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. |
----------------------------------------------------
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