MEPS Private Health Insurance Detail Section

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]

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}

I'd like to talk about the insurance which is from {CATEGORY
NAME FROM HX03 OR HX23}, that is, the health insurance {through
a self-employed business/someone in the family purchased or
obtained directly from that source.}

SELECT ‘CONTINUE’ UNLESS RESPONDENT VOLUNTEERS INSURANCE
REPORTED IN ERROR.

CONTINUE ............................... 1 {LOOP_01}
INSURANCE REPORTED IN ERROR ............ 2 {BOX_11}

[Code One]

DISPLAY ‘through a self-employed business’ IF
LOOPING ON AN HX03 CATEGORY. DISPLAY ‘someone in
the family purchased or obtained directly from
that source.’ IF LOOPING ON AN HX23 CATEGORY.

DISPLAY THE FOLLOWING FOR ‘CATEGORY NAME FROM HX03
OR HX23’:

- ‘a professional association’ IF CODED ‘1’ AT
HX03
- ‘a small business group’ IF CODED ‘2’ AT HX03
- ‘a union’ IF CODED ‘3’ AT HX03
- ‘an insurance agent’ IF CODED ‘5’ AT HX03
- ‘an insurance company’ IF CODED ‘6’ AT HX03
- ‘an HMO’ IF CODED ‘7’ AT HX03
- ‘a previous employer’ IF CODED ‘8’ AT HX03
- ‘a previous employer (COBRA)’ IF CODED ‘9’ AT
HX03
- ‘a high risk pool {(e.g., {STATE NAME FOR HIGH
RISK POOL})}’ IF CODED ‘10’ AT HX03
- ‘the {HX03OV OTHER SPECIFY TEXT}’ IF CODED ‘91’
AT HX03
- ‘{STATE EXCHANGE NAME}’ IF CODED ‘11’ AT HX03
- ‘source purchased for that business’ IF CODED
‘-7’ OR ‘-8’ AT HX03

- ‘a group or association’ IF CODED ‘1’ AT HX23
- ‘a school’ IF CODED ‘3’ AT HX23
- ‘an insurance agent’ IF CODED ‘4’ AT HX23
- ‘an insurance company’ IF CODED ‘5’ AT HX23
- ‘an HMO’ IF CODED ‘6’ AT HX23
- ‘a union’ IF CODED ‘7’ AT HX23
- ‘a previous employer (COBRA)’ IF CODED ‘8’ AT
HX23
- ‘a previous employer (not COBRA)’ IF CODED ‘9’
AT HX23
- ‘a spouse’s (or deceased spouse’s) previous
employer’ IF CODED ‘10’ AT HX23
- ‘some other employer’ IF CODED ‘11’ AT HX23
- ‘the plan of someone not living here’ IF CODED
‘12’ AT HX23
- ‘a high risk pool {(e.g., {STATE NAME FOR HIGH
RISK POOL})}’ IF CODED ‘13’ AT HX23
- ‘{STATE EXCHANGE NAME-A}’ IF CODED ‘14’ AT HX23
- ‘the {HX23OV OTHER SPECIFY TEXT} IF CODED ‘91’
AT HX23
- ‘a source that provided directly purchased
insurance’ IF CODED ‘-7’ OR ‘-8’

DISPLAY ‘(e.g., {STATE NAME FOR HIGH RISK POOL})’
IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED
OFFERS A HIGH RISK POOL HEALTH INSURANCE PLAN.
THIS INCLUDES ALL STATES EXCEPT: AZ, DE, DC, GA,
HI, ME, MA, MI, NV, NJ, NY, OH, PA, RI, VT, VA.
IF INTERVIEW STATE IS ONE OF THESE STATES, USE A
NULL DISPLAY.

FOR ‘STATE NAME FOR HIGH RISK POOL’ DISPLAY THE
HIGH RISK POOL PLAN NAME ASSOCIATED WITH THE STATE
IN WHICH INTERVIEW IS BEING CONDUCTED.

FOR ‘STATE EXCHANGE NAME’, DISPLAY THE EXCHANGE
NAME ‘A’ ASSOCIATED WITH THE STATE IN WHICH
INTERVIEW IS BEING CONDUCTED.

IF CODED '2' (INSURANCE REPORTED IN ERROR), FLAG
ITEM FOR SOURCE CLEAN-UP.

For each of the following:

ESTABLISHMENT 1
ESTABLISHMENT 2
ESTABLISHMENT 3
ESTABLISHMENT 4

ASK BOX_01AA-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.

IF LOOPING ON CODE '11' (STATE EXCHANGE NAME) AT
HX03 OR CODE ‘14’ (STATE EXCHANGE NAME) AT HX23,
AUTOMATICALLY CODE HP04A AS ‘YES’
AND
AUTOMATICALLY ADD THE ESTABLISHMENT NAME ‘{STATE
EXCHANGE NAME}’ TO THE HP04/HP06 ESTABLISHMENT
ROSTER. THEN GO TO BOX_02

IF LOOPING ON CODE ‘1’ (PROFESSIONAL ASSOCIATION),
'2' (SMALL BUSINESS GROUP), ‘5’ (INSURANCE AGENT),
‘6’ (INSURANCE COMPANY), ‘7’ (HMO), OR ‘91’
(OTHER) AT HX03 OR CODE ‘1’ (GROUP/ASSOCIATION),
‘4’ (INSURANCE AGENT), ‘5’ (INSURANCE COMPANY),
‘6’ (HMO), OR ‘91’ (OTHER) AT HX23, CONTINUE WITH
HP04A

OTHERWISE, GO TO BOX_01A

NOTE: THE HP04/HP06 ESTABLISHMENT ROSTER HAS A
CHARACTER LIMIT OF 30 CHARACTERS. IF AN
ESTABLISHMENT IS AUTOMATICALLY ADDED TO THE
ROSTER AT HP04/HP06 THAT IS OVER 30 CHARACTERS,
THE ESTABLISHMENT NAME WILL BE TRUNCATED. AS OF
P19R2/P18R4, THE FOLLOWING STATE EXCHANGE NAMES
WERE TRUNCATED:
ORIGINAL
‘the Health Insurance Marketplace’
‘the Massachusetts Health Connector’
‘the Washington Health Plan Finder’

TRUNCATED
‘Health Insurance Marketplace’
‘Massachusetts Health Connector’
‘Washington Health Plan Finder’

Is this coverage through {STATE EXCHANGE NAME-A}{, [which may also
be known as {ALIAS B} {or {ALIAS C}}]}?

YES .................................... 1 {BOX_01A}
NO ..................................... 2 {BOX_01A}
REF ................................... -7 {BOX_01A}
DK .................................... -8 {BOX_01A}

DISPLAY ‘, [which may also be known as {ALIAS B}
{or {ALIAS C}}]’ IF THERE IS MORE THAN ONE
EXCHANGE NAME ASSOCIATED WITH THE STATE IN WHICH
INTERVIEW IS BEING CONDUCTED.

DISPLAY ‘or {ALIAS C}’ IF THERE ARE THREE
EXCHANGE NAMES ASSOCIATED WITH THE STATE IN WHICH
INTERVIEW IS BEING CONDUCTED.

FOR ‘STATE EXCHANGE NAME-A’, ‘ALIAS B’, AND
‘ALIAS C’, DISPLAY THE EXCHANGE NAME(S) ASSOCIATED
WITH THE STATE IN WHICH INTERVIEW IS BEING
CONDUCTED.

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

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}

{Please give me the name of the {professional association/small
business group/union/insurance company/HMO/previous employer/
previous employer (using COBRA)/group or association/school/
spouse’s (or deceased spouse’s) previous employer/employer/
high risk pool {(e.g., {STATE NAME FOR HIGH RISK POOL})}/
{HX03OV/HX23OV OTHER SPECIFY}/source} {from which someone in
the family {purchased/obtained} this insurance/for the insurance
purchased from an agent}. / 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?}

VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:

ROSTER. ESTABLISHMENT
1. Establishment Name-30
2. Establishment Name-30
3. Establishment Name-30

DISPLAY ‘Please give … an agent.’ IF NOT LOOPING
ON HX23 CODE ‘12’ (UNDER PLAN OF SOMEONE NOT
LIVING HERE). DISPLAY ‘You mentioned...this
insurance?’ IF LOOPING ON HX23 CODE ‘12’ (UNDER
PLAN OF SOMEONE NOT LIVING HERE).

DISPLAY ‘professional association’ IF LOOPING ON
HX03 CODE ‘1’ (FROM A PROFESSIONAL ASSOCIATION).

DISPLAY ‘small business group’ IF LOOPING ON HX03
CODE ‘2’ (FROM A SMALL BUSINESS GROUP).

DISPLAY ‘union’ IF LOOPING ON HX03 CODE ‘3’ (FROM
A UNION) OR LOOPING ON HX23 CODE ‘7’ (FROM A
UNION).

DISPLAY ‘insurance company’ IF LOOPING ON HX03
CODE ‘5’ (DIRECTLY FROM AN INSURANCE AGENT) OR ‘6’
(DIRECTLY FROM INSURANCE COMPANY) OR LOOPING ON
HX23 CODE ‘4’ (DIRECTLY FROM AN INSURANCE AGENT)
OR ‘5’ (DIRECTLY FROM INSURANCE COMPANY).

DISPLAY ‘HMO’ IF LOOPING ON HX03 CODE ‘7’
(DIRECTLY FROM AN HMO) OR LOOPING ON HX23 CODE ‘6’
(DIRECTLY FROM AN HMO).

DISPLAY ‘previous employer’ IF LOOPING ON HX03
CODE ‘8’ (FROM A PREVIOUS EMPLOYER) OR LOOPING ON
HX23 CODE ‘9’ (FROM ANYONE’S PREVIOUS EMPLOYER).

DISPLAY ‘previous employer (using COBRA)’ IF
LOOPING ON HX03 CODE ‘9’ (FROM A PREVIOUS EMPLOYER
(COBRA)) OR LOOPING ON HX23 CODE ‘8’ (FROM
ANYONE’S PREVIOUS EMPLOYER (COBRA)).

DISPLAY ‘group or association’ IF LOOPING ON HX23
CODE ‘1’ (FROM A GROUP OR ASSOCIATION).

DISPLAY ‘school’ IF LOOPING ON HX23 CODE ‘3’
(DIRECTLY THROUGH A SCHOOL).

DISPLAY ‘spouse’s (or deceased spouse’s) previous
employer’ IF LOOPING ON HX23 CODE ‘10’ (FROM
SPOUSE’S/DECEASED SPOUSE’S PREVIOUS EMPLOYER).

DISPLAY ‘employer’ IF LOOPING ON HX23 CODE ‘11’
(FROM SOME OTHER EMPLOYER).

DISPLAY ‘high risk pool {(e.g., {STATE NAME FOR
HIGH RISK POOL})}’ IF LOOPING ON HX03 CODE ‘10’
(DIRECTLY FROM A HIGH RISK POOL) OR LOOPING ON
HX23 CODE ‘13’ (DIRECTLY FROM A HIGH RISK POOL).

DISPLAY ‘{HX03OV/HX23OV OTHER SPECIFY}’ IF LOOPING
ON HX03 CODE ‘91’ (OTHER) OR LOOPING ON HX23 CODE
‘91’ (OTHER SOURCE).

FOR ‘HX03OV/HX23OV OTHER SPECIFY’ DISPLAY THE
TEXT ENTERED AT EITHER HX03OV OR HX23OV.

DISPLAY ‘source’ IF LOOPING ON HX03 OR HX23 CODES
‘-7’ (REF) OR ‘-8’ (DK).

DISPLAY ‘from which someone in the family
{purchased/obtained} this insurance’ IF NOT
LOOPING ON HX03 CODE ‘5’ (DIRECTLY FROM AN
INSURANCE AGENT) OR HX23 CODE ‘4’ (DIRECTLY FROM
AN INSURANCE AGENT) IF LOOPING ON HX03 CODE ‘5’ OR
HX23 CODE ‘4’, DISPLAY, ‘for the insurance
purchased from an agent’.

DISPLAY ‘purchased’ IF LOOPING ON HX03 CODES ‘1’,
‘2’, ‘3’, ‘6’, ‘7’, ‘10’, ‘-7,’ OR ‘-8’ OR IF
LOOPING ON HX23 CODES ‘1’, ‘3’, ‘5’, ‘6’, ‘7’,
‘13’, ‘-7,’ OR ‘-8’.

DISPLAY ‘obtained’ IF LOOPING ON HX03 CODES ‘8’,
‘9’, OR ‘91’ OR IF LOOPING ON HX23 CODES ‘8’, ‘9’,
‘10’, ‘11’, OR ’91’.

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.

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.)

{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}

DISPLAY THE FOLLOWING FOR ‘CATEGORY NAME FROM HX03
OR HX23’:

- ‘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
- ‘HIGH RISK POOL’ IF CODED ‘10’ AT HX03
- THE TEXT ENTERED AT HX03OV IF CODED ‘91’ AT HX03
- ‘SOURCE 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
- ‘PREVIOUS EMPLOYER [COBRA]’ IF CODED
‘8’ AT HX23
- ‘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
- ‘HIGH RISK POOL’ IF CODED ‘13’ AT HX23
- THE TEXT ENTERED AT HX23OV IF CODED ‘91’ AT HX23
- ‘SOURCE THAT PROVIDED DIRECTLY PURCHASED
INSURANCE’ IF CODED ‘-7’ OR ‘-8’

WRITE ESTABLISHMENT TO THE RU-Establishments-
ROSTER.

{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.

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 ‘10’, FLAG ESTABLISHMENT AS
‘HIGH RISK POOL’.
IF HX03 IS CODED ‘11’, FLAG ESTABLISHMENT AS
‘EXCHANGE COVERAGE’.
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 ‘13’, FLAG ESTABLISHMENT AS
‘HIGH RISK POOL’.
IF HX23 IS CODED ‘14’, FLAG ESTABLISHMENT AS
‘EXCHANGE COVERAGE’.
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.

IF LOOPING ON AN HX23 CATEGORY, GO TO HP11

OTHERWISE, CONTINUE WITH HP09

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}

{{Are/Is}/As of {END DATE}, {were/was}} {you/{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}, {were/was}’ IF ROUND 5.

PERSON REFERS TO JOBHOLDER.

IF CODED '1' (YES), FLAG JOBHOLDER AS
'POLICYHOLDER'.

{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

{NAME OF ESTABLISHMENT} {STR-DT}
{END-DT}

{Please tell me the names of everyone who is a primary insured
person or policyholder of the/Who {is/was} the primary insured
person or policyholder of this} health coverage through
{ESTABLISHMENT} {on {END DATE}}?

{CODE ALL THAT APPLY.}

[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 ‘Please tell me the names of everyone who
is a primary insured person or policyholder of
the’ IF HX23 IS CODED ‘14’ (DIRECTLY FROM {STATE
EXCHANGE NAME}). OTHERWISE, DISPLAY ‘Who {is/was}
the primary insured person or policyholder of
the’. DISPLAY ‘CODE ALL THAT APPLY’ IF HX23 IS
CODED ‘14’ (DIRECTLY FROM {STATE EXCHANGE NAME}).
OTHERWISE, USE A NULL DISPLAY.

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.

{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

{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.

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.

IF LOOPING ON AN ESTABLISHMENT FLAGGED IN
EMPLOYMENT AS ‘PROVIDES HEALTH INSURANCE’, GO TO
BOX_07

OTHERWISE, CONTINUE WITH 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

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

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}

{Are/Is} {you/{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.

SPECIFY:

[Enter Other Specify] .................. {HP13}
REF ................................... -7 {HP13}
DK .................................... -8 {HP13}

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}

{{Are/Is}/{Were/Was}} {you/{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}'.

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 BOX_07A

{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} {your/{POLICYHOLDER}’s} {ESTABLISHMENT} insurance like that
{on {END DATE}}?

YES .................................... 1 {BOX_07A}
NO ..................................... 2 {BOX_07A}
REF ................................... -7 {BOX_07A}
DK .................................... -8 {BOX_07A}

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.

SMALL BUSINESS DETERMINATION

IF ESTABLISHMENT-PERSON-PAIR BEING ASKED ABOUT
MEETS THE FOLLOWING CONDITIONS:
- PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND
- PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS
INSURANCE, AND
- ESTABLISHMENT IS AN EMPLOYER FLAGGED AS
‘PROVIDES HEALTH INSURANCE’, AND
- ESTABLISHMENT FLAGGED AS A CURRENT-MAIN-JOB, AND
- JOB IS FLAGGED AS ‘SELF-EMPLOYED’, AND
- EM124 IS GREATER THAN 1 BUT LESS THAN 200,
CONTINUE WITH HP14A

SMALL BUSINESS DETERMINATION

IF ESTABLISHMENT-PERSON-PAIR BEING ASKED ABOUT
MEETS THE FOLLOWING CONDITIONS:
- PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND
- PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS
INSURANCE, AND
- ESTABLISHMENT IS AN EMPLOYER FLAGGED AS
‘PROVIDES HEALTH INSURANCE’, AND
- ESTABLISHMENT FLAGGED AS A CURRENT-MAIN-JOB, AND
- JOB IS FLAGGED AS ‘NOT SELF-EMPLOYED’, AND
- FIRM SIZE IS SMALL (SEE DETERMINATION BELOW)
- EM91 IS LESS THAN 200
OR
- EM92 IS CODED ‘1’ (LESS THAN 10), ‘2’ (10 TO
25), ‘3’ (26 TO 49) OR ‘4’ (50 TO 100), AND
- EM93 IS CODED ‘2’ (NO),
CONTINUE WITH HP14A

OTHERWISE, GO TO HP15

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}

In {RU STATE}, {STATE SHOP NAME-A}{, [which may also be known
as {ALIAS B} {or {ALIAS C}}],} is a {new} program where small
businesses will be able to shop for health insurance plans for
their employees. Is {your/{POLICYHOLDER}’s} health insurance
coverage through {ESTABLISHMENT} related at all to a program
like that?

YES .................................... 1 {HP15}
NO ..................................... 2 {HP15}
REF ................................... -7 {HP15}
DK .................................... -8 {HP15}

FOR ‘RU STATE’, DISPLAY THE FULL STATE NAME
ASSOCIATED WITH THIS RU’S ADDRESS.

DISPLAY ‘, [which may also be known as {ALIAS B}
{or {ALIAS C}}],’ IF THERE IS MORE THAN ONE SHOP
NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW
IS BEING CONDUCTED.

DISPLAY ‘or {ALIAS C}’ IF THERE ARE THREE SHOP
NAMES ASSOCIATED WITH THE STATE IN WHICH INTERVIEW
IS BEING CONDUCTED.

FOR ‘STATE SHOP NAME-A’ ‘ALIAS B’, AND ‘ALIAS C’,
DISPLAY THE SMALL BUSINESS HEALTH OPTIONS PROGRAM
NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW
IS BEING CONDUCTED.

DISPLAY ‘new’ IF PANEL 17 ROUND 5, PANEL 18 ROUNDS
3-5, PANEL 19 ROUNDS 1-5 OR PANEL 20 ROUNDS 1-3
(YEARS 2014 AND 2015). OTHERWISE, USE A NULL
DISPLAY.

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}

Was anyone {living here} covered as a dependent under {your/
{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.

{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'.

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.

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}

{Does/Between {START DATE} and {END DATE}, did} {your/
{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.

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

FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD-
PERS-TRPLS-ROSTER, ASK NAV_HP03 - 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.

NAVIGATOR DETAILS: LOOP_03 USES NAV_HP03 TO
CONTROL THE FLOW OF THE LOOP.

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}

SERIES: {Insurance Coverage Duration during Reference
Period / Self-Employed RU Member’s Insurance Coverage}

USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.

WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO
PAST THIS SERIES.

IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS
SERIES.

Question Series

[1. Coverage duration for [Person’s Name-65] through
[Establishment Name-30]] [Status-25]
[2. Coverage duration for [Person’s Name-65] through
[Establishment Name-30]] [Status-25]
[3. Coverage duration for [Person’s Name-65] through
[Establishment Name-30]] [Status-25]

DISPLAY ‘Self-Employed RU Member’s Insurance
Coverage’ IF LOOPING ON AN HX03 CATEGORY.
OTHERWISE, DISPLAY ‘Insurance Coverage Duration
during Reference Period.’

ROSTER DETAILS:
COL # 1 HEADER: QUESTION SERIES
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED

ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD-
PERS-TRPLS-ROSTER FOR SELECTION.

ROSTER BEHAVIOR:
1. SELECT ALLOWED.

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

ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HP16.

CONTINUE WITH BOX_09 FOR SELECTED RU MEMBER.

ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION.

AT COMPLETION OF TIME PERIOD COVERED DETAIL (HQ)
SECTION, CONTINUE WITH 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

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

IF LOOPING ON AN ESTABLISHMENT FLAGGED IN
EMPLOYMENT AS 'PROVIDES HEALTH INSURANCE' AND NOT
FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE-1,
OR
IF LOOPING ON AN ESTABLISHMENT FLAGGED AS
‘EXCHANGE COVERAGE’ (I.E., LOOPING ON HX03
CATEGORY ‘11’ OR HX23 CATEGORY ‘14’), GO TO
END_LP01

OTHERWISE, CONTINUE WITH HP18

{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}

Aside from {your/{POLICYHOLDER}’s} {ESTABLISHMENT} insurance, is
there another health insurance plan that anyone in the family obtains
from {CATEGORY NAME FROM HX03 OR HX23}?

YES .................................... 1 {END_LP01}
NO ..................................... 2 {END_LP01}
REF ................................... -7 {END_LP01}
DK .................................... -8 {END_LP01}

DISPLAY THE FOLLOWING FOR ‘CATEGORY NAME FROM HX03
OR HX23’:

- ‘a professional association’ IF CODED ‘1’ AT
HX03
- ‘a small business group’ IF CODED ‘2’ AT HX03
- ‘a union’ IF CODED ‘3’ AT HX03
- ‘an insurance agent’ IF CODED ‘5’ AT HX03
- ‘an insurance company’ IF CODED ‘6’ AT HX03
- ‘an HMO’ IF CODED ‘7’ AT HX03
- ‘a previous employer’ IF CODED ‘8’ AT HX03
- ‘a previous employer (COBRA)’ IF CODED ‘9’ AT
HX03
- ‘a high risk pool’ IF CODED ‘10’ AT HX03
- ‘the {HX03OV OTHER SPECIFY TEXT}’ IF CODED ‘91’
AT HX03
- ‘source purchased for that business’ IF CODED
‘-7’ OR ‘-8’ AT HX03
- ‘a group or association’ IF CODED ‘1’ AT HX23
- ‘a school’ IF CODED ‘3’ AT HX23
- ‘an insurance agent’ IF CODED ‘4’ AT HX23
- ‘an insurance company’ IF CODED ‘5’ AT HX23
- ‘an HMO’ IF CODED ‘6’ AT HX23
- ‘a union’ IF CODED ‘7’ AT HX23
- ‘a previous employer (COBRA)’ IF CODED ‘8’ AT
HX23
- ‘a previous employer (not COBRA)’ IF CODED ‘9’
AT HX23
- ‘a spouse’s (or deceased spouse’s) previous
employer’ IF CODED ‘10’ AT HX23
- ‘some other employer’ IF CODED ‘11’ AT HX23
- ‘the plan of someone not living here’ IF CODED
‘12’ AT HX23
- ‘a high risk pool’ IF CODED ‘13’ AT HX23
- ‘the {HX23OV OTHER SPECIFY TEXT} IF CODED ‘91’
AT HX23
- ‘a source that provided directly purchased
insurance’ IF CODED ‘-7’ OR ‘-8’

Private Health Insurance Detail (HP) Section