MEPS HC-103: 2006 Person Round Plan Public Use File
November 2008
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 Pooling Annual Files
4.3 Longitudinal Analysis
5.0 Using MEPS Data for Trend Analysis
_._ References
D. Variable Source Crosswalk
A. Data Use Agreement
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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B. Background
1.0 Household Component
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. MEPS oversamples additional policy relevant
sub-groups such as Asians and low income households. The linkage of the MEPS to
the previous year's NHIS provides additional data for longitudinal analytic
purposes.
Return To Table Of Contents
2.0 Medical Provider Component
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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3.0 Survey Management and Data Collection
MEPS HC and MPC data are collected under the
authority of the Public Health Service Act. Data are collected under
contract with Westat, Inc. 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:
www.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).
Return To Table Of Contents
C. Technical and Programming
Information
1.0 General Information
This public use data file contains data for each
person with private health insurance reported in rounds 3, 4, and 5 of Panel 10
and rounds 1, 2, and 3 of Panel 11 (i.e., the rounds for the survey panels
covering calendar year 2006) of the Medical Expenditure Panel Survey Household
Component (MEPS HC). Released as an ASCII file (with related SAS and SPSS
programming statements and data user information) and in SAS transport format,
this public use file provides information collected on a nationally
representative sample of the civilian noninstitutionalized population of the
United States during the calendar year 2006. The HC-103 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 and experiences with plans. The file
contains 82 variables and has a logical record length of 245 with an additional
2-byte carriage return/line feed at the end of each record.
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2.0 Data File Description
The Person-Round-Plan (PRPL) file for 2006 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-093 and HC-099)
requires users making analytic decisions based on understanding the complexity
of the PRPL file.
Records contain the following types of
information (Figure 1):
- 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
- Family experience with plan (collected for
rounds 2 and 4)
- Links to the job providing insurance (for
employment-based insurance only, HC-100)
1No effort has
been made to validate variables representing type of coverage with external
sources.
Flowchart depicting the five types of record information
|
FIGURE 1
CONCEPTUAL OVERVIEW OF PRPL |
| |
|
Covered
Person:
Policyholder or Dependent
Enrollment at Time of Interview or End of Year |
|
|
|
|
| |
Interview Round |
| |
| |
|
| |
Policyholder |
| |
| |
|
| |
Links to policyholder’s Job at Establishment
(Employment-Based Insurance Only) |
| |
| |
|
| |
Establishment Providing Insurance:
Type of Establishment
Types Coverage
Out-of-Pocket Premiums |
| |
| |
|
| |
Plan
(Hospital/Physician and Medigap Only):
Managed Care
Family Experience with Plan (rounds 2 & 4) |
| |
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 are asked in reference to the establishment providing
insurance to the policyholder. For example, the MEPS HC asks 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 (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.
Return To Table Of Contents
2.1 Complex File Structure with Examples
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 61,623 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-100. 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-100. 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-100. - 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-100.
Policyholders Not in the Household
Edith is a widow and has retiree insurance
from her former 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 former 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 Respondent Unit (RU),
but this PRPL record does not link to any records on any PUFs.
Changes in Insurance
Bob changes jobs between January 1st,
2006 and the date of his MEPS interview, and both jobs provided 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 11) 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-100. 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 jobs variables from Round 1 are no longer current in
Round 2, but the link exists for users.
Return To Table Of Contents
2.2 Identifiers
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-that is 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 (1) if they are covered (as a policyholder or a dependent) by
insurance policies from more than one establishment, or (2) if 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 2006. In Panel 11, 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.
Return To Table Of Contents
2.3 Adding the Characteristics of Covered Persons
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).
Return To Table Of Contents
2.4 Adding the Policyholder’s Characteristics
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 2006 (Panel 11 Round 1 or Panel 10 Round 3). Then you
would select PRPL records matching HC-093 (PUF93FLG=1) where the insurance is
through a current main job (CMJINS=1) and [(PANEL=11 and RN=1) or (PANEL=10 and
RN=3)]. From HC-093, 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-093
or HC-099. These include deceased policyholders and policyholders residing
outside the RU. For these policyholders, PUF93FLG and PUF99FLG may be equal to
2, 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.
Return To Table Of Contents
2.5 Choosing PRPL Records for Your Research Question
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-093 or HC-099. 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 five research
questions.
How many people were covered by two or more
private hospital/physician insurance plans at the end of 2006?
Select the Panel 11 Round 3 and Panel 10 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-099 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 2006?
Select the Panel 11 Round 3 and Panel 10 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-099 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 11 Round 1 and Panel 10 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-093 and use weights, strata, and PSUs to create
nationally representative estimates.
How many people were in families
that gave the highest rating for at least one of their private health plans?
Select the Panel 11 Round 2 and Panel 10 Round 4
records with SATELIG=1 and RATEPLAN=10. Select one record for each DUPERSID.
Merge each record onto PUF HC-099 and use weights, strata, and PSUs to create
nationally representative estimates.
At the time of the first
interview of 2006, 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 11 Round
1 or Panel 10 Round 3) and PHOLDER=1 and PRIVCAT=1 and EVALCOVR=1]. From the
2006 JOBS file, PUF HC-100, 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 10 may have reported retiring from a job in 2005, so, from the 2005
JOBS file, PUF HC-091, select the records with PANEL=10 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 RETIREJOB=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-099 and use weights, strata, and PSUs to create nationally representative
estimates of the number of people with one of these PRPL records.
Return To Table Of Contents
3.0 Data File Contents
3.1 ID Variables
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 person-level public
use files such as MEPS HC-093: Combined Panel 10, Round 3/Panel 11, Round 1 2006
Population Characteristics 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 other person-level public
use files by using the PHLDRIDX to match the DUPERSID on the other 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, because when an RU splits, for example, 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
EPRSIDX’s (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-100).
Return To Table Of Contents
3.2 Person Variables
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
PUF93FLG indicates whether the person has a record on HC-093, and PUF99FLG
indicates whether the person has a record on HC-099.
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 10 and Rounds 1, and 2 of Panel 11) or on December 31 (Round 3 of Panel 11
and Round 5 of Panel 10). 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 11, STATUS1-STATUS12 represent
coverage from January 2006 through December 2006, and STATUS13-24 are
inapplicable, because this information is in the year 2007. For Panel 10,
STATUS13-STATUS24 represent coverage from January 2006 through December 2006,
and STATUS1-STATUS12 are inapplicable, because this information is in the year
2005. Coverage is reported only for the interview reference period. For example,
if a person from Panel 11 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 for the second round will have STATUS3 through
STATUS8 set to 1 and the rest set to inapplicable.
Return To Table Of Contents
3.3 Policyholder Variables
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 OUTHLDR 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
rounds 1 (Panel 11) or 3 (Panel 10) and the end of 2006 will have records on
HC-093 and HC-099, and PUF93FLG and PUF99FLG will be set to 1.)
Return To Table Of Contents
3.4 Establishment Variables
The values of establishment-level variables do
not vary across the records of the persons insured through the
policyholder-establishment pair.
Return To Table Of Contents
3.4.1 Employers and Other Establishments
The type of establishment providing coverage (TYPEFLAG)
is on the record. This variable is the source for types of establishments
providing coverage that is not through an employer (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), information about only one of the establishments,
usually the employer, is on the record. (These cases are identifiable through
the PROVDINS variable on the JOBS file.) Note that when TYPEFLAG has a value of
10, "spouse/deceased spouse," 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.
Return To Table Of Contents
3.4.2 Types of Coverage through the Establishment
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’ 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 1999). 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 (POLICYHOLDER)’s (ESTABLISHMENT)
insurance like that?
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" when the insurance was not
COBRA coverage. COBRA is set to "inapplicable" when the coverage was not
employment-based, and when the coverage was through a current job. COBRA is set
to "not ascertained" 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 11 rounds 1 and 2, and Panel 10
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 11 Round 3 and Panel 10
Round 5 the number is as of December 31st.
2In 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.
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3.4.3 Out-of-Pocket Premiums
In the 2006 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 11 as
of Round 1 and Panel 10 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 10 Round 3 with missing out-of-pocket premiums, if
coverage is through a continuation job which was originally reported in Panel 10
Round 1 and type of coverage (COVTYPIN) is the same as in Panel 10 Round 1, then
OOPPREMX is set equal to OOPPREMX from Panel 10 Round 1 times the growth rate in
out-of-pocket premiums from 2005 to 2006. The growth rate is assigned by type of
coverage and is based on private sector out-of-pocket premiums reported in MEPS
Insurance Component in 2005 and 2006. For all other cases, imputed values were
assigned by a hotdeck imputation procedure which accounted for source of
insurance (private employer, state and local government, federal government,
medigap, other non-group policy), age of policyholder, number of persons covered
by the policy, 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.]
How much {(do/does)/did} (POLICYHOLDER) pay
for the (ESTABLISHMENT) coverage?
PROBE: {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 they 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
3.5 Plan Variables
The values of plan-level variables do not vary
across the records of the persons insured through the policyholder-establishment
pair. The PRPL file contains managed care and experience with plan variables for
hospital/physician and Medicare supplemental plans. For all other plans, these
variables are set to "inapplicable."
Return To Table Of Contents
3.5.1 Household Reports of Managed Care
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 purchasing the insurance 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): Now I will ask you a few questions about
how (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) works for
non-emergency care.
We are interested in knowing if (POLICYHOLDER)’s
(ESTABLISHMENT) plan is an HMO, that is, a Health Maintenance
Organization. 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. Is (POLICYHOLDER)’s
(INSURER NAME) an HMO?
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.
The variable UPRMNC identifies records for
gatekeeper plans. The household respondent has not identified the plan as an HMO
but has identified a characteristic of the plan that requires plan members to
sign up with a gatekeeper for all routine care (the exact question is given
below). In 1998, this gatekeeper feature was associated with HMO plans and with
some Preferred Provider Organization (PPO) plans. Users of the data can decide
how to classify these persons. UPRMNC is set to "yes" if the following condition
is met:
If the respondent answered "no" to the HMO
question (MC01) and "yes" to the following question (MC02):
(Do/Does) (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.
UPRMNC is set to "no" when the plan does not
require a gatekeeper and when the plan is an HMO. UPRMNC is set to
"inapplicable" when the plan is not hospital/physician or Medicare supplemental
coverage.
For plans other than HMOs and those with
gatekeepers, the variable DRLIST identifies records for plans that the household
respondent said had a book or list of doctors. The household respondent has not
identified the plan as a PPO but has identified a plan characteristic associated
with PPO plans. If both the following conditions were met:
If the person did not say the plan is an HMO (HX03, HX23, HX49, HX51, MC01) - If the respondent answered "no" to the gatekeeper question (MC02)
then the respondent was asked MC03:
Is there a book or list of doctors associated with the plan?
DRLIST is set to "inapplicable" when the plan is
not hospital/physician or Medicare supplemental coverage, when the plan is an
HMO, or when the plan requires a gatekeeper.
For HMOs and for plans with gatekeepers and lists
of doctors, the variable VISITPAY identifies records for plans that the
household respondent said paid for out-of-network visits. The household
respondent has not identified the plan as a PPO or a Point of Service (POS) plan
but has identified a plan characteristic associated with PPO and POS plans. When
the respondent answered "yes" to the gatekeeper question (MC02), or answered
"yes" to the list of doctors question (MC03), then VISITPAY has the responses to
MC04:
Will (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) not have a referral?
When the respondent said the plan is an HMO
(HX03, HX23, HX49, HX51, MC01), then VISITPAY has the responses to MC05, HX60A,
OE11B, OE25B, and OE38B:
Will (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) not have a referral?
VISITPAY is set to "inapplicable" when the plan
is not hospital/physician or Medicare supplemental coverage, or when the plan
does not require a gatekeeper and does not have a list of doctors.
Return To Table Of Contents
3.5.2 Family Experience with Plan
Experience with plan questions were asked at
Rounds 2 (Panel 11) and 4 (Panel 10) for families where at least one member was
covered by the plan at the time of the interview. The variable SATELIG indicates
whether the policyholder-establishment was eligible for the experience with plan
questions. Respondents were eligible for the experience with plan questions if
someone in the RU was covered by the plan on the date of the interview and the
insurance was hospital/physician or Medicare supplemental coverage. Question
wording is based on questions in the Consumer Assessment of Health Plans (CAHPS®),
an AHRQ-sponsored family of survey instruments designed to measure quality from
the consumer’s perspective.
The variables address the following topics:
difficulty getting a personal doctor or nurse (GTDOCPRB), delays waiting for
plan approval for care (APRVTRET, APRVDLAY), problems finding or understanding
plan information (LOOKINF, PRBFDINF), problems getting help from customer
service (CUSTSERV, PRBCSTSV), problems with paperwork (PAPRWRK, PRBPPRWK), and
rating of experience with plan (RATEPLAN).
When multiple RU members were covered by the same
private plan, the respondent answered the questions once and described
experiences for the policyholder and family members. These family (RU)-level
responses are on each Round 2 or 4 covered person-policyholder-establishment
record for the policyholder-establishment and do not vary across covered
persons.
Return To Table Of Contents
3.5.3 Change in Plan Name
The variable NAMECHNG indicates whether the name
of the plan obtained through the establishment changed from the prior round. For
Panel 11 Rounds 2 and 3 and Panel 10 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):
Since (START DATE), has there been any
change in the plan name of the health insurance (POLICYHOLDER) 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 he or she obtains insurance.
Switches in EPRSIDs and ESTBIDs between rounds indicate those other types of
changes.
Return To Table Of Contents
3.6 Links to Job Providing Insurance
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, then CMJINS is set to
"inapplicable." Generally, many edited and imputed variables describing
policyholders’ current main jobs are available on HC-093 and HC-099. If CMJINS
=1 and the policyholder has a PUF record (PUF93FLG or PUF99FLG), 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-100 and HC-091) 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-100, but
for Panel 10, if the job ended before 2006, information about the job is
contained in HC-091. 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 is 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.
Return To Table Of Contents
4.0 Linking to Other Files
4.1 National Health Interview Survey
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
www.meps.ahrq.gov/data_stats/more_info_download_data_files.jsp.
Return To Table Of Contents
4.2 Pooling Annual Files
To facilitate analysis of subpopulations and/or
low prevalence events, it may be desirable to pool together more than one year
of data to yield sample sizes large enough to generate reliable estimates. For
more details on pooling MEPS data files see
www.meps.ahrq.gov/data_stats/download_data_files_detail.jsp?cboPufNumber=HC-036.
Starting in Panel 9, values for DUPERSID from
previous panels will occasionally be re-used. Therefore, it is necessary to use
the panel variable (PANEL) in combination with DUPERSID to ensure unique
person-level identifiers across panels. Creating unique records in this manner
is advised when pooling MEPS data across multiple annual files that have one or
more identical values for DUPERSID.
Return To Table Of Contents
4.3 Longitudinal Analysis
Panel-specific files containing estimation
variables to facilitate longitudinal analysis are available for downloading in
the data section of the MEPS Web site.
Return To Table Of Contents
5.0 Using MEPS Data for Trend Analysis
MEPS began in 1996 and the utility of the survey
for analyzing analyses of 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 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.
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
smooth or stabilize analyses of trends using MEPS data such as comparing pooled
time periods (e.g. 1996-97 versus 2005-06), 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 because performing numerous
statistical significance tests of trends increases the likelihood of
inappropriately concluding a change is statistically significant.
Return To Table Of Contents
References
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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D. Variable Source Crosswalk
VARIABLE TO SOURCE
CROSSWALK
FOR MEPS PUBLIC USE FILE HC-103
HEALTH INSURANCE VARIABLES - SOURCE
Variable |
Description |
Source |
EPCPIDX |
UNIQUE RECORD IDENTIFIER (DUPERSID+EPRSIDX) |
CONSTRUCTED |
DUPERSID |
PERSON IDENTIFIER (EITHER DEPENDENT OR POLICYHOLDER) |
CONSTRUCTED |
PHLDRIDX |
PERSON IDENTIFIER OF THE POLICYHOLDER |
CONSTRUCTED |
RN |
ROUND NUMBER |
CONSTRUCTED |
ESTBIDX |
ESTABLISHMENT ID |
CONSTRUCTED |
EPRSIDX |
UNIQUELY IDENTIFIES INSURANCE COVERAGE THAT A POLICYHOLDER OBTAINS FROM ESTABLISHMENT (ESTBIDX+PHLDRIDX+RN) |
CONSTRUCTED |
PANEL |
PANEL NUMBER |
CONSTRUCTED |
JOBSIDX |
UNIQUELY IDENTIFIES POLICYHOLDER’S JOB AT THE ESTABLISHMENT THAT PROVIDED INSURANCE |
CONSTRUCTED |
JOBSINFR |
JOBSIDX INFERRED RATHER THAN REPORTED ID |
CONSTRUCTED |
JOBSFILE |
PUF NUMBER WITH JOBSIDX |
CONSTRUCTED |
PUF93FLG |
INDICATOR IF PERSON IS IN PUF HC-093 |
CONSTRUCTED |
PUF99FLG |
INDICATOR IF PERSON IS IN PUF HC-099 |
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 |
CONSTRUCTED |
OUTPHLDR |
OUT-OF-RU POLICYHOLDER FLAG |
CONSTRUCTED |
NOPUFLG |
PHLDR NOT IN HC-093 OR HC-099 |
CONSTRUCTED |
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 |
UPRHMO |
HMO COVERAGE (FROM PRPL) |
CONSTRUCTED |
UPRMNC |
PLAN REQRD COVRD PERS USE GATEKEEPER |
MC02 |
DRLIST |
DOES PLAN HAVE A BOOK/LIST OF DOCTORS? |
MC03 |
VISITPAY |
PLAN PAY FOR NON-REFER DR VISIT |
MC04 |
NAMECHNG |
HAS THERE BEEN A CHANGE IN PLAN NAME |
OE09, 23, 35 |
SATELIG |
ELIG. FOR SATIS. PLAN QUEST: 1=YES, 2=NO |
PRIVCAT, RN, EVALCOVR |
GTDOCPRB |
HOW MUCH PROBLEM GETTING PERSONAL DOC |
SP02 |
APRVTRET |
NEED APPROVAL FOR TREATMENT |
SP03 |
APRVDLAY |
DELAY WAITING FOR APPROVAL |
SP04 |
LOOKINF |
INFORMATION ON HOW PLAN WORKS |
SP05 |
PRBFDINF |
PROBLEM FINDING INFORMATION |
SP06 |
CUSTSERV |
HAS CALLED CUSTOMER SERVICE/ADMIN OFFICE |
SP07 |
PRBCSTSV |
PROBLEM GETTING HELP FROM CUST SERVICE |
SP08 |
PAPRWRK |
FILL OUT ANY PAPERWORK FOR PLAN |
SP09 |
PRBPPRWK |
PROBLEM WITH PLAN PAPERWORK |
SP10 |
RATEPLAN |
RATE EXPERIENCE WITH PLAN |
SP11 |
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