Managed Care (MC) Section


BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, ESTB.ESTBNAME,
PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY,
PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY.
----------------------------------------------------


MC01
====

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

{Is/Was} (POLICYHOLDER)’s {NAME OF INSURER BEING LOOPED ON} an HMO
{as of (END DATE)}? {When answering this question, do not consider
(POLICYHOLDER)’s insurance through Medicare.}

[With an HMO, you must generally receive care from HMO physicians.
For other doctors, the expense is not covered unless you were
referred by the HMO or there was a medical emergency.]

YES .................................... 1 {MC05}
NO ..................................... 2 {MC02}
REF ................................... -7 {MC02}
DK .................................... -8 {MC02}

HELP AVAILABLE FOR DEFINITION OF HMO.

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

DISPLAY ‘as of (END DATE)’ IF ROUND 5. OTHERWISE,
USE A NULL DISPLAY.

DISPLAY ‘When answering this question, do not
consider (POLICYHOLDER)’s insurance through
Medicare.’ IF POLICYHOLDER BEING ASKED ABOUT IS
ALSO COVERED BY MEDICARE. OTHERWISE, USE A NULL
DISPLAY.
----------------------------------------------------


MC02
====

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

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

{(Do/Does)/As of (END DATE), did} (POLICYHOLDER)’s insurance
plan require (POLICYHOLDER) to sign up with a certain primary
care doctor, group of doctors, or a certain clinic which
(POLICYHOLDER) must go to for all of (POLICYHOLDER)’s routine
care?

PROBE: Do not include emergency care or care from a specialist
you were referred to.

YES .................................... 1 {MC04}
NO ..................................... 2 {MC03}
REF ................................... -7 {MC03}
DK .................................... -8 {MC03}

HELP AVAILABLE FOR DEFINITION OF PRIMARY CARE DOCTOR AND ROUTINE CARE.

----------------------------------------------------
DISPLAY ‘(Do/Does)’ IF NOT ROUND 5. DISPLAY ‘As
of (END DATE), did’ IF ROUND 5.
----------------------------------------------------


MC03
====

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

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

{Is/As of (END DATE), was} there a book or list of doctors
associated with the plan?

YES .................................... 1 {MC04}
NO ..................................... 2 {BOX_01}
REF ................................... -7 {BOX_01}
DK .................................... -8 {BOX_01}

----------------------------------------------------
DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘As of (END
DATE), was’ IF ROUND 5.
----------------------------------------------------


MC04
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

{Will/As of (END DATE), would} (POLICYHOLDER)’s plan pay for any
of the costs of visits to doctors who are not associated with
(POLICYHOLDER)’s plan, even if (POLICYHOLDER) {(do/does)/did}
not have a referral?

YES .................................... 1 {BOX_01}
NO ..................................... 2 {BOX_01}
REF ................................... -7 {BOX_01}
DK .................................... -8 {BOX_01}

----------------------------------------------------
DISPLAY ‘Will’ AND ‘(do/does)’ IF NOT ROUND 5.
DISPLAY ‘As of (END DATE), would’ AND ‘did’ IF
ROUND 5.
----------------------------------------------------


MC05
====

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

INSURER NAME: {NAME OF INSURER BEING LOOPED ON}

{Will/As of (END DATE), would} (POLICYHOLDER)’s plan pay for any
of the costs of visits to doctors who are not part of
(POLICYHOLDER)’s HMO, even if (POLICYHOLDER) {(do/does)/did} not
have a referral?

YES .................................... 1 {BOX_01}
NO ..................................... 2 {BOX_01}
REF ................................... -7 {BOX_01}
DK .................................... -8 {BOX_01}

----------------------------------------------------
DISPLAY ‘Will’ AND ‘(do/does)’ IF NOT ROUND 5.
DISPLAY ‘As of (END DATE), would’ AND ‘did’ IF
ROUND 5.
----------------------------------------------------


BOX_01
======

----------------------------------------------------
RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN HX OR
OE.
----------------------------------------------------

Return to Top