Attachment C2 – Cognitive Interview Show Cards

CARD HX-X

Government or State Sources of Insurance

Maryland

-- Medicare

-- Medical Assistance

-- Maryland Children’s Health Program (MCHP)

-- TRICARE

-- CHAMPVA

-- VA (VETERAN’S ADMINISTRATION)

-- Other Government Program Providing Hospital/Physician Benefits

CARD HX-4

Sources of Insurance

Maryland

-- From a Group or Association

-- Directly Through a School

-- Directly From an Insurance Agent

-- Directly From Insurance Company

-- Directly From an HMO

-- From a Union

-- From Anyone’s Previous Employer

-- From Spouse/Deceased Spouse’s Previous Employer

-- From Some Other Employer

-- Under a Plan of Someone Not Living Here

-- Directly from Maryland Health Connection

-- Other Source