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September 2015
Agency for Healthcare Research and Quality
Center for Financing, Access, and Cost Trends
540 Gaither Road
Rockville, MD 20850
(301) 427-1406
Table of Contents
A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Survey Management and Data Collection
C. Technical and Programming Information
1.0 General Information
2.0 Data File Description
2.1 Complex File Structure with Examples
2.2 Identifiers
2.3 Adding the Characteristics of Covered Persons
2.4 Adding the Policyholder’s Characteristics
2.5 Choosing PRPL Records for Your Research Question
3.0 Data File Contents
3.1 ID Variables
3.2 Person Variables
3.3 Policyholder Variables
3.4 Establishment Variables
3.4.1 Employers and Other Establishments
3.4.2 Types of Coverage through the Establishment
3.4.3 Out-of-Pocket Premiums
3.5 Plan Variables
3.5.1 Household Reports of Managed Care
3.5.2 Family Experience with Plan
3.5.3 Change in Plan Name
3.6 Links to Job Providing Insurance
4.0 Linking to Other Files
4.1 National Health Interview Survey
4.2 Longitudinal Analysis
5.0 Using MEPS Data for Trend Analysis
References
D. Variable-Source Crosswalk
Individual identifiers have been removed from the
micro-data contained in these files. Nevertheless, under sections 308 (d) and
903 (c) of the Public Health Service Act (42 U.S.C. 242m and 42 U.S.C. 299 a-1),
data collected by the Agency for Healthcare Research and Quality (AHRQ) and/or
the National Center for Health Statistics (NCHS) may not be used for any purpose
other than for the purpose for which they were supplied; any effort to determine
the identity of any reported cases is prohibited by law.
Therefore in accordance with the above referenced
Federal Statute, it is understood that:
- No one is to use the data in this data set in any way except
for statistical reporting and analysis; and
- If the identity of any person or establishment should be
discovered inadvertently, then (a) no use will be made of this
knowledge, (b) the Director Office of Management AHRQ will be
advised of this incident, (c) the information that would
identify any individual or establishment will be safeguarded or
destroyed, as requested by AHRQ, and (d) no one else will be
informed of the discovered identity; and
- No one will attempt to link this data set with individually
identifiable records from any data sets other than the Medical
Expenditure Panel Survey or the National Health Interview
Survey.
By using these data you signify your agreement to
comply with the above stated statutorily based requirements with the knowledge
that deliberately making a false statement in any matter within the jurisdiction
of any department or agency of the Federal Government violates Title 18 part 1
Chapter 47 Section 1001 and is punishable by a fine of up to $10,000 or up to 5
years in prison.
The Agency for Healthcare Research and Quality
requests that users cite AHRQ and the Medical Expenditure Panel Survey as the
data source in any publications or research based upon these data.
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The Medical Expenditure Panel Survey (MEPS) provides
nationally representative estimates of health care use, expenditures, sources of
payment, and health insurance coverage for the U.S. civilian
non-institutionalized population. The MEPS Household Component (HC) also
provides estimates of respondents’ health status, demographic and socio-economic
characteristics, employment, access to care, and satisfaction with health care.
Estimates can be produced for individuals, families, and selected population
subgroups. The panel design of the survey, which includes 5 Rounds of interviews
covering 2 full calendar years, provides data for examining person level changes
in selected variables such as expenditures, health insurance coverage, and
health status. Using computer assisted personal interviewing (CAPI) technology,
information about each household member is collected, and the survey builds on
this information from interview to interview. All data for a sampled household
are reported by a single household respondent.
The MEPS-HC was initiated in 1996. Each year a new
panel of sample households is selected. Because the data collected are
comparable to those from earlier medical expenditure surveys conducted in 1977
and 1987, it is possible to analyze long-term trends. Each annual MEPS-HC sample
size is about 15,000 households. Data can be analyzed at either the person or
event level. Data must be weighted to produce national
estimates.
The set of households selected for each panel of the
MEPS HC is a subsample of households participating in the previous year’s
National Health Interview Survey (NHIS) conducted by the National Center for
Health Statistics. The NHIS sampling frame provides a nationally representative
sample of the U.S. civilian non-institutionalized population and reflects an
oversample of Blacks and Hispanics. In 2006, the NHIS implemented a new sample
design, which included Asian persons in addition to households with Black and
Hispanic persons in the oversampling of minority populations. MEPS further
oversamples additional policy relevant sub-groups such as low income households.
The linkage of the MEPS to the previous year’s NHIS provides additional data for
longitudinal analytic purposes.
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Upon completion of the household CAPI interview and
obtaining permission from the household survey respondents, a sample of medical
providers are contacted by telephone to obtain information that household
respondents can not accurately provide. This part of the MEPS is called the
Medical Provider Component (MPC) and information is collected on dates of visit,
diagnosis and procedure codes, charges and payments. The Pharmacy Component
(PC), a subcomponent of the MPC, does not collect charges or diagnosis and
procedure codes but does collect drug detail information, including National
Drug Code (NDC) and medicine name, as well as date filled and sources and
amounts of payment. The MPC is not designed to yield national estimates. It is
primarily used as an imputation source to supplement/replace household reported
expenditure information.
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MEPS HC and MPC data are collected under the authority
of the Public Health Service Act. Data are collected under contract with Westat,
Inc. (MEPS HC) and Research Triangle Institute (MEPS MPC). Data sets and summary
statistics are edited and published in accordance with the confidentiality
provisions of the Public Health Service Act and the Privacy Act. The National
Center for Health statistics (NCHS) provides consultation and technical
assistance.
As soon as data collection and editing are completed,
the MEPS survey data are released to the public in staged releases of summary
reports, micro data files, and tables via the MEPS Web site:
meps.ahrq.gov. Selected data can be
analyzed through MEPSnet, an on-line interactive tool designed to give data
users the capability to statistically analyze MEPS data in a menu-driven
environment.
Additional information on MEPS is available from the
MEPS project manager or the MEPS public use data manager at the Center for
Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality,
540 Gaither Road, Rockville, MD 20850 (301-427-1406).
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This public use data file contains data for each
person with private health insurance reported in Rounds 3, 4, and 5 of Panel 17
and Rounds 1, 2, and 3 of Panel 18 (i.e., the rounds for the survey panels
covering calendar year 2013) of the Medical Expenditure Panel Survey Household
Component (MEPS HC). Released as an ASCII file (with related SAS, SPSS, and
Stata programming statements and data user information) and in SAS transport
format, this public use file (PUF) provides information collected on a
nationally representative sample of the civilian noninstitutionalized population
of the United States during the calendar year 2013. The HC-161 file
(Person-Round-Plan Public Use File) contains records for persons insured through
private establishments providing hospital/physician, Medigap, dental, vision, or
prescription medication coverage and includes variables pertaining to managed
care. The file contains 71 variables and has a logical record length of 223 with
an additional 2-byte carriage return/line feed at the end of each record.
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The Person-Round-Plan (PRPL) file for 2013 is a
complex file of privately insured persons and their private health insurance
plans and links to the jobs providing insurance. The PRPL file is designed to
facilitate research on the sometimes complex and dynamic relationships between
consumers and their private insurance. It is not a person-level file, and
linking the PRPL file to a person-level file (such as HC-151, the Point-in-Time
Public Use File, and HC-157, the Full-Year Population Characteristics File)
requires users to make analytic decisions based on understanding the complexity
of the PRPL file.
Records contain the following types of information
(Figure 1):
- Covered person
- Flags for whether the person is the policyholder or a
dependent
- Whether enrolled at time of interview
- Months enrolled during the reference period of the interview
- Interview Round
- Policyholder
- Establishment providing insurance
- Type of establishment (employer, union, insurance agent,
etc.)
- Types of coverage (hospital/physician, Medigap, dental,
vision, prescription medication, Consolidated Omnibus Budget
Reconciliation Act (COBRA), single or family)[1]
- Out-of-pocket premiums and employee contributions
- Plan (for hospital/physician and Medicare supplemental
insurance coverage only)
- Household reports of managed care
- High deductibles and Health Savings Accounts (HSAs) for
hospital/physician insurance coverage only
- Links to the job providing insurance (for employment-based
insurance only, HC-158, the Jobs Public Use File)
[1] No effort has been made to validate variables representing type of coverage with external sources.
FIGURE 1
CONCEPTUAL OVERVIEW OF PRPL
On the records for dependents, variables link to the
policyholder’s job providing insurance, rather than the dependent’s job.
“Establishment” refers to the organization through
which the policyholder obtains private insurance. The establishment may be an
employer, a union, an insurance agent, an insurance company, a professional
association, or another type of organization. Many questions in the MEPS HC
instrument were asked in reference to the establishment providing insurance to
the policyholder. For example, the MEPS HC asked about the “types of health
insurance” or covered services, such as hospital/physician and dental coverage,
the policyholder gets through the establishment.
For each establishment, a “plan” is the insurance
company or Health Maintenance Organization (HMO) or self-insured company from
which the policyholder receives hospital/physician or Medicare supplemental (Medigap)
coverage. For some focused analyses, it may be important to recognize that
information collected at the establishment level does not necessarily pertain to
the plan level. For example, if a policyholder obtains from the establishment
two separate plans, a hospital/physician plan and a dental plan, then the dental
plan may not have the same managed care characteristics as the
hospital/physician plan.
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The PRPL file is designed to reflect the sometimes
complex and dynamic relationships between people and their private insurance. It
allows maximum flexibility for researchers, but it also requires that they make
analytical decisions in their research.
The PRPL file is a
person-round-policyholder-establishment-level file. There is one unique record
for each unique combination of establishment (source of private insurance),
policyholder, interview round, and covered person (policyholder or dependent).
Thus, the PRPL file contains at least one record for each person in each round
with private health insurance, or 58,947 total records.
The PRPL file contains records for persons insured through establishments
providing hospital/physician, Medigap, dental, vision, or prescription
medication coverage.
In most cases in this file, one person in the family
has insurance from his or her employer, and this insurance covers everyone in
the family. In this case, there is one record for each family member in each
round, and each record flags the policyholder’s current main job and links to
one job record in HC-158. However, other cases are more complex, and some
hypothetical examples follow.
Multiple Establishments
- Juan and Maria are both employed parents, both have health
insurance through their employers, and both parents choose
family coverage. In this case, there are two PRPL records for
each family member in each round.
- John and Jane are both employed parents. John has single
coverage from his employer. Jane has family coverage from her
employer. In this case, Jane and the children each have one PRPL
record for each round. John has two records for each round.
- Jamie has Medicare and Medicare supplemental insurance. In
this case, Jamie has one PRPL record in each round for the
Medicare supplemental insurance. There is no record for
Medicare, because it is public insurance.
- Arlene is a child living with her mother. Both have
Medicaid. Arlene’s father, who does not live with them, has
private insurance that covers Arlene. Arlene has one PRPL record
in each round for the private insurance. There is no record for
Medicaid, because it is public insurance.
No Private Insurance
- Paul is uninsured. In this case, Paul does not have any PRPL
records.
- Mary has Medicaid instead of private coverage. In this case,
Mary does not have any PRPL records.
Sources of Insurance: Employers and Other Establishments
- Dexter is an employed parent with family coverage through
his current main job. In this case, each family member’s PRPL
record flags Dexter’s current main job as the source of
insurance, and each family member’s PRPL record links to that
job record in PUF HC-158.
- Claire is employed, but she does not have insurance through
her job. Instead she buys a plan directly from an HMO. In this
case, Claire’s PRPL records do not flag her current main job,
nor do they link to any job records in PUF HC-158.
- Fred has hospital/physician insurance through his employer,
and he buys dental insurance through an insurance agent. In this
case, Fred has two PRPL records, and only the employment-based
insurance flags his current main job and links to a job record
in PUF HC-158.
Policyholders Not in the Household
- Edith is a widow and has retiree insurance from her deceased
husband’s former job. In this case, Edith’s PRPL record does not
link to any employment information in the MEPS. There is also a
PRPL record for Edith’s deceased husband, where he is flagged as
the policyholder and flagged as deceased, but this record does
not link to any records on any PUFs.
- Matilda’s parents are divorced. She lives with her father,
but her insurance is through her mother’s job. In this case,
Matilda’s PRPL record does not link to any employment
information in the MEPS. There is also a PRPL record for
Matilda’s mother, where she is flagged as the policyholder and
not residing in the Reporting Unit (RU), but this PRPL record
does not link to any records on any PUFs.
Changes in Insurance
- Bob changes jobs between January 1st, 2013 and
the date of his MEPS interview, and both jobs provide health
insurance. In this case, Bob has two PRPL records for the round.
EVALCOVR shows whether one or both plans covered Bob on the
interview date.
- Julie quits her job in Round 1 (Panel 18) but pays her
previous employer to continue her health insurance while she
looks for another job in Round 2. In this case, Julie’s Round 1
PRPL record flags her current main job as the source of her
insurance and links to a job record in PUF HC-158. Julie’s Round
2 PRPL record does not flag her current main job as the source
of her insurance, but it links to the same job record from Round
1. Thus, the job variables from Round 1 are no longer current in
Round 2, but the link exists for users.
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Each record contains the following ID variables:
- DUPERSID is the person identifier (either a dependent
or a policyholder).
- RN is the round of the interview in which the
enrollment data were collected.
- PHLDRIDX is the person identifier of the policyholder.
- ESTBIDX is an ID number for the establishment –
employer, union, insurance company, or other – i.e., the source of insurance
coverage on the record.
- EPRSIDX is a combination of ESTBIDX, PHLDRIDX, and RN
and it uniquely identifies the insurance coverage that a policyholder obtains
from an individual establishment.
- EPCPIDX is a combination of DUPERSID and EPRSIDX, and
it uniquely identifies each record.
- JOBSIDX is a combination of the PHLDRIDX, a round
identifier (RN), and a job number, and it uniquely identifies the
policyholder’s job at the establishment that provided insurance
(for employment-based coverage).
For each person covered by a
policyholder-establishment combination, the PHLDRIDX, ESTBIDX, and EPRSIDX
appear on each plan record for that coverage.
A person (DUPERSID) can be listed more than once on
this file if (1) they are covered (as a policyholder or a dependent) by
insurance policies from more than one establishment, or (2) they are covered in
more than one round. Within each round, establishment-policyholder pairs (EPRSIDXs)
can be listed more than once if the health plan a policyholder obtains from a
given establishment also covers his/her dependents. As noted above, there is a
PRPL record for each unique combination of establishment (source of insurance),
round, and covered person (policyholder or dependent). The following table
presents a hypothetical example that illustrates the relationship between the ID
variables on this file.
| ESTBIDX |
DUPERSID |
PHLDRIDX |
RN |
EPRSIDX |
EPCPIDX |
JOBSIDX |
| 11 |
42 |
42 |
1 |
11421 |
1142142 |
42101 |
| 11 |
42 |
42 |
2 |
11422 |
1142242 |
42201 |
| 11 |
42 |
42 |
3 |
11423 |
1142342 |
42301 |
| 22 |
64 |
64 |
1 |
22641 |
2264164 |
64101 |
| 33 |
64 |
64 |
1 |
33641 |
3364164 |
-1 |
| 44 |
61 |
61 |
1 |
44611 |
4461161 |
61101 |
| 44 |
62 |
61 |
1 |
44611 |
4461162 |
61101 |
| 44 |
63 |
61 |
1 |
44611 |
4461163 |
61101 |
| 55 |
71 |
71 |
1 |
55711 |
5571171 |
71102 |
| 55 |
71 |
71 |
2 |
55712 |
5571271 |
71102 |
The first three rows of the table represent a
situation where a person (DUPERSID=42) is listed three times in the PRPL file
because she obtains insurance from the same establishment in all three rounds.
Since the person is the policyholder, her DUPERSID is the same as the PHLDRIDX,
which is repeated in the EPRSIDX, EPCPIDX, and JOBSIDX.
The fourth and fifth rows of the table represent a
situation where a person (DUPERSID=64) is listed twice in the PRPL file because
she obtains insurance from more than one establishment. In this example, the
second establishment is not an employer or union, so JOBSIDX is inapplicable
(-1).
The sixth, seventh, and eighth rows of the table
represent a situation where a policyholder and two dependents obtain coverage
through the policyholder’s employer (a unique establishment-policyholder pair
within each round, EPRSIDX=44611). The policyholder’s PHLDRIDX appears in the
EPRSIDX and the JOBSIDX for all three covered persons.
The last two rows of the table represent a situation
where a person is retired and has retiree insurance through a job that ended
prior to 2013. In Panel 18, Round 1, the respondent reported the job from which
the sample member retired, and MEPS does not ask about that job again. However,
in each round we ask about the health insurance. So in Round 2 the JOBSIDX
contains round number 1, when the jobs data were last collected.
Finally, note that EPCPIDX uniquely identifies each
record on the file.
In order to conduct person-level analyses, it is
necessary to identify all policies that cover each individual either as a
policyholder or as a dependent. Since each person in the PRPL file is
uniquely identified by the variable DUPERSID, person-level analyses can be
conducted by examining all PRPL records containing each DUPERSID.
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The DUPERSID allows you to link on the age, sex, race,
health status, or other person-level variables from the other HC files. However,
this will result in multiple records per person, and estimates will not be
nationally representative unless you use one PRPL record per person or summarize
PRPL records to the person level (and use weights).
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The PHLDRIDX allows you to link characteristics of the
policyholder onto the records of every person covered by the plan. For example,
suppose you wanted to study persons whose private employment-based insurance is
through an employee working full time at a current main job as of the first
interview of 2013 (Panel 18 Round 1 or Panel 17 Round 3). Then you would select
PRPL records matching HC-151 (PITFLG=1) where the insurance is through a current
main job (CMJINS=1) and [(PANEL=18 and RN=1) or (PANEL=17 and RN=3)]. From
HC-151, select the DUPERSID and HOUR13 variables and rename DUPERSID to PHLDRIDX.
Merge HOUR13 onto the PRPL file by PHLDRIDX.
Some policyholders do not have records on HC-151 or
HC-157. These include deceased policyholders and policyholders residing outside
the RU. For these policyholders, PITFLG and FYFLG may be equal to 0, depending
on when the policyholder left the RU. All of the covered person records for
these establishment-policyholder pairs are flagged with DECPHLDR, OUTPHLDR, or
NOPUFLG equal to 1. Deceased policyholders complicate the estimation of
nationally representative statistics on active policies. For these
establishment-policyholder pairs, users must choose a covered person with a
positive weight. However, establishment-policyholder pairs where the
policyholder resides outside the RU should not be included in estimates, because
this will result in double counting, as RU members covering those outside the RU
are already included.
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In order to produce estimates from the data in this
file, researchers must use the person (or family) level weights released in
either of two previously released PUFs, HC-151 or HC-157. Researchers must
consult the documentation for these PUFs for guidance on creating nationally
representative estimates for different time periods.
Note that if there are multiple records per person (DUPERSID)
when you merge on weights, you will double count some people, and your estimates
will not be nationally representative. There are two solutions: select only one
record per person, or aggregate information across PRPL records.
How you develop your analytical file depends on your
research question. The PRPL file is designed to help answer a wide variety of
research questions. AHRQ cannot anticipate all these questions, so this section
provides examples of how to use the PRPL file for four research questions.
How many people were covered by two or more private
hospital/physician insurance plans at the end of 2013?
Select the Panel 18 Round 3 and Panel 17 Round 5
records with PRIVCAT>0 and MSUPINSX ne 1 and EVALCOVR=1. Count the number of records for each person (DUPERSID).
Create one person-level record for each DUPERSID that has the number of plans (PRPL
records). Merge the count variable onto PUF HC-157 and use weights, strata, and
PSUs to create nationally representative estimates.
How many people reported private dental coverage from
an employer at the end of 2013?
Select the Panel 18 Round 3 and Panel 17 Round 5
records with DENTLINS=1 and PRIVCAT in (1, 4, 5) and EVALCOVR=1. Among these records, select one record for
each person (DUPERSID). Merge each record onto PUF HC-157 and use weights,
strata, and PSUs to create nationally representative estimates.
At the time of the first interview, how many private
insurance policies for hospital/physician were not employment-based?
Select the Panel 18 Round 1 and Panel 17 Round 3
records with PRIVCAT in (2, 3, 99) and EVALCOVR=1. Select one record for each
policyholder-establishment pair (EPRSIDX). To have a positive weight for the
final count, we recommend choosing the covered person record of the policyholder
(PHOLDER=1), unless the policyholder is deceased (DECPHLDR=1), in which case
then the researcher should choose a different covered person’s record. Merge
each record onto PUF HC-151 and use weights, strata, and PSUs to create
nationally representative estimates.
At the time of the first interview of 2013, how many
people had insurance from jobs from which they retired?
Select the PRPL records for policyholders of
employment-related insurance at the time of the first interview [(Panel 18 Round
1 or Panel 17 Round 3) and PHOLDER=1 and PRIVCAT=1 and EVALCOVR=1]. From the
2013 JOBS file, PUF HC-158, select the records with jobs from which the person
retired (SUBTYPE=6 or RETIRJOB=1 or YLEFT=2 or YNOBUSN=2 or WHY_LEFT=3). Persons
in Panel 17 may have reported retiring from a job in 2012, so, from the 2012
JOBS file, PUF HC-150, select the records with PANEL=17 and (SUBTYPE=6 or
RETIRJOB=1 or YLEFT=2 or YNOBUSN=2 or WHY_LEFT=3). Combine the records from the
two JOBS files, keeping only one record per JOBSIDX. Using the JOBSIDX, merge
the selected JOBS records onto the selected PRPL records. Select the PRPL
records with SUBTYPE=6 or RETIRJOB=1 or YLEFT=2 or YNOBUSN=2 or WHY_LEFT=3 or
EMPLSTAT=2. Select one record for each DUPERSID. Merge each record onto PUF
HC-157 and use weights, strata, and PSUs to create nationally representative
estimates of the number of people with one of these PRPL records.
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In the MEPS Household Component, the definitions of
Dwelling Units (DUs) and Group Quarters are generally consistent with the
definitions employed for the National Health Interview Survey. The dwelling unit
ID (DUID) is a five-digit random ID number assigned after the case was sampled
for MEPS. The person number (PID) uniquely identifies all persons within the
dwelling unit. The variable DUPERSID is the combination of the variables DUID
and PID. The MEPS HC - PRPL file can be linked to other public use files
such as MEPS HC-151 by using the DUPERSID.
PHLDRIDX is the person identifier (DUID + PID) of the
policyholder of the private health insurance plan. Generally, the
characteristics of the policyholder can be linked from person-level public use
files by using the PHLDRIDX to match the DUPERSID on the person-level files.
However, when the policyholder is deceased or resides outside the RU, then there
are no person-level variables on public use files (unless the policyholder was alive
and resided in the household at some point during the time periods covered by
the interviews).
ESTBIDX is an ID number assigned to place of
employment and to sources of insurance.
EPRSIDX is a combination of ESTBIDX, PHLDRIDX, and RN.
In a few cases, more than one EPRSIDX may identify a policyholder-source of
coverage pair. For example, when an RU splits, through divorce or because a
child goes to college, each new RU separately reports insurance information, and
hence MEPS cannot determine with certainty whether members in both RUs have the
same policy. Although both RUs may report coverage through the same
policyholder, the RUs will have different EPRSIDXs and ESTBIDXs. (The RU letter
is embedded in the ESTBIDX and EPRSIDX.) For each RU (EPRSIDX), there is a PRPL
record for the policyholder as a covered person, but for only one of the
EPRSIDXs (the one in which the policyholder resides) is the policyholder coded
as having coverage in the STATUS or EVALCOVR variables.
JOBSIDX is a combination of the PHLDRIDX, a round
identifier (RN), and a job number, and it uniquely identifies the policyholder’s
job at the establishment that provided insurance (for employment-based
coverage). The round identifier embedded in JOBSIDX is the round in which the
job was last reported, which is not necessarily the round in which the insurance
was last reported (for example, when the job ended but the insurance continued).
JOBSIDX can be used to link on characteristics of the policyholder’s job
providing insurance from the Jobs public use file (HC-158).
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There are four person-level variables. Binary
variables indicate whether the person is the policy holder (PHOLDER) or a
dependent (DEPNDNT) on the coverage through the establishment. The variable
PITFLG indicates whether the person has a record on HC-151, and FYFLG indicates
whether the person has a record on HC-157.
There are 25 person-round-level variables. EVALCOVR is
a binary variable indicating whether the person was covered by insurance from
the establishment at the time of interview (Rounds 3 and 4 of Panel 17 and
Rounds 1 and 2 of Panel 18) or on December 31 (Round 5 of Panel 17 and Round 3
of Panel 18). The variables STATUS1-STATUS24 indicate whether the respondent
reported the person was covered by insurance from the establishment for at least
one day during the month. For Panel 18, STATUS1-STATUS12 represent coverage from
January 2013 through December 2013, and STATUS13-24 are inapplicable because
this information is in the year 2014. For Panel 17, STATUS13-STATUS24 represent
coverage from January 2013 through December 2013, and STATUS1-STATUS12 are
inapplicable because this information is in the year 2012. Coverage is reported
only for the interview reference period. For example, if a person from Panel 18
was first interviewed in February and reported she was covered in January and
February, and then in the second interview in August she reported she was
covered from March through August, then the PRPL record for the first round will
have STATUS1 and STATUS2 set to 1 and the rest set to inapplicable, and the PRPL
record for the second round will have STATUS3 through STATUS8 set to 1 and the
rest set to inapplicable.
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The values of three variables describing the
policyholder do not vary across the records of the persons covered by the plan,
regardless of whether the covered person is the policyholder. The variable
DECPHLDR indicates the policyholder is deceased. The variable OUTPHLDR indicates
the policyholder resides outside the RU. In each case, there are no person-level
records on a person-level PUF, even though the PRPL file has a record for the
policyholder as a covered person (that is, a record where PHOLDER=1). The
variable NOPUFLG indicates there is another reason the policyholder does not
have a record on a person-level PUF. The purpose of these flags is to explain
any difficulty users may have linking policyholder information onto the PRPL
file. These variables do not, however, measure mortality or policyholders’
leaving the household, which should instead be obtained from the PSTATS
variables on the person-level files. (For example, policyholders who die between
Round 1 (Panel 18) or 3 (Panel 17) and the end of 2013 will have records on
HC-151 and HC-157, and PITFLG and FYFLG will be set to 1.)
Return To Table Of Contents
The values of establishment-level variables do not
vary across the records of the persons insured through the
policyholder-establishment pair.
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The type of establishment providing coverage (TYPEFLAG)
is on the record. This variable is the source for types of establishments
providing employer-based and non-employer-based, private coverage. In this file,
TYPEFLAG includes the answers to HX03 and HX23. TYPEFLAG reflects the type of
establishment when the establishment was first reported, but it is not
necessarily updated. For example, users must link to the jobs file to obtain
information on employees who left their job since the interview in which the
employer was first reported (see Section 3.6). For employment-based coverage
through both an employer and a union (such as insurance through a
labor-management committee), for most cases, only the coverage record through
the employer establishment is retained. These cases are identifiable through the
PROVDINS variable on the JOBS File. In some cases, the union and employer may
provide different types of coverage. It is important for researchers to review
coverage type variables - HOSPINSX, MSUPINSX, PMEDINS, DENTLINS, VISIONIN, and
COBRA - to determine which establishment would be most helpful in answering
analytic questions.
As of Panel 14 Round 5 and Panel 15 Round 3, “High
Risk Pool” (TYPEFLAG = 20) was added to the list of sources of coverage at HX03
and HX23, where information is collected about purchased insurance associated
with a self-employed job and firm-size = 1, and privately purchased health
insurance not obtained through an employer.
Note that through Panel 12 Round 1, ‘Health Insurance
Purchasing Alliance’ was a source of coverage in HX03 (PURCHTYP = 4). Through
Panel 12 Round 2, it was also a source of coverage at HX23 (PRIVINS = 2). It was
removed as a source in subsequent rounds because it is ambiguous. No records
created in subsequent panels will show ‘Health Insurance Purchasing Alliance’ as
a source of coverage.
Note that when TYPEFLAG has a value of 10,
“spouse’s/deceased spouse’s previous employer,” and the spouse resides in the
RU, and the respondent selects the spouse as the policyholder at HP11, then the
policyholder’s ID is the spouse’s ID.
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The establishments in the PRPL file provide private
health insurance covering hospital/physician, Medicare supplemental insurance,
dental, vision, or prescription medication insurance. The variable PRIVCAT
identifies the type of source for hospital and physician or Medicare
supplemental insurance. HOSPINSX and MSUPINSX are edited
establishment-policyholder flags for whether the policyholder has
physician/hospital and Medigap coverage, respectively, through the
establishment. However, even when PRIVCAT indicates there is either
hospital/physician or Medigap coverage, both HOSPINSX and MSUPINSX may have
missing values. Note also that both HOSPINSX and MSUPINSX may be coded “yes” (1)
on the same record. DENTLINS, VISIONIN, and PMEDINS flags indicate the
establishment provides coverage for dental care, vision care, and prescription
medications, respectively. Below are examples of how to use these variables to
identify types of insurance:
| Identifying Types of Insurance |
Variable and Values |
Hospital and physician or Medicare
supplemental insurance |
PRIVCAT in (1, 2, 3, 4, 5, 99) |
| Medicare supplemental insurance |
MSUPINSX = 1 |
| Hospital and physician insurance |
PRIVCAT in (1, 2, 3, 4, 5, 99) & MSUPINSX ne 1 |
| Dental insurance |
DENTLINS = 1 |
The variable COBRA is a flag for whether the
respondent reported that the coverage was obtained through the requirements of
the COBRA of 1986. This act requires that certain employers allow some former
employees to continue their employment-based coverage by paying the employer the
premium (U.S. Department of Labor). This flag does not, however, indicate all
the coverage through former employers, which can be determined using TYPEFLAG
and links to former jobs in the JOBS file. COBRA is set to “yes” if any of the
three following conditions are met:
- The respondent said insurance from a previous job is the
source of coverage and the respondent answered yes to either
HP14 or OE14 (depending on when the job ended):
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)}?
Or
Did that health insurance continue
through COBRA?
- The respondent said COBRA is the source of insurance through
a self-insured firm with firm-size one (HX03)
- The respondent said COBRA is the source of insurance not
elsewhere reported (HX23)
COBRA is set to “no” (2) when the insurance was not
COBRA coverage. COBRA is set to “inapplicable” (-1) when the coverage was not
employment-based, and when the coverage was through a current job. COBRA is set
to “not ascertained” (-9) for retirement jobs first reported in the employment
section in Round 1 (EM80), retirement jobs first reported in the employment
section for new RU members (EM80), and insurance through unions reported in the
insurance section (HX23).[2] In a few cases, self-employed persons with firm size =
1 reported buying coverage through a previous job, and these cases are coded as
yes or no, while other insurance through self-employment with firm size = 1 is
coded “inapplicable.”
The variable COVTYPIN flags whether coverage was
single or family, based on the number of persons covered in the RU, whether the
establishment’s insurance covers someone outside the household, and whether the
policyholder is outside the household. For Panel 18 Rounds 1 and 2, and Panel 17
Rounds 3 and 4, the number of covered persons was measured at the time of the
interview (or end of the reference period). For Panel 18 Round 3 and Panel 17
Round 5 the number is as of December 31st. Beginning with the 2010
data, when coverage ceased before the end of the reference period for every
co-residing family member, COVTYPIN is set based on the number of persons ever
covered during the round. The variable COVROUT indicates whether out-of-RU
persons were covered by the plan.
[2] In these three cases, the survey was not designed to ascertain whether the coverage was COBRA or not, but the variable is coded as "not ascertained" to help analysts.
Return To Table Of Contents
In the MEPS, questions on out-of-pocket premiums were
asked of all policyholders with private insurance coverage for all
establishments. The variable OOPPREM provides the monthly out-of-pocket premium
paid by the policyholder for coverage through the establishment for Panel 18 as
of Round 1 and Panel 17 as of Round 3. OOPELIG flags these
covered-person-policyholder-establishment triples. OOPPREMX provides an edited
version of OOPPREM and the variable OOPFLAG identifies which records were
edited. OOPX12X is provided as a convenience to researchers and contains the
edited monthly out-of-pocket premium amount multiplied by 12, representing the
annual amount.
The edited variable OOPPREMX includes imputed values
for records which contained missing values as well as for a limited number of
records with values that were implausibly low or high. For policyholders in
Panel 17 Round 3 with missing out-of-pocket premiums, if coverage is through a
continuation job which was originally reported in Panel 17 Round 1 and type of
coverage (COVTYPIN) is the same as in Panel 17 Round 1, then OOPPREMX is set
equal to OOPPREMX from Panel 17 Round 1 times the growth rate in out-of-pocket
premiums from 2012 to 2013. The growth rate is assigned by type of coverage and
is based on private sector out-of-pocket premiums reported in the MEPS Insurance
Component in 2012 and 2013. For all other cases, imputed values were assigned by
one of several imputation methods - hot deck imputation or MEANS substitution,
both of which consider the following person/plan characteristics: source of
insurance (private employer, state and local government, federal government,
Medigap, other non-group policy), age of policyholder, educational attainment of
policyholder, number of persons covered by the policy, if there is a high family
deductible, size of employer, region and MSA, presence of supplemental benefits
such as drug, dental and vision, and active or retired job.
Both OOPPREM and OOPPREMX are coded as zero for group
policyholders who reported paying none of their premium.
OOPPREM was created using the out-of-pocket amount
reported and the frequency of payments (HX61, HX62, and HX62OV1):
For the coverage through (ESTABLISHMENT), does anyone
in the family pay all of the premium or cost, some of the premium or cost, or
none of the premium or cost?
[Do not include the cost of any co-payments,
coinsurance or deductibles anyone in the family may have had to pay.]
[Do include any contribution made to the plan
as part of a paycheck.]
How much {(do/does)/did} (POLICYHOLDER) pay for the
(ESTABLISHMENT) coverage?
{Is/Was} that per year, per month, per week, or what?
PREMLEVX shows whether OOPPREM was the full premium or
part of it. When the respondent reported the person paid some or none of the
premium, the variables BYFED, BYSTATE, BYLOCAL, BYSOMGOV, BYEMPL, BYUNION,
BYOTHER indicate who paid the rest of the premium.
For the entire set of 13 variables (OOPPREM, OOPPREMX,
OOPX12X, OOPELIG, OOPFLAG, PREMLEVX, BYFED, BYSTATE, BYLOCAL, BYSOMGOV, BYEMPL,
BYUNION, BYOTHER), the same values are reported on the records of each dependent
person covered through the policyholder’s establishment, but the policyholder
paid only once per establishment-policyholder.
Return To Table Of Contents
The values of plan-level variables do not vary across
the records of the persons insured through the policyholder-establishment pair.
Beginning in Panel 15 Round 3 and Panel 16 Round 1,
the variables ANNDEDCT (HX63A/OE09B/OE23B/OE35B) and HSAACCT
(HX63B/OE09C/OE23C/OE35C) were added to capture whether a private health plan
has a high deductible and whether that plan is associated with a Health Savings
Account (HSA) or a similar special fund/account. These questions are asked
during the first report and during the review of insurance in Rounds 1 and 3 for
all private plans except for individuals covered by disability, workers’
compensation, accident insurance, or any combination thereof, and/or individuals
covered by Medicare supplement/Medigap plans.
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The variable UPRHMO identifies records for HMO
coverage when the household respondent reported that the insurance was purchased
through an HMO, reported the insurance company was an HMO, or described the plan
as an HMO. In all cases the respondent answered a question using the term “HMO.”
UPRHMO is set to “yes” if any of the three following conditions are met:
- If the respondent reported insurance purchased directly
through an HMO (HX03, HX23)
- If the respondent identified the type of insurance company
as an HMO (HX49, HX51)
- If the respondent answered yes to the following question
(MC01):
{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.]
UPRHMO is set to “no” when the plan was not an HMO.
UPRHMO is set to “inapplicable” when the plan was not hospital/physician or
Medicare supplemental coverage.
As of Panel 17 Round 5 and Panel 18 Round 3, a series
of variables regarding managed care and private insurance were dropped from the
interview. These include questions MC02 – MC05 from the Managed Care section.
Consequently, the following variables have been removed from this delivery:
UPRMNC, DRLIST, VISITPAY.
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Starting in Panel 17 Round 4 and Panel 18 Round 2,
questions regarding the family’s experience with a private insurance plan were
removed from the interview. Consequently, the following variables have been
removed from this delivery: SATELIG, GTDOCPRB, APRVTRET, APRVDLAY, LOOKINF,
PRBFDINF, CUSTSERV, PRBCSTSV, PAPRWRK, PRBPPRWK, RATEPLAN.
Return To Table Of Contents
The variable NAMECHNG indicates whether the name of
the plan obtained through the establishment changed from the prior round. For
Panel 18 Rounds 2 and 3 and Panel 17 Rounds 3, 4 and 5, NAMECHNG is set to “yes”
if someone in the RU had coverage through the establishment in the prior round
and still had coverage at the time of the interview, and the respondent answered
yes to the following question (OE09, OE23, OE35):
{Last time we recorded that (POLICYHOLDER) (were/was)
covered by {INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD
INT DT}.}
{Since (START DATE), has there been/Between (START
DATE) and (END DATE), was there} any change in the plan name of
the health insurance (POLICYHOLDER) (have/has) through
(ESTABLISHMENT)?
If the respondent answered no, then NAMECHNG is coded
“no”. If no one in the RU had coverage through the establishment in the prior
round, no one had coverage at the time of the interview, or it is a Round 1
record, then NAMECHNG is set to “inapplicable.”
When the respondent answered yes, then MEPS HC asked
about types of benefits and managed care, which are updated on the PRPL file.
There are two important caveats to this variable.
First, changes in plan name do not necessarily imply the plan itself changed.
For example, the plan may have merely changed its name for marketing purposes.
Second, the variable NAMECHNG pertains only to changes in plan names at the same
establishment; a policyholder may switch plans if she or he switches the
establishment (including employer) through which she or he obtains insurance.
Switches in EPRSIDs and ESTBIDs between rounds indicate those other types of
changes.
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For employment-based insurance, there are two
variables linking the insurance to details about the jobs through which the
insurance was obtained, CMJINS and JOBSIDX.
Most people with employment-based insurance have it
through current main jobs. The variable CMJINS indicates whether the insurance
is through a current main job. When insurance is through a previous job or
through self-employment and there is only one employee, then CMJINS is set to
“no”. When the insurance is not employment-based, CMJINS is set to
“inapplicable.” Generally, many edited and imputed variables describing
policyholders’ current main jobs are available on HC-151 and HC-157. If CMJINS
=1 and the policyholder has a PUF record (PITFLG or FYFLG = 1), then edited and
imputed current main jobs variables are available on the indicated PUF.
For other types of jobs (for example, former jobs),
the JOBS files (HC-158 and HC-150) contain edited variables describing the job.
JOBSFILE indicates which jobs file contains information about the source of
coverage. In most cases, information about the job is in HC-158, but for Panel
17, if the job ended before 2013, information about the job is contained in
HC-150. JOBSIDX is the link to the record for the job in the JOBS file that is
the source of coverage. This link is slightly complicated, because the variable
JOBSINFR indicates links that were inferred, rather than obtained directly from
the respondent. Links were inferred because, when persons reported
employment-based health insurance at the end of the insurance section (HX23),
the plan was not always easily linked to a specific job. Most of these cases
were directly linked by establishment IDs, but others required inferences based
on whether the insurance was through a current or former job (EMPLSTAT), and
some could not be linked at all.
The variable EMPLSTAT contains the answers to question
HP12, which is asked only about the policyholders of employment-related
insurance first mentioned at the end of the insurance section of the interview
(HX23), and it is asked only in the interview round where the insurance was
first reported. Thus, it is useful only for the cases where links to jobs could
not be inferred. Because it does not contain updated information about the
policyholder’s employment at each interview, the value is set to -2 in
subsequent rounds, and users can link back to the PRPL record from the prior
rounds, using the DUPERSID, ESTBIDX, and PHLDRIDX to get the original
information.
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The set of households selected for MEPS is a subsample
of those participating in the National Health Interview Survey (NHIS), thus,
each MEPS panel can be linked back to the previous year’s NHIS public use data
files. For information on obtaining MEPS/NHIS link files please see
meps.ahrq.gov/data_stats/more_info_download_data_files.jsp.
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Panel-specific longitudinal files are available for
downloading in the data section of the MEPS Web site. For each panel, the
longitudinal file comprises MEPS survey data obtained in Rounds 1 through 5 of
the panel and can be used to analyze changes over a two-year period. Variables
in the file pertaining to survey administration, demographics, employment,
health status, disability days, quality of care, patient satisfaction, health
insurance, and medical care use and expenditures were obtained from the MEPS
full-year Consolidated files from the two years covered by that panel.
For more details or to download the data files, please
see Longitudinal Weight Files at
meps.ahrq.gov/data_stats/more_info_download_data_files.jsp.
Return To Table Of Contents
MEPS began in 1996, and the utility of the survey for
analyzing health care trends expands with each additional year of data. However,
it is important to consider a variety of factors when examining trends over time
using MEPS. Statistical significance tests should be conducted to assess the
likelihood that observed trends are not attributable to sampling variation. The
length of time being analyzed should also be considered. In particular, large
shifts in survey estimates over short periods of time (e.g. from one year to the
next) that are statistically significant should be interpreted with caution,
unless they are attributable to known factors such as changes in public policy,
economic conditions, or MEPS survey methodology.
With respect to methodological considerations, in 2013
MEPS introduced an effort to obtain more complete information about health care
utilization from MEPS respondents with full implementation in early 2014 at the
start of the final rounds of data collection for 2013. This effort likely
resulted in improved data quality and a reduction in underreporting in 2013, but
could have some modest impact on analyses involving trends in utilization across
years.
There are also statistical factors to consider in
interpreting trend analyses. Looking at changes over longer periods of time can
provide a more complete picture of underlying trends. Analysts may wish to
consider using techniques to evaluate, smooth or stabilize analyses of trends
using MEPS data such as comparing pooled time
periods (e.g. 1996-97 versus 2012-13), working with moving averages, or using
modeling techniques with several consecutive years of MEPS data to test the fit
of specified patterns over time. Finally, researchers should be aware of the
impact of multiple comparisons on Type I error. Without making appropriate
allowance for multiple comparisons, undertaking numerous statistical
significance tests of trends increases the likelihood of concluding that a
change has taken place when one has not.
Return To Table Of Contents
U.S. Department of Labor. Employee Benefits Security
Administration. 2006. An Employee’s Guide to Health Benefits under COBRA, the
Consolidated Omnibus Budget Reconciliation Act of 1986. Washington, DC.
[Available online at:
www.dol.gov/ebsa/pdf/cobraemployee.pdf]
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VARIABLE-SOURCE CROSSWALK FOR MEPS PUBLIC USE FILE HC-161
Health Insurance Variables - Source
| Variable |
Description |
Source |
| EPCPIDX |
UNIQUE RECORD IDENTIFIER (EPRSIDX + DUPERSID) |
CONSTRUCTED |
| DUPERSID |
PERSON IDENTIFIER (EITHER DEPENDENT OR POLICYHOLDER) |
CONSTRUCTED |
| PHLDRIDX |
PERSON IDENTIFIER OF THE POLICYHOLDER |
CONSTRUCTED |
| ESTBIDX |
ESTABLISHMENT ID |
CONSTRUCTED |
| EPRSIDX |
UNIQUELY IDENTIFIES
INSURANCE COVERAGE THAT A POLICYHOLDER OBTAINS
FROM ESTABLISHMENT (ESTBIDX+PHLDRIDX+RN) |
CONSTRUCTED |
| PANEL |
PANEL NUMBER |
CONSTRUCTED |
| RN |
ROUND NUMBER |
CONSTRUCTED |
| JOBSIDX |
JOB IDENTIFIER |
CONSTRUCTED |
| JOBSINFR |
JOBSIDX INFERRED RATHER THAN REPORTED ID |
CONSTRUCTED |
| JOBSFILE |
PUF NUMBER WITH JOBSIDX |
CONSTRUCTED |
| PITFLG |
PERSON IN POINT-IN-TIME PUF |
CONSTRUCTED |
| FYFLG |
PERSON IN FY PUFS |
CONSTRUCTED |
| CMJINS |
CMJ AS THE SOURCE OF PLAN: 1 YES, 2 NO |
CONSTRUCTED |
| EMPLSTAT |
POLICYHOLDER EMPLOYMENT STATUS |
HP12 |
| PHOLDER |
POLICY HOLDER |
HP09, 11 |
| DEPNDNT |
DEPENDENT OF POLICY HOLDER |
CONSTRUCTED |
| EVALCOVR |
COVERED @ INTERVIEW OR 12/31 |
HQ01, 02 |
| STATUS1 – STATUS24 |
STATUS - MONTH 1 THROUGH
STATUS - MONTH 24 |
HQ01, 02, 03, 04, 05 |
| DECPHLDR |
DECEASED POLICYHOLDER FLAG: 1 YES, 2 NO |
CONSTRUCTED |
| OUTPHLDR |
OUT-OF-RU POLICYHOLDER FLAG |
CONSTRUCTED |
| NOPUFLG |
PHLDR NOT IN FULL YEAR OR PIT PUFS |
CONSTRUCTED |
| COVROUT |
POLICY COVERS PERS NOT IN RU |
HP16, 17; OE08A, 22A, 32, 34A |
| TYPEFLAG |
TYPE OF ESTABLISHMENT |
HX03, 23; EM06, 08,
12, 14, 19, 22, 23, 28, 31, 32, 41, 44, 45, 57,
58, 71, 74, 75, 83, 86, 87, 118, 120 |
| PRIVCAT |
CATEGORY OF PRIVATE COVERAGE |
CONSTRUCTED |
| HOSPINSX |
TYPE OF HI GOTTEN: HOSPITAL/HMO (EDITED) |
HX48 |
| MSUPINSX |
TYPE OF HI GOTTEN: MEDIGAP (EDITED) |
HX48 |
| DENTLINS |
TYPE OF HI GOTTEN: DENTAL |
HX48 |
| VISIONIN |
TYPE OF HI GOTTEN: VISION |
HX48 |
| PMEDINS |
TYPE OF HI GOTTEN: PRESCRIPTION DRUG |
HX48 |
| COBRA |
COBRA COVERAGE: 1=YES, 2=NO |
CONSTRUCTED |
| COVTYPIN |
COVERAGE @INTVW: 1=SINGLE, 2=FAMILY |
HP15, 16, 17 |
| OOPELIG |
FLAG: POLICYHOLDER ESTB HAS PREMIUM |
CONSTRUCTED |
| OOPPREM |
MONTHLY OUT-OF-POCKET PREMIUM |
HX61, 62 |
| OOPPREMX |
MONTHLY OUT-OF-POCKET PREMIUM (ED/IMP) |
CONSTRUCTED |
| OOPX12X |
ANNUAL OUT-OF-POCKET PREMIUM (ED/IMP) |
CONSTRUCTED |
| OOPFLAG |
OOPPREMX EDIT/IMPUTATION FLAG |
CONSTRUCTED |
| PREMLEVX |
HOW MUCH OF PREMIUM PAID BY FAM (ED) |
HX61, 62 |
| BYFED |
FEDERAL GOVT PAID FOR
PRIV PLAN PREMIUM |
HX63 |
| BYSTATE |
STATE GOVT PAID FOR
PRIV PLAN PREMIUM |
HX63 |
| BYLOCAL |
LOCAL GOVT PAID FOR
PRIV PLAN PREMIUM |
HX63 |
| BYSOMGOV |
SOME GOVT PAID FOR
PRIV PLAN PREMIUM |
HX63 |
| BYEMPL |
EMPLOYER PAID FOR PRIV
PLAN PREMIUM |
HX63 |
| BYUNION |
UNION PAID FOR PRIV
PLAN PREMIUM |
HX63 |
| BYOTHER |
OTHER PAID FOR PRIV
PLAN PREMIUM |
HX63 |
| ANNDEDCT |
ANNUAL DEDUCTIBLE |
HX63A, OE09B, 23B, 35B |
| HSAACCT |
HSA W/THIS PLAN |
HX63B, OE09C, 23C, 35C |
| UPRHMO |
HMO COVERAGE (FROM
PRPL) |
CONSTRUCTED |
| NAMECHNG |
HAS THERE BEEN A
CHANGE IN PLAN NAME |
OE09, 23, 35 |
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