLAY ONLY. |

| 2. SELECT, ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| 1. PERSON WAS COVERED AT PREVIOUS ROUND’S |

| INTERVIEW DATE BY THE INSURANCE FROM THIS |

| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |

| POLICYHOLDER |

| 2. PERSON IS AN RU MEMBER |

----------------------------------------------------

BOX_03

======

----------------------------------------------------

| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |

| TO THE END DATE OF THE CURRENT ROUND, THAT IS: |

| |

| IF OE01 IS CODED ‘1’ (YES) AND OE03 IS CODED ‘1’ |

| (YES), |

| |

| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |

| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|

| THE REFERENCE PERIOD END DATE AND |

| |

| GO TO BOX_05 |

----------------------------------------------------

| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |

| TO PART OF THE CURRENT ROUND, THAT IS: |

| |

| IF OE01 IS CODED ‘2’ (NO) AND OE03 IS CODED ‘1’ |

| (YES), |

| |

| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |

| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|

| THE DATE RECORDED AT OE02 AND |

| |

| GO TO BOX_05 |

----------------------------------------------------

| OTHERWISE (I.E., OE03 CODED ‘2’ (NO), ‘-7’ |

| (REFUSED), OR ‘-8’ (DON’T KNOW)), |

| CONTINUE WITH OE04 |

----------------------------------------------------

OE04

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Who {is/was} no longer covered by (POLICYHOLDER)’s health

insurance through (ESTABLISHMENT) {until {{OE02 DATE}/it ended}/on

(END DATE)}?

[1. First Name, [Middle Name], Last Name-65]

[2. First Name, [Middle Name], Last Name-65]

[3. First Name, [Middle Name], Last Name-65]

----------------------------------------------------

| DISPLAY ‘is’ IF OE01 IS CODED ‘1’ (YES). |

| DISPLAY ‘was’ IF OE01 IS CODED ‘2’ (NO) OR IF |

| CURRENT ROUND IS ROUND 5. |

| |

| DISPLAY ‘until {OE02 DATE}’ IF OE01 IS CODED ‘2’ |

| (NO). |

| DISPLAY ‘on (END DATE)’ IF OE01 IS CODED ‘1’ |

| (YES). |

| |

| DISPLAY THE DATE RECORDED AT OE02 FOR ‘OE02 DATE’.|

| IF THE MONTH OR YEAR FIELD AT OE02 IS CODED ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|

| FOR ‘OE02 DATE’. |

----------------------------------------------------

| IF FAMILY STILL HAS INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED ‘1’ |

| (YES)), FLAG INSURANCE FOR ALL PERSONS NOT |

| SELECTED AT OE04 AS ‘CONTINUOUS COVERAGE’ FROM THE|

| REFERENCE PERIOD START DATE UNTIL THE REFERENCE |

| PERIOD END DATE. |

----------------------------------------------------

| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |

| THIS ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED ‘2’ |

| (NO), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED |

| AT OE04 AS ‘CONTINUOUS COVERAGE’ FROM THE |

| REFERENCE PERIOD START DATE UNTIL DATE RECORDED |

| AT OE02. |

----------------------------------------------------

| GO TO LOOP_02 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY COVERED PERSONS’ NAMES |

| (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER FOR SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| 1. PERSON WAS COVERED AT PREVIOUS ROUND’S |

| INTERVIEW DATE BY THE INSURANCE FROM THIS |

| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |

| POLICYHOLDER |

| 2. PERSON IS AN RU MEMBER |

----------------------------------------------------

LOOP_02

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER, ASK OE05 - END_LP02. |

----------------------------------------------------

| LOOP DEFINITION: LOOP_02 COLLECTS THE DATE ON |

| WHICH THE INSURANCE COVERAGE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER|

| WHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCE|

| PERIOD END DATE OR THE DATE REPORTED IN OE02. |

| THIS LOOP CYCLES ON PERSONS SELECTED AT OE04. |

----------------------------------------------------

OE05

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did the health insurance through (ESTABLISHMENT)

end for (PERSON)?

[Enter Month-2, Day-2, Year-4] .........

REF ................................... -7 {BOX_04}

DK .................................... -8 {BOX_04}

----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|

| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE05OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_04 |

----------------------------------------------------

OE05OV

======

Can you just tell me if (PERSON) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 {BOX_04}

PART OF THE MONTH ..................... 2 {BOX_04}

REF ................................... -7 {BOX_04}

DK .................................... -8 {BOX_04}

[Code One]

BOX_04

======

----------------------------------------------------

| FLAG INSURANCE FOR PERSON AS ‘CONTINUOUS COVERAGE’|

| THROUGH THE COMPLETE DATE RECORDED AT OE05 AND |

| OE05OV. |

----------------------------------------------------

END_LP02

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- |

| COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS |

| STATED IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_02 AND CONTINUE WITH BOX_05 |

----------------------------------------------------

BOX_05

======

----------------------------------------------------

| IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY |

| THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,|

| (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU |

| MEMBERS NOT COVERED BY THIS INSURANCE ON THE |

| PREVIOUS ROUND’S INTERVIEW DATE, BUT EXCLUDES RU |

| MEMBERS JUST MARKED AS NO LONGER COVERED IN OE04),|

| CONTINUE WITH OE06 |

----------------------------------------------------

| OTHERWISE, GO TO OE08A |

----------------------------------------------------

OE06

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{Since (START DATE)/Between (START DATE) and (END DATE)}, have

any persons living here, we have not yet mentioned, been covered

by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?

YES ................................... 1 {OE07}

NO .................................... 2 {OE08A}

REF ................................... -7 {OE08A}

DK .................................... -8 {OE08A}

HELP AVAILABLE FOR DEFINITION OF DEPENDENT.

----------------------------------------------------

| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |

| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |

| ROUND 5. |

----------------------------------------------------

OE07

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Who {has been/was} covered by (POLICYHOLDER)’s health insurance

through (ESTABLISHMENT) {since (START DATE)/between (START DATE)

and (END DATE)} that we have not yet mentioned?

PROBE: Anyone else?

[1. First Name, [Middle Name], Last Name-65]

[2. First Name, [Middle Name], Last Name-65]

[3. First Name, [Middle Name], Last Name-65]

----------------------------------------------------

| DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT|

| ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) |

| and (END DATE)’ IF ROUND 5. |

----------------------------------------------------

| WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- |

| COVRD-PERS-TRPLS-ROSTER. |

----------------------------------------------------

| IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG |

| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |

| AS ‘COVERING PERSON NOT LISTED IN RU’. |

----------------------------------------------------

| GO TO LOOP_03 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION|

| OF RU-MEMBERS. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY |

| SELECT ONE OR MORE FROM THE LISTED MEMBERS. |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

| 3. DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY|

| ON THIS ROSTER. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY PERSONS WHO WERE NOT COVERED BY THE |

| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |

| ON THE PREVIOUS ROUND’S INTERVIEW DATE. |

----------------------------------------------------

LOOP_03

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER, ASK OE08 - END_LP03. |

----------------------------------------------------

| LOOP DEFINITION: LOOP_03 COLLECTS THE COVERAGE |

| START DATE FOR ALL PERSONS NEWLY COVERED DURING |

| THE CURRENT ROUND BY THE INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON |

| PERSONS SELECTED AT OE07. |

----------------------------------------------------

OE08

====

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did the health insurance through (ESTABLISHMENT)

begin for (PERSON)?

[Enter Month-2, Day-2, Year-4] .........

REF ................................... -7 {BOX_06}

DK .................................... -8 {BOX_06}

----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|

| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE08OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_06 |

----------------------------------------------------

OE08OV

======

Can you just tell me if (PERSON) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 {BOX_06}

PART OF THE MONTH ..................... 2 {BOX_06}

REF ................................... -7 {BOX_06}

DK .................................... -8 {BOX_06}

[Code One]

----------------------------------------------------

| HARD CHECK: |

| COMPLETE DATE AT OE08 MUST BE < THAN COMPLETE |

| DATE AT OE02 IF A DATE IS RECORDED AT OE02 |

| OR < THAN REFERENCE PERIOD END DATE IF NO DATE |

| IS RECORDED AT OE02. |

----------------------------------------------------

BOX_06

======

----------------------------------------------------

| IF FAMILY STILL HAS INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED ‘1’ |

| (YES)), FLAG INSURANCE FOR THIS PERSON AS |

| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE08 |

| UNTIL THE REFERENCE PERIOD END DATE. |

----------------------------------------------------

| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |

| ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED ‘2’ (NO))|

| FLAG INSURANCE FOR THIS PERSON AS ‘CONTINUOUS |

| COVERAGE’ FROM DATE RECORDED AT OE08 UNTIL DATE |

| RECORDED AT OE02. |

----------------------------------------------------

END_LP03

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS STATED |

| IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_03 AND GO TO BOX_07 |

----------------------------------------------------

OE08A

=====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{Does/Between (START DATE) and (END DATE), did} (POLICYHOLDER)’s

health coverage through (ESTABLISHMENT) cover as dependents any

persons who do not live here?

YES .................................... 1 {BOX_07}

NO ..................................... 2 {BOX_07}

REF ................................... -7 {BOX_07}

DK .................................... -8 {BOX_07}

HELP AVAILABLE FOR DEFINITION OF DEPENDENT.

----------------------------------------------------

| DISPLAY ‘Does’ IF NOT ROUND 5. DISPLAY ‘Between |

| (START DATE) and (END DATE), did’ IF ROUND 5. |

----------------------------------------------------

| IF CODED ‘1’ (YES), FLAG INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR AS ‘COVERING PERSON NOT |

| LISTED IN RU’ IN OE07 |

----------------------------------------------------

BOX_07

======

----------------------------------------------------

| IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THE|

| INSURANCE THROUGH THE ESTABLISHMENT-PERSON-PAIR |

| ON THE CURRENT ROUND’S INTERVIEW DATE, THAT IS, |

| OE01 IS CODED ‘1’ (YES), CONTINUE WITH BOX_07A |

----------------------------------------------------

| OTHERWISE, GO TO END_LP01 |

----------------------------------------------------

BOX_07A

=======

----------------------------------------------------

| IF ROUND 3, CONTINUE WITH OE09A |

----------------------------------------------------

| OTHERWISE, GO TO OE09 |

----------------------------------------------------

OE09A

=====

{POLICYHOLDER’S 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 ........... 1 {OE09AA}

YES, PAY SOME OF PREMIUM/COST .......... 2 {OE09AA}

YES, BUT DON’T KNOW IF PAY ALL OR SOME

OF PREMIUM/COST ........................ 3 {OE09AA}

NO, DO NOT PAY ......................... 4 {OE09AAA}

REF ................................... -7 {OE09}

DK .................................... -8 {OE09}

[Code One]

HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.

----------------------------------------------------

| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |

| DISPLAYED HERE FOR THE INSURANCE FROM A |

| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |

| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |

| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |

| DIRECTLY PURCHASED CATEGORY. |

----------------------------------------------------

OE09AA

======

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

ESTABLISHMENT} {STR-DT}

{END-DT}

How much (do/does) (POLICYHOLDER) pay for the (ESTABLISHMENT)

coverage?

[Enter Amount in Dollars] ..............

REF ................................... -7 {BOX_08A}

DK .................................... -8 {BOX_08A}

----------------------------------------------------

| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |

| DISPLAYED HERE FOR THE INSURANCE FROM A |

| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |

| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |

| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |

| DIRECTLY PURCHASED CATEGORY. |

----------------------------------------------------

| CONTINUE WITH OE09AAOV1 |

----------------------------------------------------

OE09AAOV1

=========

UNIT OF COVERAGE:

Is that per year, per month, per week, or what?

PER YEAR ............................... 1 {BOX_08A}

QUARTERLY/EVERY 3 MONTHS ............... 2 {BOX_08A}

BIMONTHLY/EVERY 2 MONTHS ............... 3 {BOX_08A}

PER MONTH .............................. 4 {BOX_08A}

PER WEEK ............................... 5 {BOX_08A}

BIWEEKLY/EVERY 2 WEEKS ................. 6 {BOX_08A}

SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 {BOX_08A}

SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 {BOX_08A}

OTHER ................................. 91 {OE09AAOV2}

REF ................................... -7 {BOX_08A}

DK .................................... -8 {BOX_08A}

[Code One]

OE09AAOV2

=========

OTHER:

[Enter Other Specify] .................. {BOX_08A}

REF ................................... -7 {BOX_08A}

DK .................................... -8 {BOX_08A}

BOX_08A

=======

-----------------------------------------------------

| IF OE09A IS CODED ‘1’ (YES, PAY ALL OF PREMIUM/ |

| COST), GO TO OE09 |

-----------------------------------------------------

| OTHERWISE, CONTINUE WITH OE09AAA |

-----------------------------------------------------

OE09AAA

=======

{POLICYHOLDER’S 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 .................... 1

STATE GOVERNMENT ...................... 2

LOCAL GOVERNMENT ...................... 3

SOME GOVERNMENT ....................... 4

EMPLOYER .............................. 5

UNION ................................. 6

OTHER ................................. 91 {OE09AAAOV}

REF ................................... -7 {OE09}

DK .................................... -8 {OE09}

[Code All That Apply]

----------------------------------------------------

| DISPLAY ‘else’ IF OE09A IS CODED ‘2’ (YES, PAY |

| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |

| IF PAY ALL OR SOME OF PREMIUM/COST). OTHERWISE, |

| USE A NULL DISPLAY |

| |

| DISPLAY ‘some of’ IF OE09A IS CODED ‘2’ (YES, PAY |

| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |

| IF PAY ALL OR SOME OF PREMIUM/COST). DISPLAY ‘for’|

| IF OE09A IS CODED ‘4’ (NO, DO NOT PAY). |

----------------------------------------------------

| FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT |

| ALLOW ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW) IN |

| COMBINATION WITH ANY OTHER CODE. |

----------------------------------------------------

| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |

| WITH ANY OTHER CODE, CONTINUE WITH OE09AAAOV |

----------------------------------------------------

| OTHERWISE, GO TO OE09 |

----------------------------------------------------

OE09AAAOV

=========

OTHER:

[Enter Other Specify] .................. {OE09}

REF ................................... -7 {OE09}

DK .................................... -8 {OE09}

OE09

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{Last time we recorded that (POLICYHOLDER) (were/was) covered

by (READ INSURER NAME BELOW).}

{Since (START DATE), has there been/Between (START DATE) and

(END DATE), was there} any change in the plan name of the health

insurance (POLICYHOLDER) {has/had} through (ESTABLISHMENT)?

{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}

YES ................................... 1 {OE10}

NO .................................... 2 {END_LP01}

REF ................................... -7 {END_LP01}

DK .................................... -8 {END_LP01}

-----------------------------------------------------

| DISPLAY FIRST PARAGRAPH AND THE INSURER NAME IF |

| THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- |

| PAIR HAD ANY INSURERS FLAGGED AS PROVIDING MEDIGAP |

| OR HOSPITAL/PHYSICIAN BENEFITS AT ANY TIME DURING |

| THE PREVIOUS ROUND. |

-----------------------------------------------------

| DISPLAY ‘Since (START DATE), has there been’ AND |

| ‘has’ IF NOT ROUND 5. DISPLAY ‘Between (START |

| DATE) and (END DATE), was there’ AND ‘had’ IF |

| ROUND 5. |

----------------------------------------------------

-----------------------------------------------------

| IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |

| KNOW), FLAG PREVIOUS ROUND’S INSURER AS CURRENT |

| ROUND’S INSURER FOR THIS ESTABLISHMENT-PERSON- |

| PAIR. |

----------------------------------------------------

-----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PERS_INSURER_TRPLS_1 |

| |

| COL # 1 HEADER: INSURER |

| INSTRUCTIONS: DISPLAY ESTABLISHMENT NAME |

| (ESTB.ESTBNAME) |

----------------------------------------------------

OE10

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

SHOW CARD OE-1.

What type of health insurance {(do/does)/did} (POLICYHOLDER)

{now} have through (ESTABLISHMENT)’s new plan {on (END DATE)}?

CHECK ALL THAT APPLY.

HOSPITAL AND PHYSICIAN BENEFITS,

INCLUDING COVERAGE THROUGH AN HMO ... 1

DENTAL ................................. 2

PRESCRIPTION DRUGS ..................... 3

VISION ................................. 4

MEDICARE SUPPLEMENT/MEDIGAP ............ 5

LONG TERM CARE IN A NURSING HOME ....... 6

EXTRA CASH FOR HOSPITAL STAYS .......... 7

SERIOUS DISEASE OR DREAD DISEASE ....... 8

DISABILITY ............................. 9

WORKER’S COMPENSATION ................. 10

ACCIDENT .............................. 11

OTHER ................................. 91 {OE10OV}

REF ................................... -7 {BOX_08}

DK .................................... -8 {BOX_08}

[Code All That Apply]

HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.

[NOTE: ‘DISABILITY,’ ‘WORKER’S COMPENSATION,’ AND ‘ACCIDENT’

WILL NOT APPEAR ON THE SHOW CARD.]

----------------------------------------------------

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

| IF ROUND 5. |

| |

| DISPLAY ‘now’ IF NOT ROUND 5. OTHERWISE, USE A |

| NULL DISPLAY. |

| |

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

| USE A NULL DISPLAY. |

----------------------------------------------------

| FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT |

| ALLOW ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW) IN |

| COMBINATION WITH ANY OTHER CODE. |

----------------------------------------------------

| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |

| WITH ANY OTHER CODES, CONTINUE WITH OE10OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_08 |

----------------------------------------------------

OE10OV

======

OTHER:

[Enter Other Specify] .................. {BOX_08}

REF ................................... -7 {BOX_08}

DK .................................... -8 {BOX_08}

HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.

BOX_08

======

----------------------------------------------------

| NOTE: ALL ESTABLISHMENTS WHICH ARE BEING LOOPED |

| ON HERE ARE EMPLOYERS. THEREFORE, IT IS NOT |

| NECESSARY TO AUTOMATICALLY CODE OE11 IF THE |

| ESTABLISHMENT IS AN INSURANCE COMPANY OR HMO. |

----------------------------------------------------

| IF OE10 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |

| BENEFITS) OR ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), |

| ALONE OR WITH ANY OTHER COMBINATION OF CODES, |

| CONTINUE WITH OE11 |

----------------------------------------------------

| OTHERWISE, GO TO END_LP01 |

----------------------------------------------------

OE11

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

What is the new plan name for (POLICYHOLDER)’s health

insurance through (ESTABLISHMENT) which provides the {hospital

and physician benefits/Medicare Supplement or Medigap benefits}?

IF MORE THAN ONE NAME, PROBE: What is the main new plan name?

RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE {HOSPITAL

AND PHYSICIAN/MEDIGAP} BENEFITS FOR THIS PAIR.

IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, SELECT HMO.

NAME OF INSURER: [Enter Insurer]

TYPE:

INSURANCE COMPANY ...................... 1

HMO .................................... 2

SELF-INSURED COMPANY ................... 3

REF ................................... -7

DK .................................... -8

[Code One]

HELP AVAILABLE FOR DEFINITION OF INSURANCE CO/HMO/SELF-INSURED CO.

-----------------------------------------------------

| DISPLAY ‘hospital and physician benefits’ AND |

| ‘HOSPITAL AND PHYSICIAN’ IF OE10 IS CODED ‘1’ |

| (HOSPITAL AND PHYSICIAN BENEFITS), BUT NOT CODED |

| ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP). DISPLAY |

| ‘Medicare supplement or Medigap benefits’ AND |

| ‘MEDIGAP’ IF OE10 IS CODED ‘5’ (MEDICARE |

| SUPPLEMENT/MEDIGAP). |

-----------------------------------------------------

| WRITE INSURER(S) TO THE RU-ESTAB-PERSON-INSURER- |

| TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR. |

-----------------------------------------------------

----------------------------------------------------

| FLAG INSURER(S) COLLECTED AT OE11 AS CURRENT |

| ROUND’S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- |

| PAIR. |

----------------------------------------------------

-----------------------------------------------------

| IF OE10 IS CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP) |

| FLAG INSURANCE CO./HMO AS ‘SUPPLYING MEDICARE |

| SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES |

| HOSPITAL/PHYSICIAN BENEFITS)’ FOR THE CURRENT |

| ROUND. |

-----------------------------------------------------

----------------------------------------------------

| IF OE10 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |

| BENEFITS), BUT NOT ‘5’ (MEDICARE SUPPLEMENT/ |

| MEDIGAP), FLAG INSURANCE CO./HMO AS ‘SUPPLYING |

| HOSPITAL/PHYSICIAN BENEFITS’ FOR THE CURRENT |

| ROUND. |

----------------------------------------------------

LOOP_04

=======

----------------------------------------------------

| FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- |

| TRIPLES-ROSTER, ASK OE11A - END_LP04. |

----------------------------------------------------

| LOOP DEFINITION: LOOP_04 COLLECTS OTHER POLICY |

| NAMES AND MANAGED CARE INFORMATION FOR INSURERS |

| COLLECTED AT OE11. THIS LOOP CYCLES ON TRIPLES |

| THAT MEET THE FOLLOWING CONDITIONS: |

| |

| - ESTABLISHMENT-PERSON-PAIR PROVIDES THE INSURANCE|

| BEING ASKED ABOUT |

| - INSURER IS ENTERED AT OE11 |

----------------------------------------------------

OE11A

=====

{POLICYHOLDER’S 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 ...................... 1 {OE11AOV}

NO OTHER NAME .......................... 2 {BOX_09A}

REF ................................... -7 {BOX_09A}

DK .................................... -8 {BOX_09A}

HELP AVAILABLE FOR DEFINITION OF LOW OPTION/HIGH OPTION.

[Code One]

----------------------------------------------------

| DISPLAY THE NAME OF THE INSURANCE CO/HMO |

| RECORDED IN OE11 WHICH IS BEING LOOPED ON FOR |

| ‘INSURANCE...NAME’. |

----------------------------------------------------

OE11AOV

=======

OTHER NAME:

[Enter Policy Name] .................... {BOX_09A}

REF ................................... -7 {BOX_09A}

DK .................................... -8 {BOX_09A}

HELP AVAILABLE FOR DEFINITION OF LOW OPTION/HIGH OPTION.

BOX_09A

=======

----------------------------------------------------

| IF INSURER BEING LOOPED ON IS CODED ‘2’ (HMO) IN |

| OE11, CONTINUE WITH OE11B |

----------------------------------------------------

| OTHERWISE, GO TO BOX_09 |

----------------------------------------------------

OE11B

=====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

Will (POLICYHOLDER)’s plan pay for any of the costs of

visits to doctors who are not part of (POLICYHOLDER)’s

HMO, even if (POLICYHOLDER) (do/does) not have a referral?

YES .................................... 1 {END_LP04}

NO ..................................... 2 {END_LP04}

REF ................................... -7 {END_LP04}

DK .................................... -8 {END_LP04}

BOX_09

======

----------------------------------------------------

| ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER|

| |

| AT COMPLETION OF MANAGED CARE (MC) SECTION, |

| CONTINUE WITH END_LP04 |

----------------------------------------------------

END_LP04

========

----------------------------------------------------

| CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- |

| INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS |

| STATED IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER INSURERS MEET THE STATED CONDITIONS, |

| END LOOP_04 AND CONTINUE WITH END_LP01 |

----------------------------------------------------

END_LP01

========

----------------------------------------------------

| CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-|

| PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN |

| THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END |

| LOOP_01 AND CONTINUE WITH BOX_10 |

----------------------------------------------------

BOX_10

======

----------------------------------------------------

| IF ONE OR MORE RU MEMBERS DOES NOT STILL HOLD A |

| ‘CURRENT MAIN’ OR ‘CURRENT MISCELLANEOUS’ JOB THIS|

| ROUND THAT WAS REPORTED DURING THE PREVIOUS ROUND |

| AS PROVIDING HEALTH INSURANCE ON THE DATE OF THE |

| PREVIOUS ROUND’S INTERVIEW, THAT IS: |

| |

| IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE |

| RU MEET THE FOLLOWING CONDITIONS: |

| - RJ01 OR RJ06 WAS CODED ‘2’ (NO), ‘-7’ (REFUSED),|

| ‘-8’ (DON’T KNOW) DURING THIS ROUND FOR THIS |

| PAIR, AND |

| - PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND |

| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |

| INSURANCE, AND |

| - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING |

| THE PREVIOUS ROUND AS ‘PROVIDES HEALTH |

| INSURANCE’ AND, |

| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT |

| COVERED PERSON ON THE DATE OF THE PREVIOUS |

| ROUND’S INTERVIEW (HQ01 WAS CODED ‘1’ (WHOLE |

| TIME) OR HQ02 WAS CODED ‘1’ (YES) IN THE |

| PREVIOUS ROUND), AND |

| - JOB AT ESTABLISHMENT IS NOT FLAGGED AS ‘SELF- |

| EMPLOYED’ WITH A FIRM-SIZE-1, |

| |

| CONTINUE WITH LOOP_05 |

----------------------------------------------------

| OTHERWISE, GO TO BOX_19 |

----------------------------------------------------

| NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT |

| IN THE RU ON THE PREVIOUS ROUND’S INTERVIEW DATE, |

| THE FIFTH CONDITION IN THE ABOVE BOX CAN BE MET |

| IF AT LEAST ONE DEPENDENT WAS COVERED BY |

| POLICYHOLDER’S INSURANCE ON THE PREVIOUS ROUND’S |

| INTERVIEW DATE. COVERAGE FOR THE POLICYHOLDER IS |

| ASSUMED IN THAT CASE AND THE LOOP WILL CYCLE ON |

| THE POLICYHOLDER’S NAME. |

----------------------------------------------------

| NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE |

| POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, |

| INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT |

| ROUND’S INTERVIEW DATE, BUT WHERE THE |

| ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO |

| ARE STILL RU MEMBERS MAY STILL QUALIFY FOR |

| LOOP_05. |

----------------------------------------------------

LOOP_05

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- |

| PAIRS-ROSTER, ASK OE12-END_LP05. |

----------------------------------------------------

| LOOP DEFINITION: |

| |

| LOOP_05 COLLECTS INFORMATION ABOUT THE |

| CONTINUATION OF INSURANCE COVERAGE THROUGH A |

| NO LONGER HELD ‘CURRENT MAIN’ OR ‘CURRENT |

| MISCELLANEOUS’ JOB THAT WAS COLLECTED IN THE |

| PREVIOUS ROUND. THIS LOOP CYCLES ON |

| ESTABLISHMENT-PERSON-PAIRS THAT MEET THE |

| FOLLOWING CONDITIONS: |

| |

| - RJ01 OR RJ06 WAS CODED ‘2’ (NO), ‘-7’ (REFUSED),|

| ‘-8’ (DON’T KNOW) DURING THIS ROUND FOR THIS |

| PAIR, AND |

| - PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND |

| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |

| INSURANCE, AND |

| - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING |

| THE PREVIOUS ROUND AS ‘PROVIDES HEALTH |

| INSURANCE’ AND, |

| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT |

| COVERED PERSON ON THE DATE OF THE PREVIOUS |

| ROUND’S INTERVIEW (HQ01 WAS CODED ‘1’ (WHOLE |

| TIME) OR HQ02 WAS CODED ‘1’ (YES) IN THE |

| PREVIOUS ROUND), AND |

| - JOB AT ESTABLISHMENT IS NOT FLAGGED AS ‘SELF- |

| EMPLOYED’ WITH A FIRM-SIZE-1. |

-----------------------------------------------------

OE12

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

During the last interview, we recorded that someone in the

family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health

insurance. {(Are/Is)/(Were/Was)} (POLICYHOLDER) or anyone in

the family covered by (POLICYHOLDER)’s health insurance through

(ESTABLISHMENT) as of {today,} (END DATE)?

YES ................................... 1 {OE16}

NO .................................... 2 {OE13}

REF ................................... -7 {END_LP05}

DK .................................... -8 {END_LP05}

----------------------------------------------------

| DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY |

| ‘(Was/Were)’ IF ROUND 5. |

| |

| DISPLAY ‘today,’ IF NOT ROUND 5. OTHERWISE, USE A|

| NULL DISPLAY. |

----------------------------------------------------

OE13

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Did the health insurance (POLICYHOLDER) had through

(ESTABLISHMENT) continue for any period of time after

(POLICYHOLDER) stopped working at (ESTABLISHMENT)?

YES ................................... 1 {OE14}

NO .................................... 2 {OE15}

REF ................................... -7 {OE15}

DK .................................... -8 {OE15}

OE14

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Did that health insurance continue through COBRA?

YES ................................... 1 {OE15}

NO .................................... 2 {OE15}

REF ................................... -7 {OE15}

DK .................................... -8 {OE15}

HELP AVAILABLE FOR DEFINITION OF COBRA.

OE15

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did (POLICYHOLDER)’s health insurance through

(ESTABLISHMENT) end?

{IF INSURANCE ENDED ATER 12/31/{YEAR}, BACK-UP TO OE12

AND SELECT ‘YES’.}

[Enter Month-2, Day-2, Year-4] .........

REF ................................... -7

DK .................................... -8

----------------------------------------------------

| DISPLAY ‘IF INSURANCE ENDED... SELECT ‘YES’.’ IF|

| ROUND 5. OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|

| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE15OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_11 |

----------------------------------------------------

OE15OV

======

Can you just tell me if (POLICYHOLDER) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 {BOX_11}

PART OF THE MONTH ..................... 2 {BOX_11}

REF ................................... -7 {BOX_11}

DK .................................... -8 {BOX_11}

[Code One]

OE16

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Is (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)

now extended through COBRA?

YES ................................... 1 {BOX_11}

NO .................................... 2 {BOX_11}

REF ................................... -7 {BOX_11}

DK .................................... -8 {BOX_11}

HELP AVAILABLE FOR DEFINITION OF COBRA.

BOX_11

======

----------------------------------------------------

| IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT |

| THE PREVIOUS ROUND’S INTERVIEW DATE BY THE |

| INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, |

| AUTOMATICALLY CODE OE17 AS ‘1’ (YES) AND GO TO |

| BOX_12 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH OE17 |

----------------------------------------------------

OE17

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

During the last interview, we recorded that (READ NAMES BELOW)

(were/was) covered by (POLICYHOLDER)’s health insurance

through (ESTABLISHMENT).

{Are/Were} they all covered by this health insurance {until

{{OE15 DATE}/it ended}/on (END DATE)}?

{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}

YES ................................... 1 {BOX_12}

NO .................................... 2 {BOX_12}

REF ................................... -7 {BOX_12}

DK .................................... -8 {BOX_12}

----------------------------------------------------

| DISPLAY ‘Are’ IF OE12 IS CODED ‘1’ (YES). |

| DISPLAY ‘Were’ IF OE12 IS CODED ‘2’ (NO) OR IF |

| CURRENT ROUND IS ROUND 5. |

| |

| DISPLAY ‘until {OE15 DATE}’ IF OE12 IS CODED ‘2’ |

| (NO). DISPLAY ‘on (END DATE)’ IF OE12 IS CODED ‘1’|

| (YES). |

| |

| DISPLAY THE DATE RECORDED AT OE15 FOR ‘OE15 DATE’.|

| IF THE MONTH OR YEAR FIELD AT OE15 IS CODED ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|

| FOR ‘OE15 DATE’. |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY COVERED PERSONS’ NAMES |

| (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS PERSONS ON THE RU-ESTB- |

| PLCYHLDR-COVRD-PERS-TRPLS-ROSTER FOR DISPLAY. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. SELECT, ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| 1. PERSON WAS COVERED AT PREVIOUS ROUND’S |

| INTERVIEW DATE BY THE INSURANCE FROM THIS |

| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |

| POLICYHOLDER AND |

| 2. PERSON IS AN RU MBMBER |

----------------------------------------------------

BOX_12

======

----------------------------------------------------

| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |

| TO THE END DATE OF THE CURRENT ROUND, THAT IS: |

| |

| IF OE12 IS CODED ‘1’ (YES) AND OE17 IS CODED ‘1’ |

| (YES), |

| |

| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |

| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|

| THE REFERENCE PERIOD END DATE AND |

| |

| GO TO BOX_14 |

----------------------------------------------------

| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |

| TO PART OF THE CURRENT ROUND, THAT IS: |

| |

| IF OE12 IS CODED ‘2’ (NO) AND OE17 IS CODED ‘1’ |

| (YES), |

| |

| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |

| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|

| THE DATE RECORDED AT OE15 AND |

| |

| GO TO BOX_14 |

----------------------------------------------------

| OTHERWISE (I.E., OE17 CODED ‘2’ (NO), ‘-7’ |

| (REFUSED), OR ‘-8’ (DON’T KNOW)), CONTINUE WITH |

| OE18 |

----------------------------------------------------

OE18

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Who {is/was} no longer covered by (POLICYHOLDER)’s health

insurance through (ESTABLISHMENT) {until {{OE15 DATE}/it ended}/

on (END DATE)}?

[1. First Name, [Middle Name], Last Name-65]

[2. First Name, [Middle Name], Last Name-65]

[3. First Name, [Middle Name], Last Name-65]

----------------------------------------------------

| DISPLAY ‘is’ IF OE12 IS CODED ‘1’ (YES). |

| DISPLAY ‘was’ IF OE12 IS CODED ‘2’ (NO) OR IF |

| CURRENT ROUND IS ROUND 5. |

| |

| DISPLAY ‘until {OE15 DATE}’ IF OE12 IS CODED ‘2’ |

| (NO). DISPLAY ‘on (END DATE)’ IF OE12 IS CODED |

| ‘1’ (YES). |

| |

| DISPLAY THE DATE RECORDED AT OE15 FOR ‘OE15 DATE’.|

| IF THE MONTH OR YEAR FIELD AT OE15 IS CODED ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|

| FOR ‘OE15 DATE’. |

----------------------------------------------------

| IF FAMILY STILL HAS INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED ‘1’ |

| (YES)), FLAG INSURANCE FOR ALL PERSONS NOT |

| SELECTED AT OE18 AS ‘CONTINUOUS COVERAGE’ FROM THE|

| REFERENCE PERIOD START DATE UNTIL THE REFERENCE |

| PERIOD END DATE. |

----------------------------------------------------

| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |

| THIS ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED ‘2’,|

| (NO)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED|

| AT OE18 AS ‘CONTINUOUS COVERAGE’ FROM THE |

| REFERENCE PERIOD START DATE UNTIL DATE RECORDED |

| AT OE15. |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY COVERED PERSONS’ NAMES |

| (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER FOR SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| 1. PERSON WAS COVERED AT THE PREVIOUS ROUND’S |

| INTERVIEW DATE BY THE INSURANCE FROM THIS |

| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |

| POLICYHOLDER |

| 2. PERSON IS AN RU MBMBER |

----------------------------------------------------

LOOP_06

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER, ASK OE19 - END_LP06. |

----------------------------------------------------

| LOOP DEFINITION: LOOP_06 COLLECTS THE DATE ON |

| WHICH THE INSURANCE COVERAGE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER|

| WHOSE COVERAGE ENDED PRIOR TO THE REFERENCE PERIOD|

| END DATE OR THE DATE REPORTED IN OE15. THIS LOOP |

| CYCLES ON PERSONS SELECTED AT OE18. |

----------------------------------------------------

OE19

====

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did the health insurance through (ESTABLISHMENT)

end for (PERSON)?

[Enter Month-2, Day-2, Year-4] .........

REF ................................... -7 {BOX_13}

DK .................................... -8 {BOX_13}

----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ |

| (DON’T KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW), CONTINUE WITH |

| OE19OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_13 |

----------------------------------------------------

OE19OV

======

Can you just tell me if (PERSON) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 {BOX_13}

PART OF THE MONTH ..................... 2 {BOX_13}

REF ................................... -7 {BOX_13}

DK .................................... -8 {BOX_13}

[Code One]

BOX_13

======

----------------------------------------------------

| FLAG INSURANCE FOR PERSON AS ‘CONTINUOUS COVERAGE’|

| THROUGH THE COMPLETE DATE RECORDED AT OE19 AND |

| OE19OV. |

----------------------------------------------------

END_LP06

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- |

| COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS |

| STATED IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_06 AND CONTINUE WITH BOX_14 |

----------------------------------------------------

BOX_14

======

----------------------------------------------------

| IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY |

| THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,|

| (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU |

| MEMBERS NOT COVERED BY THIS INSURANCE ON THE |

| PREVIOUS ROUND’S INTERVIEW DATE, BUT EXCLUDES RU |

| MEMBERS JUST MARKED AS NO LONGER COVERED IN OE18),|

| CONTINUE WITH OE20 |

----------------------------------------------------

| OTHERWISE, GO TO OE22A |

----------------------------------------------------

OE20

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{Since (START DATE)/Between (START DATE) and (END DATE)}, have

any persons living here, that we have not yet mentioned, been

covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?

YES ................................... 1 {OE21}

NO .................................... 2 {OE22A}

REF ................................... -7 {OE22A}

DK .................................... -8 {OE22A}

HELP AVAILABLE FOR DEFINITION OF DEPENDENT.

----------------------------------------------------

| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |

| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |

| ROUND 5. |

----------------------------------------------------

OE21

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Who {has been/was} covered by (POLICYHOLDER)’s health insurance

through (ESTABLISHMENT) {since (START DATE)/between (START DATE)

and (END DATE)} that we have not yet mentioned?

PROBE: Any else?

[1. First Name, [Middle Name], Last Name-65]

[2. First Name, [Middle Name], Last Name-65]

[3. First Name, [Middle Name], Last Name-65]

----------------------------------------------------

| DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT|

| ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) |

| and (END DATE)’ IF ROUND 5. |

----------------------------------------------------

| WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- |

| COVRD-PERS-TRPLS-ROSTER. |

----------------------------------------------------

| IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG |

| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |

| AS ‘COVERING PERSON NOT LISTED IN RU’. |

----------------------------------------------------

| ROSTER DETAILS: |

| Title: RU_MEMBERS_1 |

| |

| COL #1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION|

| OF RU-MEMBERS. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT|

| ONE OR MORE FROM THE LISTED MEMBERS. |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

| 3. DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY|

| ON THIS ROSTER. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY PERSONS WHO WERE NOT COVERED BY THE |

| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |

| ON THE PREVIOUS ROUND’S INTERVIEW DATE. |

----------------------------------------------------

LOOP_07

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER, ASK OE22 - END_LP07. |

----------------------------------------------------

| LOOP DEFINITION: LOOP_07 COLLECTS THE COVERAGE |

| START DATE FOR ALL PERSONS NEWLY COVERED DURING |

| THE CURRENT ROUND BY THE INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON |

| PERSONS SELECTED AT OE21. |

----------------------------------------------------

OE22

====

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did the health insurance through (ESTABLISHMENT)

begin for (PERSON)?

[Enter Month-2, Day-2, Year-4] .........

REF ................................... -7

DK .................................... -8

----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|

| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE22OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_15 |

----------------------------------------------------

OE22OV

======

Can you just tell me if (PERSON) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 {BOX_15}

PART OF THE MONTH ..................... 2 {BOX_15}

REF ................................... -7 {BOX_15}

DK .................................... -8 {BOX_15}

[Code One]

----------------------------------------------------

| HARD CHECK: |

| COMPLETE DATE AT OE22 MUST BE < THAN COMPLETE DATE|

| AT OE15 IF A DATE IS RECORDED AT OE15 OR < THAN |

| REFERENCE PERIOD END DATE IF NO DATE IS RECORDED |

| AT OE15. |

----------------------------------------------------

BOX_15

======

----------------------------------------------------

| IF FAMILY STILL HAS INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED ‘1’ |

| (YES)), FLAG INSURANCE FOR THIS PERSON AS |

| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE22 |

| UNTIL THE REFERENCE PERIOD END DATE. |

----------------------------------------------------

| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |

| THIS ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED ‘2’ |

| (NO)), FLAG INSURANCE FOR THIS PERSON AS |

| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE22 |

| UNTIL DATE RECORDED AT OE15. |

----------------------------------------------------

END_LP07

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- |

| COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS |

| STATED IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_07 AND GO TO BOX_16 |

----------------------------------------------------

OE22A

=====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{Does/Between (START DATE) and (END DATE), did} (POLICYHOLDER)’s

health coverage through (ESTABLISHMENT) cover as dependents any

persons who do not live here?

YES .................................... 1 {BOX_16}

NO ..................................... 2 {BOX_16}

REF ................................... -7 {BOX_16}

DK .................................... -8 {BOX_16}

HELP AVAILABLE FOR DEFINITION OF DEPENDENT.

----------------------------------------------------

| DISPLAY ‘Does’ IF NOT ROUND 5. DISPLAY ‘Between |

| (START DATE) and (END DATE), did’ IF ROUND 5. |

----------------------------------------------------

| IF CODED ‘1’ (YES), FLAG INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR AS ‘COVERING PERSON NOT |

| LISTED IN RU’ IN OE21 |

----------------------------------------------------

BOX_16

======

----------------------------------------------------

| IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THE|

| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |

| ON THE CURRENT ROUND’S INTERVIEW DATE, THAT IS, |

| OE12 IS CODED ‘1’(YES), CONTINUE WITH BOX_16A |

----------------------------------------------------

| OTHERWISE, GO TO END_LP05 |

----------------------------------------------------

BOX_16A

=======

----------------------------------------------------

| IF ROUND 3, CONTINUE WITH OE23A |

----------------------------------------------------

| OTHERWISE, GO TO OE23 |

----------------------------------------------------

OE23A

=====

{POLICYHOLDER’S 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 ........... 1

YES, PAY SOME OF PREMIUM/COST .......... 2

YES, BUT DON’T KNOW IF PAY ALL OR SOME

OF PREMIUM/COST ........................ 3

NO, DO NOT PAY ......................... 4 {OE23AAA}

REF ................................... -7 {OE23}

DK .................................... -8 {OE23}

[Code One]

HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.

----------------------------------------------------

| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |

| DISPLAYED HERE FOR THE INSURANCE FROM A |

| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |

| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |

| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |

| DIRECTLY PURCHASED CATEGORY. |

----------------------------------------------------

OE23AA

======

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

ESTABLISHMENT} {STR-DT}

{END-DT}

How much (do/does) (POLICYHOLDER) pay for the (ESTABLISHMENT)

coverage?

[Enter Amount in Dollars] .............. {OE23AAOV1}

REF ................................... -7 {BOX_17A}

DK .................................... -8 {BOX_17A}

----------------------------------------------------

| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |

| DISPLAYED HERE FOR THE INSURANCE FROM A |

| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |

| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |

| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |

| DIRECTLY PURCHASED CATEGORY. |

----------------------------------------------------

OE23AAOV1

=========

Is that per year, per month, per week, or what?

UNIT OF COVERAGE:

PER YEAR ............................... 1 {BOX_17A}

QUARTERLY/EVERY 3 MONTHS ............... 2 {BOX_17A}

BIMONTHLY/EVERY 2 MONTHS ............... 3 {BOX_17A}

PER MONTH .............................. 4 {BOX_17A}

PER WEEK ............................... 5 {BOX_17A}

BIWEEKLY/EVERY 2 WEEKS ................. 6 {BOX_17A}

SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 {BOX_17A}

SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 {BOX_17A}

OTHER ................................. 91 {OE23AAOV2}

REF ................................... -7 {BOX_17A}

DK .................................... -8 {BOX_17A}

[Code One]

OE23AAOV2

=========

OTHER:

[Enter Other Specify] .................. {BOX_17A}

REF ................................... -7 {BOX_17A}

DK .................................... -8 {BOX_17A}

BOX_17A

=======

-----------------------------------------------------

| IF OE23A IS CODED ‘1’ (YES, PAY ALL OF PREMIUM/ |

| COST), GO TO OE23 |

-----------------------------------------------------

| OTHERWISE, CONTINUE WITH OE23AAA |

-----------------------------------------------------

OE23AAA

=======

{POLICYHOLDER’S 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 .................... 1

STATE GOVERNMENT ...................... 2

LOCAL GOVERNMENT ...................... 3

SOME GOVERNMENT ....................... 4

EMPLOYER .............................. 5

UNION ................................. 6

OTHER ................................. 91

REF ................................... -7 {OE23}

DK .................................... -8 {OE23}

[Code All That Apply]

----------------------------------------------------

| DISPLAY ‘else’ IF OE23A IS CODED ‘2’ (YES, PAY |

| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |

| IF PAY ALL OR SOME OF PREMIUM/COST). OTHERWISE, |

| USE A NULL DISPLAY. |

| |

| DISPLAY ‘some of’ IF OE23A IS CODED ‘2’ (YES, PAY |

| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |

| IF PAY ALL OR SOME OF PREMIUM/COST). DISPLAY ‘for’|

| IF OE23A IS CODED ‘4’ (NO, DO NOT PAY). |

----------------------------------------------------

| FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT |

| ALLOW -7 OR -8 IN COMBINATION WITH ANY OTHER CODE.|

----------------------------------------------------

| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |

| WITH ANY OTHER CODE, CONTINUE WITH OE23AAAOV |

----------------------------------------------------

| OTHERWISE, GO TO OE23 |

----------------------------------------------------

OE23AAAOV

=========

OTHER:

[Enter Other Specify] .................. {OE23}

REF ................................... -7 {OE23}

DK .................................... -8 {OE23}

OE23

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{Last time we recorded that (POLICYHOLDER) (were/was) covered

by (READ INSURER NAME BELOW).}

{Since (START DATE), has there been/Between (START DATE) and

(END DATE), was there} any change in the plan name of the health

insurance (POLICYHOLDER) {has/had} through (ESTABLISHMENT)?

{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}

YES ................................... 1 {OE24}

NO .................................... 2 {END_LP05}

REF ................................... -7 {END_LP05}

DK .................................... -8 {END_LP05}

----------------------------------------------------

| DISPLAY FIRST PARAGRAPH AND THE INSURER NAME IF |

| THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- |

| PAIR HAD ANY INSURERS FLAGGED AS PROVIDING MEDIGAP|

| OR HOSPITAL/PHYSICIAN BENEFITS AT ANY TIME DURING |

| THE PREVIOUS ROUND. |

----------------------------------------------------

| DISPLAY ‘Since (START DATE), has there been’ AND |

| ‘has’ IF NOT ROUND 5. DISPLAY ‘Between (START |

| DATE) and (END DATE), ‘was there’ AND ‘had’ IF |

| ROUND 5. |

----------------------------------------------------

| IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |

| KNOW), FLAG PREVIOUS ROUND’S INSURER AS CURRENT |

| ROUND’S INSURER FOR THIS ESTABLISHMENT-PERSON- |

| PAIR. |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PERS_INSURER_TRPLS_1 |

| |

| COL # 1 HEADER: INSURER |

| INSTRUCTIONS: DISPLAY ESTABLISHMENT NAME |

| (ESTB.ESTBNAME) |

----------------------------------------------------

OE24

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

SHOW CARD OE-1.

What type of health insurance {(do/does)/did} (POLICYHOLDER)

{now} have through (ESTABLISHMENT)’s new plan {on (END DATE)}?

CHECK ALL THAT APPLY.

HOSPITAL AND PHYSICIAN BENEFITS,

INCLUDING COVERAGE THROUGH AN HMO ... 1

DENTAL ................................. 2

PRESCRIPTION DRUGS ..................... 3

VISION ................................. 4

MEDICARE SUPPLEMENT/MEDIGAP ............ 5

LONG TERM CARE IN A NURSING HOME ....... 6

EXTRA CASH FOR HOSPITAL STAYS .......... 7

SERIOUS DISEASE OR DREAD DISEASE ....... 8

DISABILITY ............................. 9

WORKER’S COMPENSATION ................. 10

ACCIDENT .............................. 11

OTHER ................................. 91

REF ................................... -7 {BOX_17}

DK .................................... -8 {BOX_17}

[Code All That Apply]

HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.

[NOTE: ‘DISABILITY,’ ‘WORKER’S COMPENSATION,’ AND ‘ACCIDENT’

WILL NOT APPEAR ON THE SHOW CARD.]

----------------------------------------------------

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

| IF ROUND 5. |

| |

| DISPLAY ‘now’ IF NOT ROUND 5. OTHERWISE, USE A |

| NULL DISPLAY. |

| |

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

| USE A NULL DISPLAY. |

----------------------------------------------------

| FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT |

| ALLOW ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW) IN |

| COMBINATION WITH ANY OTHER CODE. |

----------------------------------------------------

| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |

| WITH ANY OTHER CODES, CONTINUE WITH OE24OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_17 |

----------------------------------------------------

OE24OV

======

OTHER:

[Enter Other Specify] .................. {BOX_17}

REF ................................... -7 {BOX_17}

DK .................................... -8 {BOX_17}

HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORES.

[NOTE: ‘DISABILITY’, ‘WORKER’S COMPENSATION’, AND

‘ACCIDENT’ WILL NOT APPEAR ON THE SHOW CARD.]

BOX_17

======

----------------------------------------------------

| IF OE24 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |

| BENEFITS) OR ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), |

| ALONE OR WITH ANY OTHER COMBINATION OF CODES, |

| CONTINUE WITH OE25 |

----------------------------------------------------

| OTHERWISE, GO TO END_LP05 |

----------------------------------------------------

| NOTE: ALL ESTABLISHMENTS WHICH ARE BEING LOOPED |

| ON HERE ARE EMPLOYERS. THEREFORE, IT IS NOT |

| NECESSARY TO AUTOMATICALLY CODE OE25 IF THE |

| ESTABLISHMENT IS AN INSURANCE CO. OR HMO. |

----------------------------------------------------

OE25

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

What is the new plan name for (POLICYHOLDER)’s health insurance

through (ESTABLISHMENT) which provides the {hospital and

physician benefits/Medicare supplement or Medigap benefits}?

IF MORE THAN ONE NAME, PROBE: What is the main new plan name?

RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE {HOSPITAL

AND PHYSICIAN/MEDIGAP} BENEFITS FOR THIS PAIR.

IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, SELECT ‘HMO’.

NAME OF INSURER: [Enter Insurer]

TYPE:

INSURANCE COMPANY ...................... 1 {LOOP_08}

HMO .................................... 2 {LOOP_08}

SELF-INSURED COMPANY ................... 3 {LOOP_08}

[Code One]

HELP AVAILABLE FOR DEFINITION OF INSURANCE CO/HMO/SELF-INSURED CO.

-----------------------------------------------------

| DISPLAY ‘hospital and physician benefits’ AND |

| ‘HOSPITAL AND PHYSICIAN’ IF OE24 IS CODED ‘1’ |

| (HOSPITAL AND PHYSICIAN BENEFITS), BUT NOT CODED |

| ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP). DISPLAY |

| ‘Medicare supplement or Medigap benefits’ AND |

| ‘MEDIGAP’ IF OE24 IS CODED ‘5’ (MEDICARE SUPPLEMENT|

| /MEDIGAP). |

-----------------------------------------------------

----------------------------------------------------

| WRITE INSURER(S) TO THE RU-ESTB-PERSON-INSURER- |

| TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR. |

----------------------------------------------------

| FLAG INSURER(S) COLLECTED AT OE25 AS CURRENT |

| ROUND’S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- |

| PAIR. |

----------------------------------------------------

| IF OE24 IS CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP)|

| FLAG INSURANCE CO./HMO AS ‘SUPPLYING MEDICARE |

| SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES |

| HOSPITAL/PHYSICIAN BENEFITS)’ FOR THE CURRENT |

| ROUND. |

----------------------------------------------------

| IF OE24 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |

| BENEFITS), BUT NOT ‘5’ (MEDICARE SUPPLEMENT/ |

| MEDIGAP), FLAG INSURANCE CO./HMO AS ‘SUPPLYING |

| HOSPITAL/PHYSICIAN BENEFITS’ FOR THE CURRENT |

| ROUND. |

----------------------------------------------------

LOOP_08

=======

----------------------------------------------------

| FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- |

| TRIPLES-ROSTER, ASK OE25AA - END_LP08. |

----------------------------------------------------

| LOOP DEFINITION: LOOP_08 COLLECTS OTHER POLICY |

| NAMES AND MANAGED CARE INFORMATION FOR INSURERS |

| COLLECTED AT OE25. THIS LOOP CYCLES ON TRIPLES |

| THAT MEET THE FOLLOWING CONDITIONS: |

| |

| - ESTABLISH-PERSON-PAIR PROVIDES THE INSURANCE |

| BEING ASKED ABOUT |

| - INSURER IS ENTERED AT OE25 |

----------------------------------------------------

OE25AA

======

{POLICYHOLDER’S 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 ...................... 1 {OE25AAOV}

NO OTHER NAME .......................... 2 {BOX_18A}

REF ................................... -7 {BOX_18A}

DK .................................... -8 {BOX_18A}

HELP AVAILABLE FOR DEFINITION OF LOW OPTION/HIGH OPTION.

[Code One]

----------------------------------------------------

| DISPLAY THE NAME OF THE INSURANCE CO/HMO |

| RECORDED IN OE25 WHICH IS BEING LOOPED ON FOR |

| ‘INSURANCE...NAME’. |

----------------------------------------------------

OE25AAOV

========

OTHER NAME:

[Enter Policy Name] .................... {BOX_18A}

REF ................................... -7 {BOX_18A}

DK .................................... -8 {BOX_18A}

HELP AVAILABLE FOR DEFINITION OF LOW OPTION/HIGH OPTION.

BOX_18A

=======

----------------------------------------------------

| IF INSURER BEING LOOPED ON IS CODED ‘2’ (HMO) IN |

| OE25, CONTINUE WITH OE25B |

----------------------------------------------------

| OTHERWISE, GO TO BOX_18 |

----------------------------------------------------

OE25B

=====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

Will (POLICYHOLDER)’s plan pay for any of the costs of

visits to doctors who are not part of (POLICYHOLDER)’s

HMO, even if (POLICYHOLDER) (do/does) not have a referral?

YES .................................... 1 {END_LP08}

NO ..................................... 2 {END_LP08}

REF ................................... -7 {END_LP08}

DK .................................... -8 {END_LP08}

BOX_18

======

----------------------------------------------------

| ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER|

| |

| AT COMPLETION OF MANAGED CARE (MC) SECTION, |

| CONTINUE WITH END_LP08 |

----------------------------------------------------

END_LP08

========

----------------------------------------------------

| CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- |

| INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS |

| STATED IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER INSURERS MEET THE STATED CONDITIONS, |

| END LOOP_08 AND CONTINUE WITH END_LP05 |

----------------------------------------------------

END_LP05

========

----------------------------------------------------

| CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-|

| PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN |

| THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PAIRS MEET THE STATED CONDITIONS, |

| END LOOP_05 AND CONTINUE WITH BOX_19 |

----------------------------------------------------

BOX_19

======

----------------------------------------------------

| IF ONE OR MORE OF RU MEMBERS WAS COVERED BY |

| INSURANCE THROUGH A NON-CURRENT EMPLOYER FROM THE |

| PREVIOUS ROUND, AN EMPLOYER FLAGGED AS ‘SELF- |

| EMPLOYED’ WITH A FIRM-SIZE-1, OR A DIRECT PURCHASE|

| SOURCE ON THE PREVIOUS ROUND’S INTERVIEW DATE, |

| THAT IS: |

| |

| IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE |

| RU MEETS THE FOLLOWING CONDITIONS: |

| - ESTABLISHMENT IS ONE OF THE FOLLOWING TYPES: |

| - FLAGGED AS A DIRECT PURCHASE SOURCE |

| - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE-1, |

| FLAGGED DURING THE PREVIOUS ROUND AS |

| ‘PROVIDES HEALTH INSURANCE’, OR |

| - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE- |

| GREATER-THAN-1, FLAGGED DURING THE PREVIOUS |

| ROUND AS ‘PROVIDES HEALTH INSURANCE’, AND |

| HAD ONE OF THE FOLLOWING JOB SUBTYPES DURING |

| THE PREVIOUS ROUND: |

| - ‘FORMER MAIN WITHIN REFERENCE PERIOD’ |

| - ‘FORMER MISCELLANEOUS JOB WITHIN REFERENCE |

| PERIOD’ |

| - ‘LAST JOB OUTSIDE REFERENCE PERIOD’ |

| - ‘RETIREMENT JOB’ |

| - PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT,|

| IF THE ESTABLISHMENT IS ONE OF THE SECOND 2 |

| TYPES NOTED ABOVE; |

| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |

| INSURANCE; |

| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT|

| COVERED PERSON ON THE DATE OF THE PREVIOUS |

| ROUND’S INTERVIEW (HQ WAS CODED ‘1’ (WHOLE |

| TIME) OR HQ02 WAS CODED ‘1’ (YES) IN THE |

| PREVIOUS ROUND); |

| |

| CONTINUE WITH LOOP_09 |

----------------------------------------------------

| OTHERWISE, GO TO BOX_29 |

----------------------------------------------------

| NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT |

| IN THE RU ON THE PREVIOUS ROUND’S INTERVIEW DATE, |

| THE LAST CONDITION IN THE ABOVE BOX CAN BE MET |

| IF AT LEAST ONE DEPENDENT WAS COVERED BY |

| POLICYHOLDER’S INSURANCE ON THE PREVIOUS ROUND’S |

| INTERVIEW DATE. THE LOOP WILL CYCLE ON THE |

| POLICYHOLDER’S NAME. |

----------------------------------------------------

| NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE |

| POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, |

| INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT |

| ROUND’S INTERVIEW DATE, BUT WHERE THE |

| ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO |

| ARE STILL RU MEMBERS MAY STILL QUALIFY FOR |

| LOOP_09. |

----------------------------------------------------

| NOTE: FOR DIRECT PURCHASE AND SELF-EMPLOYED-FIRM-|

| SIZE-1, THE CONTEXT HEADER SHOULD DISPLAY THE NAME|

| OF THE SOURCE PROVIDING THE INSURANCE RATHER THAN |

| THE NAME OF THE DIRECT PURCHASE CATEGORY OR THE |

| SELF-EMPLOYED-FIRM-SIZE-1 EMPLOYER NAME OR TYPE OF|

| PURCHASE CATEGORY. FOR EMPLOYERS WHICH ARE NOT |

| SELF-EMPLOYED WITH FIRM-SIZE-1, USE THE JOBHOLDER |

| NAME AND EMPLOYER NAME IN THE CONTEXT HEADER. |

----------------------------------------------------

LOOP_09

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- |

| PAIRS-ROSTER, ASK BOX_19A - END_LP09 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_09 COLLECTS INFORMATION |

| ABOUT THE CONTINUATION OF INSURANCE COVERAGE |

| THROUGH A NON-CURRENT EMPLOYER FROM THE PREVIOUS |

| ROUND, AN EMPLOYER FLAGGED AS ‘SELF-EMPLOYED’ WITH|

| A FIRM-SIZE-1, OR A DIRECT PURCHASE SOURCE THAT |

| WAS COLLECTED IN THE PREVIOUS ROUND. THIS LOOP |

| CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET |

| THE FOLLOWING CONDITIONS: |

| |

| - ESTABLISHMENT IS ONE OF THE FOLLOWING TYPES: |

| - FLAGGED AS A DIRECT PURCHASE SOURCE |

| - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE-1, |

| FLAGGED DURING THE PREVIOUS ROUND AS ‘PROVIDES|

| HEALTH INSURANCE’, OR |

| - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE- |

| GREATER-THAN-1, FLAGGED DURING THE PREVIOUS |

| ROUND AS ‘PROVIDES HEALTH INSURANCE’, AND HAD |

| ONE OF THE FOLLOWING JOB SUBTYPES DURING THE |

| PREVIOUS ROUND: |

| - ‘FORMER MAIN WITHIN REFERENCE PERIOD’ |

| - ‘FORMER MISCELLANEOUS JOB WITHIN REFERENCE |

| PERIOD’ |

| - ‘LAST JOB OUTSIDE REFERENCE PERIOD’ |

| - ‘RETIREMENT JOB’ |

| - PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT, |

| IF THE ESTABLISHMENT IS ONE OF THE SECOND 2 |

| TYPES NOTED ABOVE; |

| - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS |

| INSURANCE; |

| - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT |

| COVERED PERSON ON THE DATE OF THE PREVIOUS |

| ROUND’S INTERVIEW (HQ WAS CODED ‘1’ (WHOLE TIME)|

| OR HQ02 WAS CODED ‘1’ (YES) IN THE PREVIOUS |

| ROUND) |

----------------------------------------------------

BOX_19A

=======

----------------------------------------------------

| IF THE POLICYHOLDER OF THIS ESTABLISHMENT-PERSON- |

| PAIR IS FLAGGED AS ‘POLICYHOLDER NOT LISTED IN RU |

| (DU)’ OR ‘POLICYHOLDER DECEASED’, CONTINUE WITH |

| OE25A |

----------------------------------------------------

| OTHERWISE, GO TO OE26 |

----------------------------------------------------

OE25A

=====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

INTERVIEWER: IF (POLICYHOLDER)’S NAME IS LISTED ON THE

ROSTER BELOW, SELECT IT. IF NOT, SELECT ‘NAME NOT ON ROSTER’

AND CONTINUE.

[1. First Name,[Middle Name],Last Name-35] .

[2. First Name,[Middle Name],Last Name-35] .

[3. First Name,[Middle Name],Last Name-35] .

[Code One]

----------------------------------------------------

| IF A DU MEMBER’S NAME IS SELECTED FROM THE |

| ROSTER, REPLACE THIS NAME AS THE CURRENT |

| POLICYHOLDER OF THIS ESTABLISHMENT-PERSON-PAIR. |

| IF ‘NAME NOT ON ROSTER’ SELECTED LEAVE THE |

| POLICYHOLDER NAME OF THIS ESTABLISHMENT-PERSON- |

| PAIR AS IS. |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: DU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY DU MEMBERS’ FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS PERSONS ON THE DU-MEMBERS- |

| ROSTER FOR SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. SELECT ALLOWED. |

| 2. MULTIPLE SELECT, ADD, DELETE, AND EDIT |

| DISALLOWED. |

| 3. DISPLAY ‘NAME NOT ON ROSTER’ AS LAST ENTRY ON |

| THIS ROSTER. |

----------------------------------------------------

| ROSTER FILTER: |

| NO FILTER; DISPLAY ALL. |

----------------------------------------------------

OE26

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

During the last interview, we recorded that someone in the

family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health

insurance. {(Are/Is)/(Were/Was)} (POLICYHOLDER) or anyone in

the family covered by (POLICYHOLDER)’s health insurance through

(ESTABLISHMENT) as of {today,} (END DATE)?

YES .................................... 1

NO ..................................... 2 {OE28}

REF ................................... -7 {END_LP09}

DK .................................... -8 {END_LP09}

----------------------------------------------------

| DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY |

| ‘(Was/Were)’ IF ROUND 5. |

| |

| DISPLAY ‘today,’ IF NOT ROUND 5. OTHERWISE, USE A|

| NULL DISPLAY. |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND THIS ESTABLISHMENT-PERSON- |

| PAIR IS AN ESTABLISHMENT FLAGGED AS ‘SELF- |

| EMPLOYED’ WITH FIRM-SIZE-1, CONTINUE WITH OE27 |

----------------------------------------------------

| OTHERWISE (I.E., IF CODED ‘1’ (YES) AND |

| ESTABLISHMENT-PERSON-PAIR IS NOT AN ESTABLISHMENT |

| WITH FIRM-SIZE-1), GO TO BOX_20 |

----------------------------------------------------

OE27

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Is this insurance still through (POLICYHOLDER)’s self-employed

business?

YES .................................... 1 {BOX_20}

NO ..................................... 2 {BOX_20}

REF ................................... -7 {BOX_20}

DK .................................... -8 {BOX_20}

HELP AVAILABLE FOR DEFINITION OF SELF-EMPLOYED.

OE28

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did (POLICYHOLDER)’s health insurance through

(ESTABLISHMENT) end?

{IF INSURANCE ENDED AFTER 12/31/{YEAR}, BACK-UP TO OE26

AND SELECT ‘YES’.}

[Enter Month-2, Day-2, Year-4] .........

REF ................................... -7 {BOX_20}

DK .................................... -8 {BOX_20}

----------------------------------------------------

| DISPLAY ‘IF INSURANCE ENDED... SELECT ‘YES’.’ IF |

| ROUND 5. OTHERWISE, USE A NULL DISPLAY |

----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|

| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE28OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_20 |

----------------------------------------------------

OE28OV

======

Can you just tell me if (POLICYHOLDER) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 {BOX_20}

PART OF THE MONTH ..................... 2 {BOX_20}

REF ................................... -7 {BOX_20}

DK .................................... -8 {BOX_20}

[Code One]

BOX_20

======

----------------------------------------------------

| IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT |

| THE PREVIOUS ROUND’S INTERVIEW DATE BY THE |

| INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, |

| AUTOMATICALLY CODE OE29 AS ‘1’ (YES) AND GO TO |

| BOX_21 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH OE29 |

----------------------------------------------------

OE29

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

During the last interview, we recorded that (READ NAMES BELOW)

(were/was) covered by (POLICYHOLDER)’s health insurance

through (ESTABLISHMENT).

{Are/Were} they all covered by this health insurance {until

{{OE28 DATE}/it ended}/on (END DATE)}?

{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}

YES ................................... 1 {BOX_21}

NO .................................... 2 {BOX_21}

REF ................................... -7 {BOX_21}

DK .................................... -8 {BOX_21}

----------------------------------------------------

| DISPLAY ‘Are’ IF OE26 IS CODED ‘1’ (YES). |

| DISPLAY ‘Were’ IF OE26 IS CODED ‘2’ (NO) OR IF |

| CURRENT ROUND IS ROUND 5. |

| |

| DISPLAY ‘until {OE28 DATE}’ IF OE26 IS CODED ‘2’ |

| (NO). DISPLAY ‘on (END DATE)’ IF OE26 IS CODED |

| ‘1’ (YES). |

| |

| DISPLAY THE DATE RECORDED AT OE28 FOR ‘OE28 DATE’.|

| IF THE MONTH OR YEAR FIELD AT OE28 IS CODED ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|

| FOR ‘OE28 DATE’. |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY COVERED PERSONS’ NAMES |

| (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER FOR DISPLAY. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. DISPLAY ONLY. |

| 2. SELECT, ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| 1. PERSON WAS COVERED AT PREVIOUS ROUND’S |

| INTERVIEW DATE BY THE INSURANCE FROM THIS |

| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |

| POLICYHOLDER |

| 2. PERSON IS AN RU MBMBER |

----------------------------------------------------

BOX_21

======

----------------------------------------------------

| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |

| TO THE END DATE OF THE CURRENT ROUND, THAT IS: |

| |

| IF OE26 IS CODED ‘1’ (YES) AND OE29 IS CODED ‘1’ |

| (YES), |

| |

| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |

| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|

| THE REFERENCE PERIOD END DATE AND |

| |

| GO TO BOX_23 |

----------------------------------------------------

| IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND |

| TO PART OF THE CURRENT ROUND, THAT IS: |

| |

| IF OE26 IS CODED ‘2’ (NO) AND OE29 IS CODED ‘1’ |

| (YES). |

| |

| FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING |

| THE POLICYHOLDER) AS ‘CONTINUOUS COVERAGE’ THROUGH|

| THE DATE RECORDED AT OE28 AND |

| |

| GO TO BOX_23 |

----------------------------------------------------

| OTHERWISE (I.E., OE29 CODED ‘2’ (NO), ‘-7’ |

| (REFUSED), OR ‘-8’ (DON’T KNOW)), CONTINUE WITH |

| OE30 |

----------------------------------------------------

OE30

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Who {is/was} no longer covered by (POLICYHOLDER)’s health

insurance through (ESTABLISHMENT) {{until {OE28 DATE}/it ended}/

on (END DATE)}?

[1. First Name, [Middle Name], Last Name-65]

[2. First Name, [Middle Name], Last Name-65]

[3. First Name, [Middle Name], Last Name-65]

----------------------------------------------------

| DISPLAY ‘is’ IF OE26 IS CODED ‘1’ (YES). |

| DISPLAY ‘was’ IF OE26 IS CODED ‘2’ (NO) OR IF |

| CURRENT ROUND IS ROUND 5. |

| |

| DISPLAY ‘until {OE28 DATE}’ IF OE26 IS CODED ‘2’ |

| (NO). |

| DISPLAY ‘on (END DATE)’ IF OE26 IS CODED ‘1’ |

| (YES). |

| |

| DISPLAY THE DATE RECORDED AT OE28 FOR ‘OE28 DATE’.|

| IF THE MONTH OR YEAR FIELD AT OE28 IS CODED ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|

| FOR ‘OE28 DATE’. |

----------------------------------------------------

| IF FAMILY STILL HAS INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED ‘1’ |

| (YES)), FLAG INSURANCE FOR ALL PERSONS NOT |

| SELECTED AT OE30 AS ‘CONTINUOUS COVERAGE’ FROM THE|

| REFERENCE PERIOD START DATE UNTIL THE REFERENCE |

| PERIOD END DATE. |

----------------------------------------------------

| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |

| THIS ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED ‘2’ |

| (NO)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED|

| AT OE30 AS ‘CONTINUOUS COVERAGE’ FROM THE |

| REFERENCE PERIOD START DATE UNTIL DATE RECORDED |

| AT OE28 |

----------------------------------------------------

| GO TO LOOP_10 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY COVERED PERSONS’ NAMES |

| (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER FOR SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| 1. PERSON WAS COVERED AT PREVIOUS ROUND’S |

| INTERVIEW DATE BY THE INSURANCE FROM THIS |

| ESTABLISHMENT-PERSON-PAIR, INCLUDING THE |

| POLICYHOLDER |

| 2. PERSON IS AN RU MBMBER |

----------------------------------------------------

LOOP_10

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER, ASK OE31 - END_LP10. |

----------------------------------------------------

| LOOP DEFINITION: LOOP_10 COLLECTS THE DATE ON |

| WHICH THE INSURANCE COVERAGE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER|

| WHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCE|

| PERIOD END DATE OR THE DATE REPORTED IN OE28. |

| THIS LOOP CYCLES ON PERSONS SELECTED AT OE30. |

-----------------------------------------------------

OE31

====

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did the health insurance through (ESTABLISHMENT)

end for (PERSON)?

[Enter Month-2, Day-2, Year-4] ......... {OE31OV}

REF ................................... -7 {BOX_22}

DK .................................... -8 {BOX_22}

----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|

| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE31OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_22 |

----------------------------------------------------

OE31OV

======

Can you just tell me if (PERSON) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 {BOX_22}

PART OF THE MONTH ..................... 2 {BOX_22}

REF ................................... -7 {BOX_22}

DK .................................... -8 {BOX_22}

[Code One]

BOX_22

======

----------------------------------------------------

| FLAG INSURANCE FOR PERSON AS ‘CONTINUOUS COVERAGE’|

| THROUGH THE COMPLETE DATE RECORDED AT OE31 AND |

| OE31OV. |

----------------------------------------------------

END_LP10

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- |

| COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS |

| STATED IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_10 AND CONTINUE WITH BOX_23 |

----------------------------------------------------

BOX_23

======

----------------------------------------------------

| IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY |

| THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,|

| (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU |

| MEMBERS NOT COVERED BY THIS INSURANCE ON THE |

| PREVIOUS ROUND’S INTERVIEW DATE, BUT EXCLUDES RU |

| MEMBERS JUST MARKED AS NO LONGER COVERED IN OE30),|

| CONTINUE WITH OE32 |

----------------------------------------------------

| OTHERWISE, GO TO OE34A |

----------------------------------------------------

OE32

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{Since (START DATE)/Between (START DATE) and (END DATE)}, have

any persons living here, we have not yet mentioned, been covered

by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?

YES ................................... 1 {OE33}

NO .................................... 2 {OE34A}

REF ................................... -7 {OE34A}

DK .................................... -8 {OE34A}

HELP AVAILABLE FOR DEFINITION OF DEPENDENT.

----------------------------------------------------

| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |

| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |

| ROUND 5. |

----------------------------------------------------

OE33

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Who {has been/was} covered by (POLICYHOLDER)’s health insurance

through (ESTABLISHMENT) {since (START DATE)/between (START DATE)

and (END DATE)} that we have not yet mentioned?

PROBE: Anyone else?

[1. First Name, [Middle Name], Last Name-65]

[2. First Name, [Middle Name], Last Name-65]

[3. First Name, [Middle Name], Last Name-65]

----------------------------------------------------

| DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT|

| ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) |

| and (END DATE)’ IF ROUND 5. |

----------------------------------------------------

| WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- |

| COVRD-PERS-TRPLS-ROSTER. |

----------------------------------------------------

| IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG |

| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |

| AS ‘COVERING PERSON NOT LISTED IN RU’. |

----------------------------------------------------

| GO TO LOOP_11 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION|

| OF RU-MEMBERS. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY |

| SELECT ONE OR MORE FROM THE LISTED MEMBERS. |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

| 3. DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY|

| ON THIS ROSTER. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY PERSONS WHO WERE NOT COVERED BY THE |

| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |

| ON THE PREVIOUS ROUND’S INTERVIEW DATE. |

----------------------------------------------------

LOOP_11

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER, ASK OE34 - END_LP11. |

----------------------------------------------------

| LOOP DEFINITION: LOOP_11 COLLECTS THE COVERAGE |

| START DATE FOR ALL PERSONS NEWLY COVERED DURING |

| THE CURRENT ROUND BY THE INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON |

| PERSONS SELECTED AT OE33. |

----------------------------------------------------

OE34

====

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did the health insurance through (ESTABLISHMENT)

begin for (PERSON)?

[Enter Month-2, Day-2, Year-4] .........

REF ................................... -7 {BOX_24}

DK .................................... -8 {BOX_24}

-----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T |

| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE34OV |

-----------------------------------------------------

| OTHERWISE, GO TO BOX_24 |

-----------------------------------------------------

OE34OV

======

Can you just tell me if (PERSON) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 {BOX_24}

PART OF THE MONTH ..................... 2 {BOX_24}

REF ................................... -7 {BOX_24}

DK .................................... -8 {BOX_24}

[Code One]

----------------------------------------------------

| HARD CHECK: |

| COMPLETE DATE AT OE34 MUST BE < THAN COMPLETE |

| DATE AT OE28 IF A DATE IS RECORDED AT OE28 OR |

| < THAN REFERENCE PERIOD END DATE IF NO DATE IS |

| RECORDED AT OE28. |

----------------------------------------------------

BOX_24

======

----------------------------------------------------

| IF FAMILY STILL HAS INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED ‘1’ |

| (YES)), FLAG INSURANCE FOR THIS PERSON AS |

| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE34 |

| UNTIL THE REFERENCE PERIOD END DATE. |

----------------------------------------------------

| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |

| THIS ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED ‘2’ |

| (NO)), FLAG INSURANCE FOR THIS PERSON AS |

| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE34 |

| UNTIL DATE RECORDED AT OE28. |

----------------------------------------------------

END_LP11

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- |

| COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS |

| STATED IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_11 AND CONTINUE WITH BOX_25 |

----------------------------------------------------

OE34A

=====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{Does/Between (START DATE) and (END DATE), did} (POLICYHOLDER)’s

health coverage through (ESTABLISHMENT) cover as dependents any

persons who do not live here?

YES .................................... 1 {BOX_25}

NO ..................................... 2 {BOX_25}

REF ................................... -7 {BOX_25}

DK .................................... -8 {BOX_25}

HELP AVAILABLE FOR DEFINITION OF DEPENDENT.

----------------------------------------------------

| DISPLAY ‘Does’ IF NOT ROUND 5. DISPLAY ‘Between |

| (START DATE) and (END DATE), did’ IF ROUND 5. |

----------------------------------------------------

| IF CODED ‘1’ (YES), FLAG INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR AS ‘COVERING PERSON NOT |

| LISTED IN RU’ IN OE33 |

----------------------------------------------------

BOX_25

======

----------------------------------------------------

| IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THE|

| INSURANCE THROUGH THE ESTABLISHMENT-PERSON-PAIR ON|

| THE CURRENT ROUND’S INTERVIEW DATE, THAT IS, OE26 |

| IS CODED ‘1’(YES), CONTINUE WITH BOX_25A |

----------------------------------------------------

| OTHERWISE, GO TO END_LP09 |

----------------------------------------------------

BOX_25A

=======

----------------------------------------------------

| IF ROUND 3, CONTINUE WITH OE35A |

----------------------------------------------------

| OTHERWISE, GO TO OE35 |

----------------------------------------------------

OE35A

=====

{POLICYHOLDER’S 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 ........... 1 {OE35AA}

YES, PAY SOME OF PREMIUM/COST .......... 2 {OE35AA}

YES, BUT DON’T KNOW IF PAY ALL OR SOME

OF PREMIUM/COST ........................ 3 {OE35AA}

NO, DO NOT PAY ......................... 4 {OE35AAA}

REF ................................... -7 {OE35}

DK .................................... -8 {OE35}

[Code One]

HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.

----------------------------------------------------

| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |

| DISPLAYED HERE FOR THE INSURANCE FROM A |

| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |

| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |

| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |

| DIRECTLY PURCHASED CATEGORY. |

----------------------------------------------------

OE35AA

======

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

ESTABLISHMENT} {STR-DT}

{END-DT}

How much (do/does) (POLICYHOLDER) pay for the (ESTABLISHMENT)

coverage?

[Enter Amount in Dollars] .............. {OE35AAOV1}

REF ................................... -7 {BOX_26A}

DK .................................... -8 {BOX_26A}

----------------------------------------------------

| NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE |

| DISPLAYED HERE FOR THE INSURANCE FROM A |

| SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM |

| DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF |

| THE SOURCE, NOT THE NAME OF THE EMPLOYER OR |

| DIRECTLY PURCHASED CATEGORY. |

----------------------------------------------------

OE35AAOV1

=========

Is that per year, per month, per week, or what?

UNIT OF COVERAGE:

PER YEAR ............................... 1 {BOX_26A}

QUARTERLY/EVERY 3 MONTHS ............... 2 {BOX_26A}

BIMONTHLY/EVERY 2 MONTHS ............... 3 {BOX_26A}

PER MONTH .............................. 4 {BOX_26A}

PER WEEK ............................... 5 {BOX_26A}

BIWEEKLY/EVERY 2 WEEKS ................. 6 {BOX_26A}

SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 {BOX_26A}

SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 {BOX_26A}

OTHER ................................. 91 {OE35AAOV2}

REF ................................... -7 {BOX_26A}

DK .................................... -8 {BOX_26A}

[Code One]

OE35AAOV2

=========

OTHER:

[Enter Other Specify] .................. {BOX_26A}

REF ................................... -7 {BOX_26A}

DK .................................... -8 {BOX_26A}

BOX_26A

=======

-----------------------------------------------------

| IF OE35A IS CODED ‘1’ (YES, PAY ALL OF PREMIUM/ |

| COST), GO TO OE35 |

-----------------------------------------------------

| OTHERWISE, CONTINUE WITH OE35AAA |

-----------------------------------------------------

OE35AAA

=======

{POLICYHOLDER’S 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 .................... 1

STATE GOVERNMENT ...................... 2

LOCAL GOVERNMENT ...................... 3

SOME GOVERNMENT ....................... 4

EMPLOYER .............................. 5

UNION ................................. 6

OTHER ................................. 91 {OE35AAAOV}

REF ................................... -7 {OE35}

DK .................................... -8 {OE35}

[Code All That Apply]

----------------------------------------------------

| DISPLAY ‘else’ IF OE35A IS CODED ‘2’ (YES, PAY |

| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |

| IF PAY ALL OR SOME OF PREMIUM/COST). OTHERWISE, |

| USE A NULL DISPLAY |

| |

| DISPLAY ‘some of’ IF OE35A IS CODED ‘2’ (YES, PAY |

| SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON’T KNOW |

| IF PAY ALL OR SOME OF PREMIUM/COST). DISPLAY ‘for’|

| IF OE35A IS CODED ‘4’ (NO, DO NOT PAY). |

----------------------------------------------------

| FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT |

| ALLOW ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW) IN |

| COMBINATION WITH ANY OTHER CODE. |

----------------------------------------------------

| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |

| WITH ANY OTHER CODE, CONTINUE WITH OE35AAAOV |

----------------------------------------------------

| OTHERWISE, GO TO OE35 |

----------------------------------------------------

OE35AAAOV

=========

OTHER:

[Enter Other Specify] ..................

REF ................................... -7

DK .................................... -8

OE35

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{Last time we recorded that (POLICYHOLDER) (were/was) covered

by (READ INSURER NAME BELOW).}

{Since (START DATE), has there been/Between (START DATE) and

(END DATE), was there} any change in the plan name of the health

insurance (POLICYHOLDER) {has/had} through (ESTABLISHMENT)?

{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}

YES ................................... 1

NO .................................... 2 {END_LP09}

REF ................................... -7 {END_LP09}

DK .................................... -8 {END_LP09}

----------------------------------------------------

| DISPLAY FIRST PARAGRAPH AND THE ROSTER OF INSURER |

| NAMES IF THE INSURANCE THROUGH THIS ESTABLISHMENT-|

| PERSON-PAIR HAD ANY INSURERS FLAGGED AS PROVIDING |

| MEDIGAP OR HOSPITAL/PHYSICIAN BENEFITS AT ANY TIME|

| DURING THE PREVIOUS ROUND. |

----------------------------------------------------

| DISPLAY ‘Since (START DATE), has there been’ AND |

| ‘has’ IF NOT ROUND 5. DISPLAY ‘Between (START |

| DATE) and (END DATE), was there’ AND ‘had’ IF |

| ROUND 5. |

----------------------------------------------------

| IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |

| KNOW), FLAG PREVIOUS ROUND’S INSURER AS CURRENT |

| ROUND’S INSURER FOR THIS ESTABLISHMENT-PERSON- |

| PAIR. |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND ESTABLISHMENT IS FLAGGED AS|

| AN INSURANCE CO. OR HMO, CONTINUE WITH OE36 |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND ESTABLISHMENT IS NOT |

| FLAGGED AS AN INSURANCE CO. OR HMO, GO TO OE37 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PERS_INSURER_TRPLS_1 |

| |

| COL # 1 HEADER: INSURER |

| INSTRUCTIONS: DISPLAY ESTABLISHMENT NAME |

| (ESTB.ESTBNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS INSURERS IN THE RU-ESTB-PERS- |

| INSURER-TRPLS-ROSTER FOR DISPLAY. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. SELECT, ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| 1. FLAGGED AS ‘SUPPLYING HOSPITAL AND PHYSICIAN |

| BENEFITS’ AND/OR ‘SUPPLYING MEDICARE SUPPLEMENT|

| /MEDIGAP BENEFITS’ AND |

| 2. ARE ASSOCIATED WITH THE INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR. |

----------------------------------------------------

OE36

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

What is the new plan name of (POLICYHOLDER)’s health insurance

through (ESTABLISHMENT)?

[Enter Plan Name/Establishment Name] .............. {OE37}

----------------------------------------------------

| WRITE ESTABLISHMENT NAME CORRECTION TO THE RU- |

| ESTABLISHMENT-PERSONS-PAIRS-ROSTER. THIS IS THE |

| CORRECTED ESTABLISHMENT NAME. |

----------------------------------------------------

| FLAG INSURER ENTERED ABOVE AS CURRENT ROUND’S |

| INSURER FOR THIS POLICYHOLDER-ESTABLISHMENT PAIR. |

----------------------------------------------------

| NOTE: IF A SOURCE OF INSURANCE WAS DIRECTLY |

| PURCHASED FROM AN HMO OR INSURANCE COMPANY, THE |

| ESTABLISHMENT NAME IS THE SAME AS THE INSURER |

| NAME. THEREFORE, ANY CHANGE IN PLAN NAME |

| AUTOMATICALLY DICTATES A CHANGE IN THE |

| ESTABLISHMENT NAME. |

----------------------------------------------------

OE37

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

SHOW CARD OE-1.

What type of health insurance {(do/does)/did} (POLICYHOLDER)

{now} have through (ESTABLISHMENT)’s new plan {on (END DATE)}?

CHECK ALL THAT APPLY.

HOSPITAL AND PHYSICIAN BENEFITS,

INCLUDING COVERAGE THROUGH AN HMO ... 1

DENTAL ................................. 2

PRESCRIPTION DRUGS ..................... 3

VISION ................................. 4

MEDICARE SUPPLEMENT/MEDIGAP ............ 5

LONG TERM CARE IN A NURSING HOME ....... 6

EXTRA CASH FOR HOSPITAL STAYS .......... 7

SERIOUS DISEASE OR DREAD DISEASE ....... 8

DISABILITY ............................. 9

WORKER’S COMPENSATION ................. 10

ACCIDENT .............................. 11

OTHER ................................. 91 {OE37OV}

REF ................................... -7 {BOX_26}

DK .................................... -8 {BOX_26}

[Code All That Apply]

HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.

[NOTE: ‘DISABILITY,’ ‘WORKER’S COMPENSATION,’ AND ‘ACCIDENT’

WILL NOT APPEAR ON THE SHOW CARD.]

----------------------------------------------------

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

| IF ROUND 5. |

| |

| DISPLAY ‘now’ IF NOT ROUND 5. OTHERWISE, USE A |

| NULL DISPLAY. |

| |

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

| USE A NULL DISPLAY. |

----------------------------------------------------

| FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT |

| ALLOW ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW) IN |

| COMBINATION WITH ANY OTHER CODE. |

----------------------------------------------------

| IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION |

| WITH ANY OTHER CODES, CONTINUE WITH OE37OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_26 |

----------------------------------------------------

OE37OV

======

OTHER:

[Enter Other Specify] .................. {BOX_26}

REF ................................... -7 {BOX_26}

DK .................................... -8 {BOX_26}

HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.

BOX_26

======

----------------------------------------------------

| IF OE37 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |

| BENEFITS) OR ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), |

| ALONE OR WITH ANY OTHER COMBINATION OF CODES, |

| CONTINUE WITH BOX_27 |

----------------------------------------------------

| OTHERWISE, GO TO END_LP09 |

----------------------------------------------------

BOX_27

======

----------------------------------------------------

| IF ESTABLISHMENT ALREADY FLAGGED AS ‘INSURANCE |

| CO’. OR ‘HMO’, AUTOMATICALLY CODE OE38 WITH |

| APPROPRIATE RESPONSES AND GO TO LOOP_12 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH OE38 |

----------------------------------------------------

OE38

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

What is the new plan name for (POLICYHOLDER)’s health insurance

through (ESTABLISHMENT) which provides the {hospital and

physician benefits/Medicare supplement or Medigap benefits}?

IF MORE THAN ONE NAME, PROBE: What is the main new plan name?

RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE {HOSPITAL

AND PHYSICIAN/MEDIGAP} BENEFITS FOR THIS PAIR.

IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, SELECT ‘HMO’.

NAME OF INSURER: [Enter Insurer]

TYPE:

INSURANCE COMPANY ...................... 1 {LOOP_12}

HMO .................................... 2 {LOOP_12}

SELF-INSURED COMPANY ................... 3 {LOOP_12}

[Code One]

HELP AVAILABLE FOR DEFINITION OF INSURANCE CO/HMO/SELF-INSURED CO.

-----------------------------------------------------

| DISPLAY ‘hospital and physician benefits’ AND |

| ‘HOSPITAL AND PHYSICIAN’ IF OE37 IS CODED ‘1’ |

| (HOSPITAL AND PHYSICIAN BENEFITS), BUT NOT CODED |

| ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP). |

| DISPLAY ‘Medicare supplement or Medigap benefits’ |

| AND ‘MEDIGAP’ IF OE37 IS CODED ‘5’ (MEDICARE |

| SUPPLEMENT/MEDIGAP). |

-----------------------------------------------------

| WRITE INSURER(S) TO THE RU-ESTAB-PERSON-INSURER- |

| TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR |

-----------------------------------------------------

----------------------------------------------------

| FLAG INSURER(S) COLLECTED AT OE38 AS CURRENT |

| ROUND’S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- |

| PAIR. |

----------------------------------------------------

| IF OE37 IS CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP)|

| FLAG INSURANCE CO./HMO AS ‘SUPPLYING MEDICARE |

| SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES |

| HOSPITAL/PHYSICIAN BENEFITS)’ FOR THE CURRENT |

| ROUND. |

----------------------------------------------------

| IF OE37 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN |

| BENEFITS), BUT NOT ‘5’ (MEDICARE SUPPLEMENT/ |

| MEDIGAP), FLAG INSURANCE CO./HMO AS ‘SUPPLYING |

| HOSPITAL/PHYSICIAN BENEFITS’ FOR THE CURRENT |

| ROUND. |

----------------------------------------------------

LOOP_12

=======

----------------------------------------------------

| FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- |

| TRIPLES-ROSTER, ASK OE38A - END_LP12. |

----------------------------------------------------

| LOOP DEFINITION: LOOP_12 COLLECTS OTHER POLICY |

| NAMES AND MANAGED CARE INFORMATION FOR INSURERS |

| COLLECTED AT OE38. THIS LOOP CYCLES ON TRIPLES |

| THAT MEET THE FOLLOWING CONDITIONS: |

| |

| - ESTABLISHMENT-PERSON-PAIR PROVIDES THE INSURANCE|

| BEING ASKED ABOUT |

| - INSURER IS ENTERED AT OE38 |

----------------------------------------------------

OE38A

=====

{POLICYHOLDER’S 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 ...................... 1 {OE38AOV}

NO OTHER NAME .......................... 2 {BOX_28A}

REF ................................... -7 {BOX_28A}

DK .................................... -8 {BOX_28A}

HELP AVAILABLE FOR DEFINITION OF LOW OPTION/HIGH OPTION.

[Code One]

----------------------------------------------------

| DISPLAY THE NAME OF THE INSURANCE CO/HMO |

| RECORDED IN OE38 WHICH IS BEING LOOPED ON |

| FOR ‘INSURANCE...NAME’. |

----------------------------------------------------

OE38AOV

=======

OTHER NAME:

[Enter Policy Name] .................... {BOX_28A}

REF ................................... -7 {BOX_28A}

DK .................................... -8 {BOX_28A}

HELP AVAILABLE FOR DEFINITION OF LOW OPTION/HIGH OPTION.

BOX_28A

=======

----------------------------------------------------

| IF INSURER BEING LOOPED ON IS CODED ‘2’ (HMO) IN |

| OE38, CONTINUE WITH OE38B |

----------------------------------------------------

| OTHERWISE, GO TO BOX_28 |

----------------------------------------------------

OE38B

=====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

Will (POLICYHOLDER)’s plan pay for any of the costs of

visits to doctors who are not part of (POLICYHOLDER)’s

HMO, even if (POLICYHOLDER) (do/does) not have a referral?

YES .................................... 1 {END_LP12}

NO ..................................... 2 {END_LP12}

REF ................................... -7 {END_LP12}

DK .................................... -8 {END_LP12}

BOX_28

======

----------------------------------------------------

| ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER|

| |

| AT COMPLETION OF MANAGED CARE (MC) SECTION, |

| CONTINUE WITH END_LP12 |

----------------------------------------------------

END_LP12

========

----------------------------------------------------

| CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- |

| INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS |

| STATED IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER INSURERS MEET THE STATED CONDITIONS, |

| END LOOP_12 AND CONTINUE WITH END_LP09 |

----------------------------------------------------

END_LP09

========

----------------------------------------------------

| CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-|

| PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN |

| THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END |

| LOOP_09 AND CONTINUE WITH BOX_29 |

----------------------------------------------------

BOX_29

======

----------------------------------------------------

| IF ONE OR MORE RU MEMBERS WAS A COVERED PERSON BY |

| AN ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS |

| ROUND’S INTERVIEW DATE WHERE THE ESTABLISHMENT IS |

| A PRIVATE SOURCE OF INSURANCE AND THE POLICYHOLDER|

| IS FLAGGED AS ‘POLICYHOLDER/DEPENDENT IN DIFFERENT|

| RUS’ AT THE CURRENT ROUND’S INTERVIEW DATE, |

| CONTINUE WITH LOOP_13 |

----------------------------------------------------

| OTHERWISE, GO TO BOX_33 |

----------------------------------------------------

| NOTE: WHEN A POLICYHOLDER LEAVES AN RU, WE WILL |

| NEVER ASK RJ AND THAT POLICYHOLDER WILL NEVER |

| QUALIFY FOR LOOPS 01, 05, OR 09. WE CREATED A |

| NEW LOOP, LOOP_13 THAT WILL HANDLE THE SITUATIONS |

| WHERE THE POLICYHOLDER HAS LEFT THE RU AND LEFT |

| DEPENDENTS BEHIND, OR THE SITUATION WHERE THE |

| DEPENDENTS HAVE LEFT THE RU (WITHOUT THE |

| POLICYHOLDER). THIS SITUATION WILL BE FLAGGED AS |

| ‘POLICYHOLDER/DEPENDENT IN DIFFERENT RUs’. THIS |

| FLAG CAN BE ASSOCIATED WITH ANY ESTABLISHMENT- |

| PERSON-PAIR IN A PARTICULAR RU WHERE THEY ARE |

| COVERED PERSONS, BUT THE POLICYHOLDER IS IN |

| ANOTHER RU. THIS FLAG SHOULD NEVER EXIST ON A |

| PAIR IN AN RU WHERE THE POLICYHOLDER OF THE PAIR |

| IS IN THE SAME RU AS ALL OF THE DEPENDENTS OR |

| WHERE THE POLICYHOLDER OF THE PAIR WAS ORIGINALLY |

| CREATED AS ‘POLICYHOLDER NOT IN RU/DU’ OR |

| ‘POLICYHOLDER DECEASED’. |

----------------------------------------------------

LOOP_13

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- |

| PAIRS-ROSTER, ASK OE39 - END_LP13. |

----------------------------------------------------

| LOOP DEFINITION: |

| |

| LOOP_13 COLLECTS INFORMATION ABOUT THE |

| CONTINUATION OF INSURANCE COVERAGE THROUGH AN |

| ESTABLISHMENT-PERSON-PAIR WHERE THE POLICYHOLDER |

| OR THE ELIGIBLE DEPENDENT(S) HAVE MOVED FROM THE |

| RU. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS|

| THAT MEET THE FOLLOWING CONDITIONS: |

| |

| - THE ESTABLISHMENT IS A PRIVATE SOURCE OF |

| INSURANCE |

| - THE ESTABLISHMENT-PERSON-PAIR IS FLAGGED AS |

| ‘POLICYHOLDER/DEPENDENT MOVED’ AT THE CURRENT |

| ROUND’S INTERVIEW DATE FOR THIS RU |

| - AT LEAST ONE RU MEMBER WAS A COVERED PERSON FOR |

| THIS ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS |

| ROUND’S INTERVIEW DATE |

| - POLICYHOLDER IS NOT A CURRENT RU MEMBER |

----------------------------------------------------

OE39

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

During the last interview, we recorded that someone in the

family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health

insurance. {Is/Was} anyone in the family, living here {now},

covered by (POLICYHOLDER)’s health insurance through

(ESTABLISHMENT) as of {today,} (END DATE)?

IF RESPONDENT VOLUNTEERS THAT THIS INSURANCE HAS ALREADY BEEN

DISCUSSED, SELECT ‘INSURANCE ALREADY DISCUSSED’.

YES ................................... 1

NO .................................... 2 {OE40}

INSURANCE ALREADY DISCUSSED ........... 3 {END_LP13}

REF ................................... -7 {END_LP13}

DK .................................... -8 {END_LP13}

[Code One]

----------------------------------------------------

| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF |

| ROUND 5. |

| |

| DISPLAY ‘today,’ AND ‘ now’ IF NOT ROUND 5. |

| OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| IF CODED ‘3’ (INSURANCE ALREADY DISCUSSED), FLAG |

| ITEM FOR SOURCE CLEAN-UP. |

----------------------------------------------------

| IF YES AND ONLY ONE PERSON IS FLAGGED AS COVERED |

| AT THE END OF THE PREVIOUS ROUND, AUTOMATICALLY |

| CODE OE41 AS ‘1’ (YES) AND GO TO BOX_31. |

| |

| IF YES AND MORE THAN ONE PERSON FLAGGED AS COVERED|

| AT THE END OF THE PREVIOUS ROUND, GO TO OE41. |

----------------------------------------------------

OE40

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did this health insurance through (ESTABLISHMENT)

end?

{IF INSURANCE ENDED AFTER 12/31/{YEAR}, BACK-UP TO OE39

AND SELECT ‘YES’.}

[Enter Month-2, Day-2, Year-4] .........

REF ................................... -7

DK .................................... -8

----------------------------------------------------

| DISPLAY ‘IF INSURANCE ENDED... SELECT ‘YES’.’ IF|

| ROUND 5. OTHERWISE, USE A NULL DISPLAY |

----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|

| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE40OV |

----------------------------------------------------

| IF ONLY ONE PERSON COVERED AT THE END OF THE |

| PREVIOUS ROUND, GO TO LOOP_14 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH OE41 |

----------------------------------------------------

OE40OV

======

Can you just tell me if (POLICYHOLDER) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1

PART OF THE MONTH ..................... 2

REF ................................... -7

DK .................................... -8

[Code One]

----------------------------------------------------

| IF ONLY ONE PERSON COVERED AT END OF PREVIOUS |

| ROUND, GO TO LOOP_14 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH OE41 |

----------------------------------------------------

OE41

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

During the last interview, we recorded that (READ NAMES BELOW)

(were/was) covered by (POLICYHOLDER)’s health insurance

through (ESTABLISHMENT).

{Are/Were} they all covered by this health insurance {until

{{OE40 DATE}/it ended}/on (END DATE)}?

TO SCROLL, USE ARROW KEYS.

TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.

{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}

YES ................................... 1

NO .................................... 2

REF ................................... -7

DK .................................... -8

----------------------------------------------------

| DISPLAY ‘Are’ IF OE39 IS CODED ‘1’ (YES). |

| DISPLAY ‘Were’ IF OE39 IS CODED ‘2’ (NO) OR IF |

| CURRENT ROUND IS ROUND 5. |

| |

| DISPLAY ‘until {OE40 DATE}’ IF OE39 IS CODED ‘2’ |

| (NO). |

| DISPLAY ‘on (END DATE)’ IF OE39 IS CODED ‘1’ |

| (YES). |

| |

| DISPLAY THE DATE RECORDED AT OE40 FOR ‘OE40 DATE’.|

| IF THE MONTH AND DAY FIELD AT OE40 IS CODED ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|

| FOR ‘OE40 DATE’. |

----------------------------------------------------

| IF OE39 IS CODED ‘1’ (YES) AND OE41 IS CODED ‘1’ |

| (YES), |

| |

| FLAG INSURANCE FOR ALL COVERED PERSONS AS |

| ‘CONTINUOUS COVERAGE’ THROUGH THE REFERENCE PERIOD|

| END DATE. |

----------------------------------------------------

| IF OE39 IS CODED ‘2’ (NO) AND OE41 IS CODED ‘1’ |

| (YES), |

| |

| FLAG INSURANCE FOR ALL COVERED PERSONS AS |

| ‘CONTINUOUS COVERAGE’ THROUGH THE DATE RECORDED |

| AT OE40. |

----------------------------------------------------

| IF OE41 IS CODED ‘1’ (YES) AND OE39 IS CODED ‘1’ |

| (YES) OR ‘2’ (NO), GO TO BOX_31 |

----------------------------------------------------

| OTHERWISE (I.E., OE41 CODED ‘2’ (NO), ‘-7’ |

| (REFUSED), OR ‘-8’ (DON’T KNOW)), CONTINUE |

| WITH OE42 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY COVERED PERSONS’ NAMES |

| (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS PERSONS ON THE RU-ESTB- |

| PLCYHLDR-COVRD-PERS-TRPLS-ROSTER FOR DISPLAY. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. SELECT, ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| 1. PERSON WAS COVERED AT THE PREVIOUS ROUND’S |

| INTERVIEW DATE BY THE INSURANCE FROM THIS |

| ESTABLISHMENT-PERSON-PAIR |

| AND |

| 2. PERSON IS AN RU MBMBER |

----------------------------------------------------

OE42

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Who {is/was} no longer covered by (POLICYHOLDER)’s health

insurance through (ESTABLISHMENT) {until {{OE40 DATE}/it ended}/on

(END DATE)}?

[1. First Name, [Middle Name], Last Name-65]

[2. First Name, [Middle Name], Last Name-65]

[3. First Name, [Middle Name], Last Name-65]

----------------------------------------------------

| DISPLAY ‘is’ IF OE39 IS CODED ‘1’ (YES). |

| DISPLAY ‘was’ IF OE39 IS CODED ‘2’ (NO) OR IF |

| CURRENT ROUND IS ROUND 5. |

| |

| DISPLAY ‘until {OE40 DATE}’ IF OE39 IS CODED ‘2’ |

| (NO). |

| DISPLAY ‘on (END DATE)’ IF OE39 IS CODED ‘1’ |

| (YES). |

| |

| DISPLAY THE DATE RECORDED AT OE40 FOR ‘OE40 DATE’.|

| IF THE MONTH AND DAY FIELD AT OE40 IS CODED ‘-7’ |

| (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’|

| FOR ‘OE40 DATE’. |

----------------------------------------------------

| IF FAMILY STILL HAS INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED ‘1’ |

| (YES)), FLAG INSURANCE FOR ALL PERSONS NOT |

| SELECTED AT OE42 AS ‘CONTINUOUS COVERAGE’ FROM THE|

| REFERENCE PERIOD START DATE UNTIL THE REFERENCE |

| PERIOD END DATE. |

----------------------------------------------------

| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |

| THIS ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED ‘2’ |

| (NO), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED |

| AT OE42 AS ‘CONTINUOUS COVERAGE’ FROM THE |

| REFERENCE PERIOD START DATE UNTIL DATE RECORDED |

| AT OE40. |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY COVERED PERSONS’ NAMES |

| (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER FOR SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| 1. PERSON WAS COVERED AT PREVIOUS ROUND’S |

| INTERVIEW DATE BY THE INSURANCE FROM THIS |

| ESTABLISHMENT-PERSON-PAIR |

| AND |

| 2. PERSON IS AN RU MBMBER |

----------------------------------------------------

LOOP_14

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER, ASK OE43 - END_LP14. |

----------------------------------------------------

| LOOP DEFINITION: LOOP_14 COLLECTS THE DATE ON |

| WHICH THE INSURANCE COVERAGE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER|

| WHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCE|

| PERIOD END DATE OR THE DATE REPORTED IN OE40. |

| THIS LOOP CYCLES ON PERSONS SELECTED AT OE42. |

----------------------------------------------------

OE43

====

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did the health insurance through (ESTABLISHMENT)

end for (PERSON)?

[Enter Month-2, Day-2, Year-4] .........

REF ................................... -7

DK .................................... -8

----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|

| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE43OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_30 |

----------------------------------------------------

OE43OV

======

Can you just tell me if (PERSON) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 {BOX_30}

PART OF THE MONTH ..................... 2 {BOX_30}

REF ................................... -7 {BOX_30}

DK .................................... -8 {BOX_30}

[Code One]

BOX_30

======

----------------------------------------------------

| FLAG INSURANCE FOR PERSON AS ‘CONTINUOUS COVERAGE’|

| THROUGH THE COMPLETE DATE RECORDED AT OE43 AND |

| OE43OV. |

----------------------------------------------------

END_LP14

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- |

| COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS |

| STATED IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_14 AND CONTINUE WITH BOX_31 |

----------------------------------------------------

BOX_31

======

----------------------------------------------------

| IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY |

| THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,|

| (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU |

| MEMBERS NOT COVERED BY THIS INSURANCE ON THE |

| PREVIOUS ROUND’S INTERVIEW DATE, BUT EXCLUDES RU |

| MEMBERS JUST MARKED AS NO LONGER COVERED IN OE42),|

| CONTINUE WITH OE44 |

----------------------------------------------------

| OTHERWISE, GO TO OE47 |

----------------------------------------------------

OE44

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{Since (START DATE)/Between (START DATE) and (END DATE)}, have

any persons living here, we have not yet mentioned, been covered

by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?

YES ................................... 1 {OE45}

NO .................................... 2 {OE47}

REF ................................... -7 {OE47}

DK .................................... -8 {OE47}

HELP AVAILABLE FOR DEFINITION OF DEPENDENT.

----------------------------------------------------

| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |

| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |

| ROUND 5. |

----------------------------------------------------

OE45

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Who {has been/was} covered by (POLICYHOLDER)’s health insurance

through (ESTABLISHMENT) {since (START DATE)/between (START DATE)

and (END DATE)} that we have not yet mentioned?

PROBE: Anyone else?

[1. First Name, [Middle Name], Last Name-65]

[2. First Name, [Middle Name], Last Name-65]

[3. First Name, [Middle Name], Last Name-65]

----------------------------------------------------

| DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT|

| ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) |

| and (END DATE)’ IF ROUND 5. |

----------------------------------------------------

| WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- |

| COVRD-PERS-TRPLS-ROSTER. |

----------------------------------------------------

| IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG |

| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |

| AS ‘COVERING PERSON NOT LISTED IN RU’. |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION|

| OF RU-MEMBERS. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY |

| SELECT ONE OR MORE FROM THE LISTED MEMBERS. |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

| 3. DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY|

| ON THIS ROSTER. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY PERSONS WHO WERE NOT COVERED BY THE |

| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |

| ON THE PREVIOUS ROUND’S INTERVIEW DATE. |

----------------------------------------------------

LOOP_15

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER, ASK OE46 - END_LP15. |

----------------------------------------------------

| LOOP DEFINITION: LOOP_15 COLLECTS THE COVERAGE |

| START DATE FOR ALL PERSONS NEWLY COVERED DURING |

| THE CURRENT ROUND BY THE INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON |

| PERSONS SELECTED AT OE45. |

----------------------------------------------------

OE46

====

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

On what date did the health insurance through (ESTABLISHMENT)

begin for (PERSON)?

[Enter Month-2, Day-2, Year-4] .........

REF ................................... -7

DK .................................... -8

----------------------------------------------------

| IF DAY FIELD IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T|

| KNOW) AND MONTH FIELD IS NOT CODED ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW), CONTINUE WITH OE46OV |

----------------------------------------------------

| OTHERWISE, GO TO BOX_32 |

----------------------------------------------------

OE46OV

======

Can you just tell me if (PERSON) was covered under that

insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 {BOX_32}

PART OF THE MONTH ..................... 2 {BOX_32}

REF ................................... -7 {BOX_32}

DK .................................... -8 {BOX_32}

[Code One]

----------------------------------------------------

| HARD CHECK: |

| EDIT: COMPLETE DATE AT OE46 MUST BE < THAN |

| COMPLETE DATE AT OE40 IF A DATE IS RECORDED AT |

| OE40 OR < THAN REFERENCE PERIOD END DATE IF NO |

| DATE IS RECORDED AT OE40. |

----------------------------------------------------

BOX_32

======

----------------------------------------------------

| IF FAMILY STILL HAS INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED ‘1’ |

| (YES)), FLAG INSURANCE FOR THIS PERSON AS |

| ‘CONTINUOUS COVERAGE’ FROM DATE RECORDED AT OE46 |

| UNTIL THE REFERENCE PERIOD END DATE. |

----------------------------------------------------

| IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH |

| ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED ‘2’ (NO))|

| FLAG INSURANCE FOR THIS PERSON AS ‘CONTINUOUS |

| COVERAGE’ FROM DATE RECORDED AT OE46 UNTIL DATE |

| RECORDED AT OE40. |

----------------------------------------------------

END_LP15

========

----------------------------------------------------

| CYCLE ON NEXT PERSON IN RU-ESTB-PLCYHLDR-COVRD- |

| PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS STATED |

| IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_15 AND GO TO END_LP13 |

----------------------------------------------------

OE47

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{Does/Between (START DATE) and (END DATE), did} (POLICYHOLDER)’s

health coverage through (ESTABLISHMENT) cover as dependents any

persons who do not live here?

YES .................................... 1 {END_LP13}

NO ..................................... 2 {END_LP13}

REF ................................... -7 {END_LP13}

DK .................................... -8 {END_LP13}

HELP AVAILABLE FOR DEFINITION OF DEPENDENT.

----------------------------------------------------

| DISPLAY ‘Does’ IF NOT ROUND 5. DISPLAY ‘Between |

| (START DATE) and (END DATE), did’ IF ROUND 5. |

----------------------------------------------------

| IF CODED ‘1’ (YES), FLAG INSURANCE THROUGH THIS |

| ESTABLISHMENT-PERSON-PAIR AS ‘COVERING PERSON NOT |

| LISTED IN RU’ IN OE45 |

----------------------------------------------------

END_LP13

========

----------------------------------------------------

| CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-|

| PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN |

| THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END |

| LOOP_13 AND CONTINUE WITH BOX_33 |

----------------------------------------------------

BOX_33

======

----------------------------------------------------

| RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN HX. |

----------------------------------------------------

28-271

File Type	application/msword
File Title	MEPS Old Employment and Private Related Insurance - P12R5/P13R3/P14R1
Subject	OE Section Item Specifications
Author	Agency for Healthcare Research and Quality
Last Modified By	wcarroll
File Modified	2009-07-09
File Created	2009-07-09