MEPS-HC Core Interview

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

Attachment 57 -- HC Private Health Insurance Detail 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⚠️ Notice: This form may be outdated.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 Private Health Insurance Detail (HP) Section

December 8, 2008

Private Health Insurance Detail (HP) Section

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

| NOTE: THROUGHOUT THIS SECTION IN CAPI, FOR |

| ‘CATEGORY NAME FROM HX03 OR HX23’, DISPLAY THE |

| FOLLOWING: |

| |

| - ‘PROFESSIONAL ASSOCIATION’ IF CODED ‘1’ AT HX03 |

| - ‘SMALL BUSINESS GROUP’ IF CODED ‘2’ AT HX03 |

| - ‘UNION’ IF CODED ‘3’ AT HX03 |

| - ‘INSURANCE AGENT’ IF CODED ‘5’ AT HX03 |

| - ‘INSURANCE COMPANY’ IF CODED ‘6’ AT HX03 |

| - ‘HMO’ IF CODED ‘7’ AT HX03 |

| - ‘PREVIOUS EMPLOYER’ IF CODED ‘8’ AT HX03 |

| - ‘PREVIOUS EMPLOYER (COBRA)’ IF CODED ‘9’ AT HX03|

| - THE TEXT ENTERED AT HX03OV IF CODED ‘91’ AT HX03|

| - ‘SOURCE THE INSURANCE WAS PURCHASED FROM FOR |

| THAT BUSINESS’ IF CODED ‘-7’ OR ‘-8’ AT HX03 |

| |

| - ‘GROUP OR ASSOCIATION’ IF CODED ‘1’ AT HX23 |

| - ‘SCHOOL’ IF CODED ‘3’ AT HX23 |

| - ‘INSURANCE AGENT’ IF CODED ‘4’ AT HX23 |

| - ‘INSURANCE COMPANY’ IF CODED ‘5’ AT HX23 |

| - ‘HMO’ IF CODED ‘6’ AT HX23 |

| - ‘UNION’ IF CODED ‘7’ AT HX23 |

| - ‘ANYONE’S PREVIOUS EMPLOYER (COBRA)’ IF CODED |

| ‘8’ AT HX23 |

| - ‘ANYONE’S PREVIOUS EMPLOYER (NOT COBRA)’ IF |

| CODED ‘9’ AT HX23 |

| - ‘SPOUSE’S/DECEASED SPOUSE’S PREVIOUS EMPLOYER’ |

| IF CODED ‘10’ AT HX23 |

| - ‘SOME OTHER EMPLOYER’ IF CODED ‘11’ AT HX23 |

| - ‘PLAN OF SOMEONE NOT LIVING HERE’ IF CODED ‘12’ |

| AT HX23 |

| - THE TEXT ENTERED AT HX23OV IF CODED ‘91’ AT HX23|

| - ‘SOURCE THAT PROVIDED THE DIRECTLY PURCHASED |

| INSURANCE’ IF CODED ‘-7’ OR ‘-8’ |

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

| THROUGHOUT THE SPECIFICATIONS FOR THIS CAPI |

| SECTION, FOR SCREENS THAT SPECIFY THE REFERENCE |

| PERIOD {END DATE} AS PART OF THE CONTEXT HEADER, |

| CAPI DISPLAYS THE {END DATE} ONLY FOR ROUND 5. IN |

| ANY OTHER ROUND, CAPI DOES NOT DISPLAY THE {END |

| DATE} IN THE CONTEXT HEADER. FOR MOST PERSONS, |

| THE END DATE FOR ROUND 5 WILL BE DECEMBER 31 OF |

| THE SECOND YEAR OF THE PANEL. |

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

| NOTE THAT ‘HEALTH INSURANCE PURCHASING ALLIANCE’ |

| (CODE ‘4’ AT HX03 AND CODE ‘2’ AT HX23) WAS |

| OMITTED IN PANEL 12 ROUND 2 AND WILL BE OMITTED IN|

| ALL FUTURE ROUNDS. |

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

| NOTE THAT ESTABLISHMENT ADDRESS INFORMATION AND |

| THE INFORMED CONSENT SCREENS WERE OMITTED STARTING|

| IN PANEL 12 ROUND 3. THIS INFORMATION WAS |

| IN PANEL 12 ROUNDS 1 AND 2. |

| |

| STARTING IN PANEL 13 THESE ITEMS WILL BE OMITTED |

| IN ALL ROUNDS. |

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

BOX_00

======

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

| CONTEXT HEADER DISPLAY INSTRUCTIONS: |

| DISPLAY PERS.FULLNAME, ESTB.ESTBNAME, |

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

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

| ‘INSURANCE SOURCE’. |

| |

| FOR ‘INSURANCE SOURCE’, DISPLAY THE CATEGORY TEXT |

| FROM HX23. IF HX23=91, DISPLAY THE OTHER SPECIFY |

| TEXT. |

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

BOX_01

======

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

| IF LOOPING ON ANY ESTABLISHMENT FLAGGED IN THE |

| EMPLOYMENT (EM) SECTION AS 'PROVIDES HEALTH |

| INSURANCE' AND NOT FLAGGED AS ‘SELF-EMPLOYED’ |

| WITH A FIRM-SIZE-1, GO TO LOOP_01 |

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

| IF LOOPING ON AN HX03 CATEGORY OR IF LOOPING ON |

| AN HX23 CATEGORY (EXCEPT CODE ‘3’ (DIRECTLY FROM |

| A SCHOOL)), GO TO HP03 |

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

| IF LOOPING ON CODE '3' (DIRECTLY FROM A SCHOOL) |

| AT HX23, CONTINUE WITH HP01 |

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

HP01

====

Does the insurance from the school cover only injuries caused

by accidents, or does it have general health coverage?

GENERAL HEALTH COVERAGE ................ 1 {HP02}

ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 {BOX_11}

REF ................................... -7 {HP02}

DK .................................... -8 {HP02}

HELP AVAILABLE FOR DEFINITION OF GENERAL HEALTH COVERAGE.

[Code One]

HP02

====

Would the insurance from the school cover health services

outside of a school clinic?

YES .................................... 1 {HP03}

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

REF ................................... -7 {HP03}

DK .................................... -8 {HP03}

HP03

====

INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}

I'd like to talk about the insurance which is from (a/an)

{CATEGORY NAME FROM HX03 OR HX23}.

SELECT ‘CONTINUE’ UNLESS RESPONDENT VOLUNTEERS INSURANCE

REPORTED IN ERROR.

CONTINUE ............................... 1 {LOOP_01}

INSURANCE REPORTED IN ERROR ............ 2 {BOX_11}

[Code One]

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

| FOR ‘CATEGORY NAME FROM HX03 OR HX23’ DISPLAY THE |

| CATEGORY TEXT FROM HX03 OR HX23. SEE NOTE BOX AT |

| BEGINNING OR HP SECTION FOR DETAILS. |

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

| IF CODED '2' (INSURANCE REPORTED IN ERROR), FLAG |

| ITEM FOR SOURCE CLEAN-UP. |

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

LOOP_01

=======

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

| For each of the following: |

| |

| ESTABLISHMENT 1 |

| ESTABLISHMENT 2 |

| ESTABLISHMENT 3 |

| ESTABLISHMENT 4 |

| |

| ask BOX_01A-END_LP01 |

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

| LOOP DEFINITION: LOOP-01 COLLECTS DETAILED |

| INFORMATION ABOUT INSURANCE PROVIDED THROUGH AN |

| EMPLOYER OR THE ESTABLISHMENT NAMES OF THE |

| INSURANCE SOURCE COLLECTED IN EITHER HX03 OR HX23.|

| IF LOOPING ON INSURANCE PROVIDED FROM AN EMPLOYER |

| ONLY ONE LOOP CYCLE IS COMPLETED. |

| |

| IF LOOPING ON INSURANCE PROVIDED THROUGH AN |

| INSURANCE SOURCE COLLECTED IN HX03 OR HX23, THE |

| FIRST LOOP CYCLE COLLECTS THE MAIN ESTABLISHMENT |

| NAME OF THE INSURANCE SOURCE. SUBSEQUENT CYCLES, |

| IF ANY, ARE DETERMINED BY THE RESPONSE TO HP18. |

| IF HP18 IS CODED '1' (YES), THE LOOP CYCLES AGAIN |

| TO COLLECT THE NEXT ESTABLISHMENT NAME. IF HP18 |

| IS NOT ASKED OR IS CODED '2' (NO), '-7' (REFUSED),|

| OR '-8' (DON'T KNOW), THE LOOP ENDS. |

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

BOX_01A

=======

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

| IF LOOPING ON ANY ESTABLISHMENT FLAGGED IN |

| EMPLOYMENT AS 'PROVIDES HEALTH INSURANCE' AND NOT |

| FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE-1, |

| GO TO HP09 |

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

| OTHERWISE, CONTINUE WITH HP04 |

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

HP04A

=====

OMITTED.

HP04

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

Please give me the name of one of the {CATEGORY NAME FROM HX03

OR HX23} {from which anyone in the family purchased this

insurance/which covers anyone in the family/insurance companies

for the insurance purchased from an agent}.

INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT

(ESTABLISHMENT) BELOW:

|--------------------------|

| ROSTER. ESTABLISHMENT |

|--------------------------|

| 1. Establishment Name-30 |

| |

|--------------------------|

| 2. Establishment Name-30 |

| |

|--------------------------|

| 3. Establishment Name-30 |

| |

|--------------------------|

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

| DISPLAY ‘(CATEGORY NAME FROM HX03 OR HX23)’ IF |

| NOT LOOPING ON CODE ‘5’ (INSURANCE AGENT) AT HX03 |

| OR CODE ‘4’ (INSURANCE AGENT) AT HX23. |

| |

| DISPLAY ‘from which anyone in the family purchased|

| this insurance’ IF NOT LOOPING ON CODE ‘5’ |

| (INSURANCE AGENT) AT HX03 OR CODES ‘4’ (INSURANCE |

| AGENT) OR ‘12’ (UNDER PLAN OF SOMEONE NOT LIVING |

| HERE) AT HX23. |

| |

| DISPLAY ‘which covers anyone in the family’ IF |

| LOOPING ON CODE ‘12’ (UNDER PLAN OF SOMEONE NOT |

| LIVING HERE) AT HX23. |

| |

| DISPLAY ‘insurance company for the insurance |

| purchased from an agent’ if looping on CODE ‘5’ |

| (INSURANCE AGENT) AT HX03 OR code ‘4’ (INSURANCE |

| AGENT) AT HX23. |

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

| FOR ‘CATEGORY NAME FROM HX03 OR HX23’ DISPLAY THE |

| CATEGORY TEXT FROM HX03 OR HX23. SEE NOTE BOX AT |

| BEGINNING OF HP SECTION FOR DETAILS. |

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

| THE CONTEXT HEADER DISPLAYED ON SCREENS |

| HP04 - HP08 DEPENDS ON THE PATH THAT LEADS TO |

| THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON |

| (I.E., JOBHOLDER WHEN COMING FROM AN HX03 |

| CATEGORY), CAPI DISPLAYS THE PERSON AND START |

| DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, |

| CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. |

| OTHERWISE, CAPI DISPLAYS THE START DATE. FOR |

| ROUND 5, CAPI ALSO DISPLAYS THE END DATE OF THE |

| REFERENCE PERIOD. |

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

| DISPLAY AN “ADD ESTABLISHMENT” OPTION ON THIS |

| SCREEN. |

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

| IF ‘ADD ESTABLISHMENT’ OPTION IS SELECTED, |

| CONTINUE WITH BOX_01B |

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

| OTHERWISE (ESTABLISHMENT WAS SELECTED FROM THE |

| LIST), GO TO BOX_02 |

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

| ROSTER DETAILS: |

| TITLE: RU_ESTB_3 |

| |

| COL # 1 HEADER: ESTABLISHMENT |

| INSTRUCTIONS: DISPLAY ESTABLISHMENT NAME |

| (ESTB.ESTBNAME) |

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

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-ESTABLISHMENTS-ROSTERS FOR |

| DISPLAY OF PRIVATE INSURANCE ESTABLISHMENTS. |

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

| ROSTER BEHAVIOR: |

| 1. SELECT ALLOWED. |

| |

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

| DISALLOWED. |

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

| ROSTER FILTER: |

| DISPLAY ESTABLISHMENTS THAT ARE SOURCES OF PRIVATE|

| INSURANCE. THIS DOES NOT INCLUDE ESTABLISHMENTS |

| FLAGGED AS ‘EMPLOYER’ AND ‘SELF-EMPLOYED’ WITH A |

| FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES. |

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

BOX_01B

=======

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

| IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT|

| LIVING HERE) AT HX23 AND IF 'ADD ESTABLISHMENT' |

| IS SELECTED, GO TO HP07. (NOTE THAT HP07 IS NOT A |

| SEPARATE SCREEN; IT REPRESENTS A POPUP ON HP04.) |

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

| IF 'ADD ESTABLISHMENT' IS SELECTED AND IF NOT |

| LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT |

| LIVING HERE) AT HX23, CONTINUE WITH HP06 (NOTE |

| THAT HP06 IS NOT A SEPARATE SCREEN; IT REPRESENTS |

| A POPUP ON HP04.) |

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

HP05

====

OMITTED.

HP06

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}

ENTER NAME OF ESTABLISHMENT WHERE PERSON PURCHASED

INSURANCE.

{ESTABLISHMENT: [_____________] {BOX_02}

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

| WRITE ESTABLISHMENT TO THE RU-Establishments- |

| ROSTER. |

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

HP07

====

{STR-DT}

{END-DT}

You mentioned that someone in the family receives health

insurance from the plan of someone not living here. How

does that policyholder get this insurance?

INTERVIEWER: RECORD ESTABLISHMENT NAME BELOW.

[Establishment Name] .................. {BOX_02}

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

| ONLY CATEGORY ‘12’ (UNDER PLAN OF SOMEONE NOT |

| LIVING HERE) OF HX23 IS ASKED HP07. |

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

| WRITE ESTABLISHMENT TO THE RU-Establishments- |

| ROSTER. |

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

HP08

====

OMITTED.

BOX_02

======

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

| IF HX03 IS CODED '1' OR '2' FLAG ESTABLISHMENT AS |

| 'GROUP'. |

| IF HX03 IS CODED '3', FLAG ESTABLISHMENT AS |

| 'UNION'. |

| IF HX03 IS CODED '5', FLAG ESTABLISHMENT AS |

| 'INSURANCE COMPANY-FROM AN AGENT'. |

| IF HX03 IS CODED '6', FLAG ESTABLISHMENT AS |

| 'INSURANCE COMPANY'. |

| IF HX03 IS CODED '7', FLAG ESTABLISHMENT AS 'HMO'.|

| IF HX03 IS CODED '8', FLAG ESTABLISHMENT AS |

| 'PREVIOUS EMPLOYER, NOT COBRA'. |

| IF HX03 IS CODED '9', FLAG ESTABLISHMENT AS |

| 'COBRA'. |

| IF HX03 IS CODED '91', FLAG ESTABLISHMENT AS |

| 'UNKNOWN TYPE-COLLECTED AT OTHER'. |

| |

| IF HX23 IS CODED '1', FLAG ESTABLISHMENT AS |

| 'GROUP'. |

| IF HX23 IS CODED '3', FLAG ESTABLISHMENT AS |

| 'SCHOOL'. |

| IF HX23 IS CODED '4', FLAG ESTABLISHMENT AS |

| 'INSURANCE COMPANY-FROM AN AGENT’. |

| IF HX23 IS CODED '5', FLAG ESTABLISHMENT AS |

| 'INSURANCE COMPANY'. |

| IF HX23 IS CODED '6', FLAG ESTABLISHMENT AS |

| 'HMO'. |

| IF HX23 IS CODED '7', FLAG ESTABLISHMENT AS |

| 'UNION'. |

| IF HX23 IS CODED '8', FLAG ESTABLISHMENT AS |

| 'COBRA'. |

| IF HX23 IS CODED '9', FLAG ESTABLISHMENT AS |

| 'PREVIOUS EMPLOYER, NOT COBRA'. |

| IF HX23 IS CODED '10', FLAG ESTABLISHMENT AS |

| 'SPOUSE PREVIOUS EMPLOYER'. |

| IF HX23 IS CODED '11', FLAG ESTABLISHMENT AS |

| 'EMPLOYER'. |

| IF HX23 IS CODED '12', FLAG ESTABLISHMENT AS |

| 'UNKNOWN TYPE-OUTSIDE RU'. |

| IF HX23 IS CODED ‘91’, FLAG ESTABLISHMENT AS |

| ‘UNKNOWN TYPE - COLLECTED AT OTHER’. |

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

| NOTE THAT ‘HEALTH INSURANCE PURCHASING ALLIANCE’ |

| (CODE ‘4’ AT HX03 AND CODE ‘2’ AT HX23) WAS |

| OMITTED IN PANEL 12 ROUND 2 AND WILL BE OMITTED IN|

| ALL FUTURE ROUNDS. |

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

BOX_03

======

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

| IF LOOPING ON AN HX23 CATEGORY, GO TO HP11 |

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

| OTHERWISE, CONTINUE WITH HP09 |

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

HP09

====

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

ESTABLISHMENT} {STR-DT}

{END-DT}

{(Are/Is)/As of (END DATE), was} (PERSON) the primary insured

person or policyholder of this health coverage through

(ESTABLISHMENT)?

YES .................................... 1 {LOOP_02}

NO ..................................... 2 {HP10}

REF ................................... -7 {HP10}

DK .................................... -8 {HP10}

HELP AVAILABLE FOR DEFINITION OF POLICYHOLDER.

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

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

| (END DATE), was’ IF ROUND 5. |

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

| PERSON REFERS TO JOBHOLDER. |

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

| IF CODED '1' (YES), FLAG JOBHOLDER AS |

| 'POLICYHOLDER'. |

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

HP10

====

{NAME OF ESTABLISHMENT} {STR-DT}

{END-DT}

Who {is/was} the primary insured person or policyholder of this

health coverage through (ESTABLISHMENT) {on (END DATE)}?

{JOBHOLDER/EMPLOYER-PAIR 1}

{JOBHOLDER/EMPLOYER-PAIR 2}

{JOBHOLDER/EMPLOYER-PAIR 3}

JOBHOLDER/EMPLOYER IS LISTED ........... 1 {END_LP01}

JOBHOLDER/EMPLOYER IS NOT LISTED ....... 2 {END_LP01}

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

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

HELP AVAILABLE FOR DEFINITION OF POLICYHOLDER.

[Code One]

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

| DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF |

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

| OTHERWISE, USE NULL DISPLAY. |

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

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

| KNOW), FLAG FOR EVENT CLEANUP. |

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

| ROSTER DETAILS: |

| TITLE: RU_ESTB_PERS_PAIRS_2 |

| |

| COL # 1 HEADER: JOBHOLDER/EMPLOYER PAIR |

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

| AND LAST NAME/ESTABLISHMENT NAME (PERS.FULLNAME/ |

| ESTB.ESTBNAME) |

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

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- |

| ROSTER FOR DISPLAY OF EMPLOYER/JOBHOLDER PAIRS. |

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

| ROSTER BEHAVIOR: |

| 1. DISPLAY ONLY. |

| |

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

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

| ROSTER FILTER: |

| DISPLAY ALL PAIRS ON THE RU-ESTABLISHMENT-PERSON- |

| PAIRS-ROSTER THAT MEET BOTH OF THE FOLLOWING |

| CONDITIONS: |

| |

| 1. ESTABLISHMENT IS FLAGGED AS AN 'EMPLOYER' THAT |

| IS ALSO FLAGGED AS ‘PROVIDES HEALTH INSURANCE’ |

| AND |

| |

| 2. PERSON IS A JOBHOLDER AT THE JOB PROVIDED BY |

| ESTABLISHMENT |

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

HP11

====

{NAME OF ESTABLISHMENT} {STR-DT}

{END-DT}

Who {is/was} the primary insured person or policyholder of this

health coverage through (ESTABLISHMENT) {on (END DATE)}?

[1. First Name,[Middle Name],Last Name-35] ..

[2. First Name,[Middle Name],Last Name-35] ..

[3. First Name,[Middle Name],Last Name-35] ..

HELP AVAILABLE FOR DEFINITION OF POLICYHOLDER.

[Code All that Apply]

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

| DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF |

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

| OTHERWISE, USE NULL DISPLAY. DISPLAY A |

| “POLICYHOLDER NOT LISTED IN DU” AND “POLICYHOLDER |

| DECEASED” OPTION ON THIS SCREEN. |

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

| IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND |

| 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO |

| LOOP_02 |

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

| IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN |

| COMBINATION WITH OTHER NAMES EXCEPT 'POLICYHOLDER |

| NOT LISTED IN DU’, GO TO HP11B |

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

| IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE|

| OR IN COMBINATION WITH OTHER NAMES AND/OR |

| ‘POLICYHOLDER DECEASED’, CONTINUE WITH HP11A |

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

| ROSTER DETAILS: |

| TITLE: DU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

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

| AND LAST NAMES (PERS.FULLNAME) |

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

| ROSTER DEFINITION: THIS ITEM DISPLAYS DU-MEMBERS- |

| ROSTER FOR SELECTION. |

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

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| |

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

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

| ROSTER FILTER: |

| NO FILTER; DISPLAY ALL DU MEMBERS. |

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

HP11A

=====

{NAME OF ESTABLISHMENT} {STR-DT}

{END-DT}

INTERVIEWER: ENTER NAME OR DESCRIPTION OF POLICYHOLDER WHO

IS NOT IN THE DU:

[Enter Specify-15] .................... {LOOP_02}

HELP AVAILABLE FOR DEFINITION OF POLICYHOLDER.

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

| whenever this policyholder is being asked ABOUT |

| IN THE REMAINDER OF HP, HQ, HX, AND OE, THE |

| POLICYHOLDER NAME IN THE CONTEXT HEADER WILL BE |

| DISPLAYED AS ‘PLCYHLDR NOT IN DU-’ FOLLOWED BY |

| THE 15 CHARACTER ENTRY AT HP11A. |

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

| IF 'POLICYHOLDER DECEASED' SELECTED AT HP11, |

| CONTINUE WITH HP11B |

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

| OTHERWISE, GO TO LOOP_02 |

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

HP11B

=====

{NAME OF ESTABLISHMENT} {STR-DT}

{END-DT}

INTERVIEWER: ENTER NAME OF DECEASED POLICYHOLDER:

[Enter Specify-40] .................... {LOOP_02}

HELP AVAILABLE FOR DEFINITION OF POLICYHOLDER.

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

| FLAG POLICYHOLDER AS ‘DECEASED’. |

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

| WHENEVER THE POLICYHOLDER IS BEING ASKED ABOUT |

| IN THE REMAINDER OF HP, HQ, HX, AND OE, THE |

| POLICYHOLDER NAME IN THE CONTEXT HEADER WILL BE |

| DISPLAYED AS ‘PLCYHLDR DECEASED-’ FOLLOWED BY THE |

| FIRST 15 CHARACTERS OF THE ENTRY AT HP11B. |

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

LOOP_02

=======

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

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

| PAIRS-ROSTER, ASK BOX_04 - END_LP02 |

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

| LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION |

| ABOUT THE POLICYHOLDER AND DEPENDENTS FOR EACH |

| ESTABLISHMENT-PERSON. THIS LOOP CYCLES ON EACH |

| ESTABLISHMENT-PERSON-PAIR CREATED AT HP09 AND HP11|

| DURING THE CURRENT ROUND FOR THE ESTABLISHMENT |

| BEING CYCLED ON IN LOOP_01. |

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

BOX_04

======

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

| IF LOOPING ON AN ESTABLISHMENT FLAGGED IN |

| EMPLOYMENT AS ‘PROVIDES HEALTH INSURANCE’, GO TO |

| BOX_07 |

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

| OTHERWISE, CONTINUE WITH BOX_05 |

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

BOX_05

======

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

| IF HX23 IS CODED ‘8’ (PREVIOUS EMPLOYER-COBRA), |

| ‘9’ (PREVIOUS EMPLOYER-NOT COBRA), ‘10’ (SPOUSE |

| PREVIOUS EMPLOYER), OR ‘11’ (OTHER EMPLOYER) |

| CONTINUE WITH BOX_06 |

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

| OTHERWISE, GO TO BOX_07 |

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

BOX_06

======

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

| IF POLICYHOLDER WAS FLAGGED AT HP11 AS 'DECEASED',|

| CODE HP12 AS '4' (DECEASED) AUTOMATICALLY BY CAPI |

| AND GO TO HP13 |

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

| IF POLICYHOLDER IS NOT A CURRENT RU MEMBER, GO TO |

| BOX_07 |

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

| OTHERWISE, CONTINUE WITH HP12 |

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

HP12

====

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

(Are/Is) (POLICYHOLDER) currently employed at this job,

retired from this job, previously employed at this job, or is

it some other situation?

CURRENTLY EMPLOYED ..................... 1 {HP13}

RETIRED ................................ 2 {HP13}

PREVIOUSLY EMPLOYED .................... 3 {HP13}

DECEASED ............................... 4 {HP13}

OTHER ................................. 91 {HP12OV}

REF ................................... -7 {HP13}

DK .................................... -8 {HP13}

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

[Code One]

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

| IF CODED '4' (DECEASED), FLAG POLICYHOLDER AS |

| 'DECEASED'. |

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

| HARD CHECK: |

| CODE ‘4’ (DECEASED) CANNOT BE SELECTED FOR A |

| POLICYHOLDER WHO IS A CURRENT RU MEMBER. |

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

HP12OV

======

OTHER:

[Enter Other Specify] .................. {HP13}

REF ................................... -7 {HP13}

DK .................................... -8 {HP13}

HP13

====

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

{(Are/Is)/(Were/Was)} (POLICYHOLDER) a federal government

employee at this job?

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

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

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

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

HELP AVAILABLE FOR DEFINITION OF FEDERAL GOVERNMENT.

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

| DISPLAY '(Are/Is)' IF HP12 IS CODED ‘1’ (CURRENTLY|

| EMPLOYED). OTHERWISE, DISPLAY '(Were/Was)'. |

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

BOX_07

======

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

| IF ESTABLISHMENT THAT PROVIDES INSURANCE IS |

| FLAGGED AS: |

| |

| 'EMPLOYER' AND JOB SUBTYPE IS NOT 'CURRENT MAIN', |

| 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE |

| PERIOD', OR 'RETIREMENT JOB' |

| OR |

| 'EMPLOYER' AND [JOB SUBTYPE IS 'FORMER MAIN', |

| 'FORMER MISCELLANEOUS' OR 'LAST JOB OUTSIDE |

| REFERENCE PERIOD'] AND JOB IS ALSO FLAGGED AS |

| 'NOT RETIRED FROM’ |

| OR |

| ‘PREVIOUS EMPLOYER, NOT COBRA’ (I.E., HX03-CODE |

| ‘8’; HX23-CODE ‘9’) |

| OR |

| ‘EMPLOYER’ (I.E., HX23-CODE ‘11’) AND HP12 IS NOT |

| CODED ‘1’ (CURRENTLY EMPLOYED) |

| OR |

| ‘SPOUSE PREVIOUS EMPLOYER’ (I.E., HX23-CODE ‘10’) |

| OR |

| ‘UNKNOWN TYPE-OUTSIDE RU’ (I.E., HX23-CODE ‘12’) |

| OR |

| ‘UNKNOWN TYPE-COLLECTED AT OTHER’ (I.E., HX23- |

| CODE ‘91’), |

| |

| CONTINUE WITH HP14 |

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

| OTHERWISE, GO TO HP15 |

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

HP14

====

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

Some employer insurance can be continued after leaving the

company by continuing to pay the premium. This is sometimes

referred to as a COBRA plan.

{Is/Was} (POLICYHOLDER)’s (ESTABLISHMENT) insurance like that

{on (END DATE)}?

YES .................................... 1 {HP15}

NO ..................................... 2 {HP15}

REF ................................... -7 {HP15}

DK .................................... -8 {HP15}

HELP AVAILABLE FOR DEFINITION OF COBRA.

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

| DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF |

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

| OTHERWISE, USE NULL DISPLAY. |

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

HP15

====

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

Was anyone {living here} covered as a dependent under

(POLICYHOLDER)'s health coverage through (ESTABLISHMENT)

at any time {since (START DATE)/between (START DATE) and

(END DATE)}?

YES .................................... 1 {HP16}

NO ..................................... 2 {HP17}

REF ................................... -7 {HP17}

DK .................................... -8 {HP17}

HELP AVAILABLE FOR DEFINITION OF DEPENDENT.

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

| DISPLAY 'living here' IF LOOPING ON CODE ‘12’ |

| (OUTSIDE RU) AT HX23. |

| |

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

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

| ROUND 5. |

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

HP16

====

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DATE}

Who is that?

PROBE: Was anyone else covered as a dependent {since

(START DATE)/between (START DATE) and (END DATE)}?

[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 All That Apply]

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

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

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

| ROUND 5. |

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

| IF 'PERSON NOT LISTED IN RU' IS SELECTED, FLAG |

| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR |

| AS 'COVERING PERSON NOT LISTED IN RU'. |

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

| GO TO BOX_08 |

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

| 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. |

| |

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

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

| ROSTER FILTER: |

| DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER |

| EXCLUDING THE PERSON WHO IS THE POLICYHOLDER FOR |

| THIS INSURANCE; THAT IS, DO NOT DISPLAY THE NAME |

| OF PERSON IN THE ESTABLISHMENT-PERSON-PAIR BEING |

| ASKED ABOUT. |

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

| DISPLAY 'PERSON NOT LISTED IN RU' AS LAST ITEM ON |

| ROSTER. |

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

HP17

====

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

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

health coverage through (ESTABLISHMENT) cover as dependents any

persons who do not live here?

YES .................................... 1 {BOX_08}

NO ..................................... 2 {BOX_08}

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

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

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 HP16. |

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

BOX_08

======

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

| IF THERE ARE NO POLICYHOLDERS OR DEPENDENTS WHO |

| ARE CURRENT RU MEMBERS, THAT IS, POLICYHOLDER IS A|

| DU MEMBER BUT NOT A CURRENT RU MEMBER, OR IS |

| FLAGGED AS 'NOT LISTED IN DU' OR 'POLICYHOLDER |

| DECEASED' AND INSURANCE ALSO FLAGGED ONLY AS |

| 'COVERING PERSON NOT IN RU', GO TO END_LP02 |

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

| OTHERWISE, CONTINUE WITH LOOP_03 |

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

LOOP_03

=======

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

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

| PERS-TRPLS-ROSTER, ASK BOX-09-END_LP03 |

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

| LOOP DEFINITION: LOOP_03 COLLECTS TIME PERIOD |

| COVERAGE FOR ALL CURRENT RU MEMBERS COVERED BY THE|

| INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR. |

| THIS LOOP CYCLES ON CURRENT RU MEMBERS WHO ARE |

| SELECTED AS DEPENDENTS AT HP16 AND THE RU MEMBER |

| WHO IS FLAGGED AS THE POLICYHOLDER FOR THIS |

| INSURANCE. |

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

BOX_09

======

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

| ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION. |

| |

| AT COMPLETION OF TIME PERIOD COVERED DETAIL (HQ) |

| SECTION, CONTINUE WITH END_LP03 |

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

END_LP03

========

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

| 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_03 AND CONTINUE WITH END_LP02 |

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

END_LP02

========

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

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

| PAIRS-ROSTER WHO MEETS THE CONDITIONS STATED IN |

| THE LOOP DEFINITION. |

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

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

| LOOP_02 AND CONTINUE WITH BOX_10 |

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

BOX_10

======

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

| IF LOOPING ON AN ESTABLISHMENT FLAGGED IN |

| EMPLOYMENT AS 'PROVIDES HEALTH INSURANCE' AND NOT |

| FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE-1, GO |

| TO END_LP01 |

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

| OTHERWISE, CONTINUE WITH HP18 |

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

HP18

====

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF

ESTABLISHMENT} {STR-DT}

{END-DT}

Aside from (POLICYHOLDER)’s (ESTABLISHMENT) insurance, is there

another health insurance plan that anyone in the family obtains

from (a/an) {CATEGORY NAME FROM HX03 OR HX23}?

YES .................................... 1 {END_LP01}

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

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

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

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

| FOR ‘CATEGORY NAME FROM HX03 OR HX23’, DISPLAY |

| THE CATEGORY TEXT FROM HX03 OR HX23. SEE NOTE BOX|

| AT BEGINNING OF HP SECTION FOR DETAILS. |

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

END_LP01

========

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

| IF HP18 IS CODED '1' (YES), CYCLE TO COLLECT NEXT |

| ESTABLISHMENT NAME. |

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

| IF HP18 IS NOT ASKED OR IS CODED '2' (NO), '-7' |

| (REFUSED), OR '-8' (DON'T KNOW), END LOOP_01 AND |

| CONTINUE WITH BOX_11 |

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

BOX_11

======

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

| RETURN TO THE HEALTH INSURANCE (HX) SECTION. |

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

28-155

File Type	application/msword
File Title	MEPS Private Health Insurance Detail - P12R5/P13R3/P14R1
Subject	HP Section Item Specifications
Author	Agency for Healthcare Research and Quality
Last Modified By	wcarroll
File Modified	2009-07-09
File Created	2009-07-09