Health Insurance (HX) Section

BOX_00 (HX1000)

BOX_10 (HX1005)

HX10 (HX1010)

BLAISE NAME: HXStart

Question Text:

{Let's talk about all the health insurance coverage the household may have to help pay for the costs of medical care {since {START DATE} /between {START DATE} and {END DATE}}./I recorded some information earlier about the health insurance coverage for this household {since {START DATE}/between {START DATE} and {END DATE}}, but I need to ask again to be sure I have details for all the health insurance coverage the household may have to help pay for the costs of medical care.}

{ASK RESPONDENT TO GET INSURANCE CARDS/IDENTIFYING INFORMATION IF NOT ALREADY AVAILABLE.}

PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1

Programmer Instructions: If round 1, go to BOX_40.

Otherwise, continue with BOX_20.

Display Instructions: Display 'Let's talk … and {END DATE}}. ' if no source of payments selected for any RU member in the charge/payment or flat fee section in the current round (SOPFlag = NO). Otherwise (SOPFlag = YES), display 'I recorded some …. costs of medical care.'

Display 'since {START DATE}' if not round 5.

Display 'between {START DATE} and {END DATE}' if round 5.

Display 'ASK...AVAILABLE.' if round 1. Otherwise, use a null display.

BOX_20 (HX1015)

BOX_30 (HX1020)

BOX_40 (HX1025)

LOOP_10 (HX1030)

BOX_45 (HX1031)

HX14 (HX1032)

BLAISE NAME: HIOneTwoPlan

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

You mentioned that {you/{PERSON}} {were/was} covered by health insurance from both {EMPLOYER} and {UNION}

{at some point after {START DATE}/between {START DATE} and {END DATE}}. Is that just one plan or two separate plans?

Responses: ONE PLAN 1 HX15 (HX1033)

TWO SEPARATE PLANS 2 BOX_50 (HX1040)

IF VOLUNTEERED: INSURANCE 3 HX21 (HX1036)

REPORTED IN ERROR

Programmer Instructions: If coded '2' (TWO SEPARATE PLANS), create two insurance records - one for this employer and one for this union. [For insurance through employer: set Insurance.HIPubPriv=Private and Insurance.HISrc=Employer and set Insurance.HISrcName to JobsEstbName] [set CreateQ and OrigRnd] [For insurance through union: set Insurance.HIPubPriv=Private and Insurance.HISrc=Union and set Insurance.HISrcName to UnionName] [set CreateQ and OrigRnd]

If coded '3' (IF VOLUNTEERED: INSURANCE REPORTED IN ERROR), flag Insurance linked to both the Employer and the Union for clean-up. Neither pair will go into HP section to create insurance. However, HX21-HX23 will be asked one time when cycling through LOOP_10 for an Employer and that employer is linked to a union that also provides health insurance (EM710 is coded '3' (BOTH EMPLOYER AND UNION)).

Display Instructions: For 'EMPLOYER' display the name of the Employer associated with the job being cycled on during this loop.

For 'UNION' display the name of the union entered at EM720 that is associated with the job being cycled on during this loop.

If round 1 through round 4, display 'at some point after {START DATE}'. If round 5, display 'between {START DATE} and {END DATE}'.

HX15 (HX1033)

BLAISE NAME: HIEmpUnion

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

Is that health insurance plan then just from {your/{PERSON}'s} employer, {EMPLOYER}, or is it just from {your/his/her} union, {UNION}?

Responses: JUST FROM EMPLOYER 1 BOX_50 (HX1040)

JUST FROM UNION 2 END_LP10 (HX1045)

Programmer Instructions: If coded '1' (JUST FROM EMPLOYER), create insurance for this employer [set Insurance.HIPubPriv=Private and Insurance.HISrc=Employer and set Insurance.HISrcName to JobsEstbName] [set CreateQ and OrigRnd]. Then flag insurance linked to the Union for clean-up. That insurance for the Union will not go into HP section to create insurance.

If coded '2' (JUST FROM UNION), create insurance for this union [set Insurance.HIPubPriv=Private and Insurance.HISrc=Union and set Insurance.HISrcName to UnionName] [set CreateQ and OrigRnd]. Then flag insurance linked to the Employer for clean-up. The insurance for the Employer will not go into HP section to create insurance, but the Union will go into HP during a later cycle through LOOP_10.

Display Instructions: For 'EMPLOYER' display the name of the Employer linked to the job currently being cycled on.

For 'UNION' display the name of the union entered at EM720 that is linked to the job currently being cycled on.

HX16 (HX1034)

BLAISE NAME: HIUnionIntro

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

Now we will discuss the health insurance that is from {your/{PERSON}'s} union, {UNION}.

PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 BOX_50 (HX1040)

Display Instructions: For 'UNION' display the name of the union entered at EM720 that is currently being cycled on.

HX20 (HX1035)

BLAISE NAME: HIEmpUnionDisavow

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

You mentioned that {you/{PERSON}} {were/was} covered by health insurance from {JOB/UNION PROVIDING INSURANCE} {at some point after {START DATE}/between {START DATE} and {END DATE}}.

SELECT 'CONTINUE' UNLESS RESPONDENT VOLUNTEERS INSURANCE REPORTED IN ERROR.

Responses: CONTINUE 1 BOX_50 (HX1040)

INSURANCE REPORTED IN ERROR 2 HX21 (HX1036)

Programmer Instructions: If coded '1' (CONTINUE) and looping on job providing insurance, create insurance for this job [set Insurance.HIPubPriv=Private and Insurance.HISrc=Employer and set Insurance.HISrcName to JobsEstbName] [set CreateQ and OrigRnd]

If coded '1' (CONTINUE) and looping on union providing insurance, create insurance for this union [set Insurance.HIPubPriv=Private and Insurance.HISrc=Union and set Insurance.HISrcName to UnionName] [set CreateQ and OrigRnd]

If coded '2' (INSURANCE REPORTED IN ERROR), for the current interviewing session EMPHI will remain unchanged and the insurance source being cycled on during LOOP_10 will finish out the loop (without going into HP), but the insurance will be flagged for cleanup and will not count as insurance during the current round.

Placeholder for MHOP specifications. This will be deleted once those specifications are available: If coded '2' (INSURANCE REPORTED IN ERROR), there will need to be some clean up during inter round processing between the EM/RJ and HX sections to correct responses to EMPHI and other data that is being collected at HX21-HX23 but will eventually be stored as part of the Employment data.

Display Instructions: For 'JOB/UNION PROVIDING INSURANCE', display the name of the job or union (being cycled on) that provides health insurance or the name of the reviewed job now provides health insurance [EMPHI=Yes for the current round].

If round 1 through round 4, display 'at some point after {START DATE}'. If round 5, display 'between {START DATE} and {END DATE}'.

HX21 (HX1036)

BLAISE NAME: OffrdHIChoseNotHX

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{Earlier, I recorded that {you/{PERSON}} {belong/belongs} to {UNION NAME} at {EMPLOYER}.} {Since {START DATE}/Between {START DATE} and {END DATE}}, {were/was} {you/{PERSON}} offered health insurance through {EMPLOYER}?

HELP: F1

Responses: YES 1

NO 2 HX23 (HX1038)

REFUSED RF END_LP10 (HX1045)

DON'T KNOW DK END_LP10 (HX1045)

Programmer Instructions: If coded '1' (YES) and insurance source being cycled on through LOOP_10 is a reviewed job/employer (RJ10 or RJ60 was asked in the current round for this insurance source), go to END_LP10. Otherwise, continue with HX22.

Placeholder for MHOP specifications. This will be deleted once those specifications are available:

OffrdHIChoseNotHX will need to be set during inter round processing when data between the EM/RJ and HX sections are cleaned for this job that now does not have health insurance.

IF coded '1' (YES) set OffrdHIChoseNotHX =YES

If coded '2' (NO), 'RF' or 'DK' set OffrdHIChoseNotHX =NO

Display Instructions: Display 'since {START DATE}' if not round 5.

Display 'between {START DATE} and {END DATE}' if round 5.

Display '{Earlier, I recorded that {you/{PERSON}} belong to {UNION NAME} at {EMPLOYER}.}' if cycling through LOOP_10 for a newly created union that provides health insurance (EMPHI=YES) for the union only, but not the job itself (EM710=2). Otherwise, use a null display.

For "UNION NAME" display the name of the newly created union (UnionName entered at EM720) being cycled on through LOOP_10 that provides health insurance (EMPHI=YES).

If cycling through LOOP_10 for a newly created union that provides health insurance (EMPHI=YES) for the union only, but not the job itself (EM710=2), display the name of the Job linked to this union for "EMPLOYER".

If cycling through LOOP_10 for a newly created job (not a union) or a reviewed job (not a union) that now provides health insurance [EMPHI=Yes for the current round], display the name of that job/employer being cycled on through LOOP_10 for "EMPLOYER".

HX22 (HX1037)

BLAISE NAME: ChoicePlansHX

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Even though {you/he/she} chose not to take health insurance, did {you/{PERSON}} have a choice of different health insurance plans that provided hospital and physician benefits or was only one health insurance plan offered through {EMPLOYER}?

HELP: F1

Responses: YES, MORE THAN ONE PLAN 1 END_LP10 (HX1045)

NO, ONLY ONE PLAN 2 END_LP10 (HX1045)

REFUSED RF END_LP10 (HX1045)

DON'T KNOW DK END_LP10 (HX1045)

Display Instructions: If cycling through LOOP_10 for a newly created union that provides health insurance (EMPHI=YES) for the union only, but not the job itself (EM710=2), display the name of the Job linked to this union for "EMPLOYER".

If cycling through LOOP_10 for a newly created job (not a union) or a reviewed job (not a union) that now provides health insurance [EMPHI=Yes for the current round], display the name of that job/employer being cycled on through LOOP_10 for "EMPLOYER".

HX23 (HX1038)

BLAISE NAME: AnyOffrdHIHX

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Was health insurance offered to any employees at {EMPLOYER}?

Responses: YES 1 END_LP10 (HX1045)

NO 2 END_LP10 (HX1045)

REFUSED RF END_LP10 (HX1045)

DON'T KNOW DK END_LP10 (HX1045)

Display Instructions: If cycling through LOOP_10 for a newly created union that provides health insurance (EMPHI=YES) for the union only, but not the job itself (EM710=2), display the name of the Job linked to this union for "EMPLOYER".

If cycling through LOOP_10 for a newly created job (not a union) or a reviewed job (not a union) that now provides health insurance [EMPHI=Yes for the current round], display the name of that job/employer being cycled on through LOOP_10 for "EMPLOYER".

BOX_50 (HX1040)

END_LP10 (HX1045)

BOX_60 (HX1050)

BOX_70 (HX1055)

HX30 (HX1060)

BLAISE NAME: AnyCareR25

Question Text:

We show that {PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N} {{are/is}} {either} {65 years old or older} {or} {joined the household since our last interview}.

{{Have you/Has {PERSON}}/Have any of these people} been covered by Medicare {since {START DATE}/between {START DATE} and {END DATE}}?

HELP: F1

Responses: YES 1

NO 2 LOOP_20 (HX1085)

REFUSED RF LOOP_20 (HX1085)

DON'T KNOW DK LOOP_20 (HX1085)

Programmer Instructions: If HX30 is coded '1' (YES) and only one RU member eligible for HX30, select that person automatically by CAPI at HX40 and go to LOOP_ 20.

If HX30 is coded '1' (YES) and more than one RU member eligible for HX30, go to HX40.

Roster behavior:

1. Select, add, delete, and edit disallowed.

Display Instructions: Roster 1 - Report

Roster definition:

This item displays RU-members-roster for display of RU-members. Display RU members' first, middle, and last names (Person.FullName).

Roster filter:

Display RU-members who meet one of the following conditions:

1. Person is a new RU member this round, excluding merges, [(Person[].PreloadOrd = EMPTY],
   
   OR
2. Person turned 65 years old this round and no insurance for this person has Insurance.HISrc=Medicare and OrigRnd < > current round.
   
   OR
3. Person = >65 (or in age category 9) in the previous round (Preload.xxx) and no insurance for this person has Insurance.HISrc=Medicare and OrigRnd < > current round.

For '{PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N}', use the roster definition and filter specifications above. Substitute "you" for the person's full name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".

Display '{are/is}' and '65 years old or older' if anyone on this roster turned 65 since start date or were = > 65 (or in age category 9) in the previous round. Display 'is' if the only eligible RU member to be displayed at HX30 is someone other than the respondent. Otherwise, display "are".

Display 'joined the household since our last interview' if any new RU members added to the RU this round.

Display 'either' and 'or' if any new RU members added to the RU this round and if anyone on this roster turned 65 since start date or were = >65(or in age category 9) in the previous round.

Display '{Have you/Has {PERSON}' if only one eligible RU member to be displayed at HX30.

Otherwise, display 'Have any of these people'.

Display 'since {START DATE}' if not round 5. Display 'between {START DATE} and {END DATE}' if round 5.

HX40 (HX1065)

BLAISE NAME: WhoCareR25Roster

Question Text:

Who is covered by Medicare?

PROBE: Who else is covered by Medicare?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 LOOP_20 (HX1085)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 LOOP_20 (HX1085)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 LOOP_20 (HX1085)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 LOOP_20 (HX1085)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 LOOP_20 (HX1085)

Programmer Instructions: Roster behavior:

1. Multiple select allowed. Interviewer may select one or more from the listed members.

For each person selected, create insurance through Medicare for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Medicare and Insurance.HISrcName=Medicare and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display Instructions: Roster 2 - no add/edit/delete

Roster definition:

Use HX30 definition.

Roster filter:

Use HX30 filter.

BOX_80 (HX1070)

HX50_01 (HX1075)

BLAISE NAME: WhoCareR1GE65

Question Text:

& HX-1

Medicare is a health insurance program for persons 65 years or over and for some persons with disabilities. People covered by Medicare usually have a card that looks like this.

At any time since {START DATE}, {have you/has {PERSON 1}} been covered by Medicare?

HELP: F1

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: After grid completion, if at least one current RU member who is 64 years of age or younger (< = 64) or in age categories 1-8, continue with HX60.

Otherwise, go to LOOP_20.

Preloaded grid type 1: forced navigation including HX50_01, HX50_02, HX50_03, HX50_ 04, HX50_N.

For each person coded '1' (YES), create insurance through Medicare for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Medicare and Insurance.HISrcName=Medicare and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display Instructions: Roster 1-Report no add/edit/delete allowed.

Format the following columns on the form pane.

Col#1: RU Member

Instructions: Display RU members' First Middle and Last name (Pers.FullName).

Roster Filter:

Display only those RU members who are 65 years of age or older (= > 65) or in age category 9.

Display variable question text. Replace "At any time since {START DATE}, {have you/has {PERSON 1}} been covered by Medicare?":

HX50_02: What about {PERSON 2}?

HX50_03: What about {PERSON 3}?

HX50_04: What about {PERSON N}? Has {he/she} been covered by Medicare at any time since {START DATE}?

HX50_N: Repeat question text HX50_02-HX50_N for as many RU members that fit the roster filter criteria.

Display first names only in the variable question text display. Substitute "you" for the person's first name if the respondent is included in this list.

Display first paragraph of question text in brackets and grayed out text when on HX50_02 - HX50_N. Display in bold black and no brackets when on HX50_01.

HX60 (HX1080)

BLAISE NAME: WhoCareR1LT65Roster

Question Text:

& HX-1

{Medicare is a health insurance program for persons 65 years or over and for some persons with disabilities. People covered by Medicare usually have a card that looks like this.}

At any time since {START DATE}, {have/has} {PERSON 1 <=64, PERSON 2 <=64, PERSON 3 <=64} been covered by Medicare?

ENTER ALL THAT APPLY.

HELP: F1

Responses: {FIRST NAME,[MIDDLE NAME], LAST NAME} 1 1 LOOP_20 (HX1085)

{FIRST NAME,[MIDDLE NAME], LAST NAME} 2 2 LOOP_20 (HX1085)

{FIRST NAME,[MIDDLE NAME], LAST NAME} 3 3 LOOP_20 (HX1085)

{FIRST NAME,[MIDDLE NAME], LAST NAME} 4 4 LOOP_20 (HX1085)

{FIRST NAME,[MIDDLE NAME], LAST NAME} N 5 LOOP_20 (HX1085)

NO ONE 99 LOOP_20 (HX1085)

Programmer Instructions: Roster behavior:

Multiple select allowed. Interviewer may select one or more from the listed members..

For each person selected, create insurance through Medicare for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Medicare and Insurance.HISrcName=Medicare and Insurance.Plcyhldr = PersID and CovdPers.Depend=PersID] [set Create Q and OrigRnd]

Hard check:

Code '99' (NO ONE) cannot be selected in combination with any other response option. If HX60 is coded '99' (NO ONE) is selected with any other response code: "NO ONE CANNOT BE SELECTED IF ANOTHER RESPONSE OPTION IS ALREADY SELECTED. VERIFY AND RE-ENTER."

Display Instructions: Roster 2 - no add/edit/delete

Roster definition:

This item displays the RU-MEMBERS-ROSTER for selection of RU members. Display RU members' first, middle, and last names (Person.FullName)

Roster filter:

Display RU members who are 64 years of age or younger (< = 64) or in age categories 1-8.

Display 'Medicare is a health insurance program for persons 65 years or over and for some persons with disabilities. People covered by Medicare usually have a card that looks like this.' if HX50 was NOT asked (i.e., no RU members are 65 years of age or older or in age category 9). Otherwise, use a null display.

For '{PERSON 1 <=64, PERSON 2 <=64, PERSON 3 <=64}', display the first names only of all RU members who are 64 years of age or younger or in age categories 1-8. Substitute "you" for the person's first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "or" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "or".

Display 'have' if list includes the respondent. Otherwise, display 'has'.

LOOP_20 (HX1085)

BOX_90 (HX1090)

BOX_100 (HX1095)

BOX_110 (HX1100)

HX70 (HX1105)

BLAISE NAME: CareDisab

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{Do/Does} {you/{PERSON}} receive Medicare because of a medical condition or a disability?

HELP: F1

Responses: YES 1 END_LP20 (HX1115)

NO 2 END_LP20 (HX1115)

REFUSED RF END_LP20 (HX1115)

DON'T KNOW DK END_LP20 (HX1115)

Display Instructions:

HX80 (HX1110)

BLAISE NAME: RcvSocSec

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

People with Social Security usually get Medicare. {Do/Does} {you/{PERSON}} receive Social Security?

HELP: F1

Responses: YES 1 END_LP20 (HX1115)

NO 2 END_LP20 (HX1115)

REFUSED RF END_LP20 (HX1115)

DON'T KNOW DK END_LP20 (HX1115)

Display Instructions:

END_LP20 (HX1115)

BOX_120 (HX1120)

HX90 (HX1130)

BLAISE NAME: AnyCaid

Question Text:

& HX-2

{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME} are state programs that pay for health care for persons in need. People covered by {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME} may have a (piece of paper/card) that looks something like this.

At any time {since {START DATE}/between {START DATE} and {END DATE}}, has anyone in the household been covered by {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME} ?

HELP: F1

Responses: YES 1

NO 2 BOX_140 (HX1160)

REFUSED RF BOX_140 (HX1160)

DON'T KNOW DK BOX_140 (HX1160)

Programmer Instructions: If coded '1' (YES) and single-person RU, autocode HX100_01 as '1' (YES) for that person and go to BOX_130.

If coded '1' (YES) and multi-person RU, continue with HX100_01.

Display Instructions: Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'state name for Medicaid' (substituting the real state name for program) if the state in which interview is being conducted does not use the name 'Medicaid.' For the specific name to use by state, see the plan fill file.

Display 'or STATE CHIP NAME' under all conditions substituting the real state name for program.

For the specific name to use by state, see the plan fill file.

Display 'since {START DATE}' if not round 5.

Display 'between {START DATE} and {END DATE}' if round 5.

HX100_01 (HX1135)

BLAISE NAME: WhoCaid

Question Text:

{Have you/Has {PERSON 1}} been covered by {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME} at any time {since {START DATE}/between {START DATE} and {END DATE}}?

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded grid type 1: forced navigation including HX100_01, HX100_02, HX100_03, HX100_ 04, HX100_N.

After grid completion, continue with BOX_130.

For each person coded '1' (YES), create insurance through Medicaid/SCHIP for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Medicaid and Insurance.HISrcName={Medicaid/{STATE NAME FOR MEDICAID}}/{STATE CHIP NAME} and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Hard check: At least one person must be coded '1' (YES). If no RU member coded '1' (YES), display the following message: "IF NO ONE COVERED BY MEDICAID/SCHIP, BACK UP TO HX90 (AnyCaid) AND REVIEW RESPONSES."

Display Instructions: Roster 1 - Report no add/edit/delete

Format the following columns on the form pane.

Col#1: RU Member

Instructions: Display RU members' First Middle and Last name (Person.FullName)

Roster filter: none, display all.

Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the real state name for program) if the state in which interview is being conducted does not use the name 'Medicaid.' For the specific name to use by state, see the plan fill file.

Display 'or STATE CHIP NAME' under all conditions substituting the real name for program. For the specific name to use by state, see the plan fill file.

Display 'since {START DATE}' if not round 5.

Display 'between {START DATE} and {END DATE}' if round 5.

Display variable question text. Replace "{Have you/Has {PERSON 1}} been covered by {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME} at any time {since {START DATE}/between {START DATE} and {END DATE}}?" with:

HX100_02: What about {PERSON 2}?

HX100_03: What about {PERSON 3}?

HX100_04: What about {PERSON N}? Has {he/she} been covered by {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME} at any time {since {START DATE}/between {START DATE} and {END DATE}}?

HX100_N: Repeat question text HX100_02-HX100_N for as many RU members that fit the roster filter criteria.

BOX_130 (HX1145)

HX105 (HX1155)

BLAISE NAME: CaidStExch

Question Text:

Is the coverage with {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME} through {STATE EXCHANGE NAME-A} {, [which may also be known as {ALIAS B} {or {ALIAS C}}]}?

Responses: YES 1 BOX_140 (HX1160)

NO 2 BOX_140 (HX1160)

REFUSED RF BOX_140 (HX1160)

DON'T KNOW DK BOX_140 (HX1160)

Programmer Instructions: If coded '1' (YES), set HX_Main.CaidExch=Yes. Else, set HX_Main.CaidExch=No.

Display Instructions: Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the real state name for program) if the state in which interview is being conducted does not use the name 'Medicaid.' For the specific name to use by state, see the plan fill file.

Display 'or STATE CHIP NAME' under all conditions substituting the real name for program. For the specific name to use by state, see the plan fill file.

Display ', [which may also be known as {ALIAS B} {or {ALIAS C}}]' if there is more than one exchange name associated with the state in which interview is being conducted.

Display 'or {ALIAS C}' if there are three exchange names associated with the state in which interview is being conducted.

For 'STATE EXCHANGE NAME-A', 'ALIAS B', and 'ALIAS C', display the exchange name associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

BOX_140 (HX1160)

HX110 (HX1165)

BLAISE NAME: AnyMilitCovg

Question Text:

{Previously, we've recorded that {MILITARY PERSON 1, MILITARY PERSON 2, MILITARY PERSON N} {is/are} {full- time active duty in the Armed Forces} {or} {honorably discharged from active duty}.}

At any time {since {START DATE}/between {START DATE} and {END DATE}}, has anyone in the household been covered by military health care, such as TRICARE, CHAMPVA, or VA coverage?

HELP: F1

Responses: YES 1

NO 2 BOX_160 (HX1195)

REFUSED RF BOX_160 (HX1195)

DON'T KNOW DK BOX_160 (HX1195)

Programmer Instructions: If coded '1' (YES) and single-person RU, autocode HX120_01 as '1' (YES) for that person and go to HX125_01.

If coded '1' (YES) and multi-person RU, continue with HX120_01.

Display Instructions: Display 'Previously, we've recorded that {MILITARY PERSON 1, MILITARY PERSON 2, MILITARY PERSON N} {is/are} {full-time active duty in the Armed Forces} {or} {honorably discharged from active duty}.' if at least one current RU member is currently FT active duty (Person.FTADuty=Yes) or honorably discharged from the Armed Forces in any round [Person.HonDisch=Yes (preloaded value or current round value)]. Otherwise, use a null display.

Display 'full-time active duty in the Armed Forces' if at least one current RU member is currently FT active duty. Otherwise, use a null display.

Display 'honorably discharged from active duty' if at least one RU member has been honorably discharged in any round. Otherwise, use a null display.

Display 'or' if there is at least one current RU member who is FT active duty and one current RU member who is honorably discharged in any round. Otherwise, use a null display.

For '{MILITARY PERSON 1, MILITARY PERSON 2, MILITARY PERSON N}', display the first names of all RU members who are either currently FT active duty or honorably discharged from the Armed Forces in any round. Separate the names using a comma and substitute 'you' if the respondent's name is part of the list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".

Display 'is' if only one person listed and that person is not selected as respondent. Otherwise, display 'are'.

Display 'since {START DATE}' if not round 5.

Display 'between {START DATE} and {END DATE}' if round 5.

HX120_01 (HX1170)

BLAISE NAME: WhoMilitCovg

Question Text:

{Have you/Has {PERSON 1}} been covered by military health care, such as TRICARE, CHAMPVA, or VA coverage, at any time {since {START DATE}/between {START DATE} and {END DATE}}?

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded grid type 1: forced navigation including HX120_01, HX120_02, HX120_03, HX120_ 04, HX120_N.

After grid completion, continue with HX125_01.

For each person coded '1' (YES), create insurance through Military health care for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Military and Insurance.HISrcName=Military Health and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Hard check: At least one person must be coded '1' (YES). If no RU member coded '1' (YES), display the following message: "IF NO ONE COVERED BY MILITARY HEALTH CARE, BACK UP TO HX110 (AnyMilitCovg) AND REVIEW RESPONSES."

Display Instructions: Roster 1 - Report no add/edit/delete

Format the following columns on the form pane.

Col#1: RU Member

Instructions: Display RU members' First Middle and Last name (Person.FullName)

Roster filter: none, display all.

Display 'since {START DATE}' if not round 5.

Display 'between {START DATE} and {END DATE}' if round 5.

Display variable question text. Replace "{Have you/Has {PERSON 1}} been covered by military health care, such as TRICARE, CHAMPVA, or VA coverage, at any time {since {START DATE}/between {START DATE} and {END DATE}}?" with:

HX120_02: What about {PERSON 2}?

HX120_03: What about {PERSON 3}?

HX120_04: What about {PERSON N}? Has {he/she} been covered by military health care, such as TRICARE, CHAMPVA, or VA coverage, at any time {since {START DATE}/between {START DATE} and {END DATE}}?

HX120_N: Repeat question text HX120_02-HX120_N for as many RU members that fit the roster filter criteria.

HX125_01 (HX1175)

BLAISE NAME: CodeAllMilitPlan

Question Text:

What types of military health coverage {do/does} {you/{PERSON 1}} have? {Do you/Does {he/she}} have TRICARE Standard, TRICARE Prime, TRICARE Extra, TRICARE for Life, CHAMPVA, or VA (Veteran's Administration)?

ENTER ALL THAT APPLY.

HELP: F1

Responses: TRICARE STANDARD 1

TRICARE PRIME 2

TRICARE EXTRA 3

TRICARE FOR LIFE 4

CHAMPVA 5

VA (VETERAN'S ADMINISTRATION) 6

Programmer Instructions: Preloaded grid type 1: forced navigation including HX125_01, HX125_02, HX125_03, HX125_04, HX125_N After grid completion, continue with BOX_150.

DK and RF disallowed.

Display Instructions: Roster 1-Report no add/edit/delete allowed. Format the following columns on the form pane.

Col#1: RU Member

Instructions: Display RU members' First Middle and Last name (Person.FullName)

Roster Filter:

Display only those RU members "COVERED BY MILITARY HEALTH" during the current round, that is, coded '1' (YES) at HX120.

Display variable question text. Replace "What types of military health coverage {do/does} {you/{PERSON 1}} have? {Do you/Does {he/she}} have TRICARE Standard, TRICARE Prime, TRICARE Extra, TRICARE for Life, CHAMPVA, or VA (Veteran's Administration)?" with:

HX125_02: What about {PERSON 2}?

HX125_03: What about {PERSON 3}?

HX125_04: What about {PERSON N}? Does {he/she} have TRICARE Standard, TRICARE Prime,

TRICARE Extra, TRICARE for Life, CHAMPVA, or VA (Veteran's Administration)?

HX125_N: Repeat question text HX125_02-HX125_N for as many RU members that fit the roster filter criteria.

Display first names only in the variable question text display. Substitute "you" for the person's first name if the respondent is included in this list.

BOX_150 (HX1185)

BOX_160 (HX1195)

HX130 (HX1200)

BLAISE NAME: AnyIHS

Question Text:

The Indian Health Service (IHS) is the health care system for federally recognized American Indian and Alaska Natives.

The IHS is not a health insurance provider but rather, it provides healthcare only to eligible Alaska Natives and American Indians at its federal hospitals and clinics.

At any time {since {START DATE}/between {START DATE} and {END DATE}}, has anyone in this household been enrolled in the Indian Health Service?

Responses: YES 1

NO 2 BOX_180 (HX1225)

REFUSED RF BOX_180 (HX1225)

DON'T KNOW DK BOX_180 (HX1225)

Programmer Instructions: If HX130 is coded '1' (YES) and single-person RU, select person at HX140 automatically by CAPI and go to BOX_170.

If HX130 is coded '1' (YES) and multi-person RU, continue with HX140.

Display Instructions: Display 'since {START DATE}' if not round 5.

Display 'between {START DATE} and {END DATE}' if round 5.

HX140 (HX1205)

BLAISE NAME: WhoIHSRoster

Question Text:

Who is enrolled in the Indian Health Service (IHS)?

PROBE: Who else is enrolled in the Indian Health Service (IHS) {since {START DATE}/between {START DATE} and {END DATE}}?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 BOX_170 (HX1215)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 BOX_170 (HX1215)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 BOX_170 (HX1215)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 BOX_170 (HX1215)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 BOX_170 (HX1215)

Programmer Instructions: Roster behavior:

Multiple select allowed. Interviewer may select from the listed members.

For each person selected, create insurance through Indian Health Service for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=IHS and Insurance.HISrcName=Indian Health Service and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display 'since {START DATE}' if not round 5.

Display 'between {START DATE} and {END DATE}' if round 5.

Display Instructions: Roster 2 - no add/edit/delete

Roster definition:

This item displays RU-MEMBERS-ROSTER for selection of RU-members. Display RU member's first, middle, and last names (Person.FullName) Roster filter: none, display all.

BOX_170 (HX1215)

BOX_180 (HX1225)

HX150 (HX1235)

BLAISE NAME: AnyGovProg

Question Text:

{Not counting insurance you already told me about, at/At} any time {since {START DATE}/between {START DATE} and {END DATE}}, has anyone in the household had any other type of health insurance from any state or local government agency which provided hospital and physician benefits?

HELP: F1

Responses: YES 1 HX160 (HX1240)

NO 2 HX190 (HX1270)

REFUSED RF HX190 (HX1270)

DON'T KNOW DK HX190 (HX1270)

Display Instructions: Display 'Not counting insurance you already told me about, at' if any sources of insurance are recorded for this RU for the current round.. Otherwise, display 'At'.

Display 'since {START DATE}' if not round 5.

Display 'between {START DATE} and {END DATE}' if round 5.

Display HX150 and HX160 on the same form pane.

HX160 (HX1240)

BLAISE NAME: GovProgName

Question Text:

What is the name of the program?

Responses: 1

Programmer Instructions: If HX150 is coded '1' (YES) and single-person RU, select person at HX170 automatically by CAPI and go to BOX_190.

If HX150 is coded '1' (YES) and multi-person RU, continue with HX170.

Note: 'GOVT-HOS/PHY-{PROGRAM NAME FROM HX160}' substituting 17 characters of the entry at HX160 should be used for the Insurance.HISrcName in the context header (where appropriate).

Set HX_Main.GHPProgName=Yes.

Display Instructions: Display HX150 and HX160 on the same form pane.

HX170 (HX1245)

BLAISE NAME: WhoGovProgRoster

Question Text:

Who is covered by {PROGRAM NAME FROM HX160}, the program sponsored by a state or local government agency which provided hospital and physician benefits?

PROBE: Who else is covered by {PROGRAM NAME FROM HX160}, the program sponsored by a state or local government agency which provided hospital and physician benefits {since {START DATE}/between {START DATE} and {END DATE}}?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 BOX_190 (HX1255)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 BOX_190 (HX1255)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 BOX_190 (HX1255)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 BOX_190 (HX1255)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 BOX_190 (HX1255)

Programmer Instructions: Roster behavior:

Multiple select allowed. Interviewer may select from the listed members.

For each person selected, create insurance through Gov't-Hospital/Physician for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=GHP and Insurance.HISrcName= GOVT-HOS/PHY-{PROGRAM NAME FROM HX160}' and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display Instructions: Roster 2 - no add/edit/delete

Roster definition:

This item displays RU-members-roster for selection of RU-members. Display RU member's first, middle, and last names (Person.FullName)

Roster filter: none, display all.

For '{PROGRAM NAME FROM HX160}', display the text entry from HX160.

Display 'since {START DATE}' if not round 5.

Display 'between {START DATE} and {END DATE}' if round 5.

BOX_190 (HX1255)

HX180 (HX1265)

BLAISE NAME: GovProgStExch

Question Text:

Is the coverage with {PROGRAM NAME FROM HX160}, the program sponsored by a state or local government agency which provided hospital and physician benefits, through {STATE EXCHANGE NAME-A} {, [which may also be known as {ALIAS B} {or {ALIAS C}}]}?

Responses: YES 1 HX190 (HX1270)

NO 2 HX190 (HX1270)

REFUSED RF HX190 (HX1270)

DON'T KNOW DK HX190 (HX1270)

Programmer Instructions: If coded '1' (YES), set HX_Main.GHPExchange=Yes. Else, set HX_Main.GHPExchange=No.

Display Instructions: For '{PROGRAM NAME FROM HX160}', display the text entry from HX160.

Display ', [which may also be known as {ALIAS B} {or {ALIAS C}}]' if there is more than one exchange name associated with the state in which interview is being conducted.

Display 'or {ALIAS C}' if there are three exchange names associated with the state in which interview is being conducted.

For 'STATE EXCHANGE NAME-A', 'ALIAS B' and 'ALIAS C' display the exchange name associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

HX190 (HX1270)

BLAISE NAME: AnyOthHICovg

Question Text:

&HX-3

Next, I have some questions about other sources of health insurance anyone in this household may have had {since {START DATE} /between {START DATE} and {END DATE}} to help pay hospital and doctor bills and other health expenses such as nursing home care or prescribed medicines. {This includes Medigap or Medicare Supplements which some people who are eligible for Medicare have through a private carrier as additional coverage.}

Please look at card HX-3. It lists various ways people can obtain health insurance. {Not counting insurance you already told me about, at/At} any time {since {START DATE}/between {START DATE} and {END DATE}}, was anyone in this household covered by health insurance from any {other} source, such as those listed on the card?

Responses: YES 1 HX200 (HX1275)

NO 2 BOX_210 (HX1300)

REFUSED RF BOX_210 (HX1300)

DON'T KNOW DK BOX_210 (HX1300)

Display Instructions: Display 'since {START DATE}' if not round 5. Display 'between {START DATE} and {END DATE}' if round 5.

Display 'This includes...coverage.' if anyone in RU is "COVERED BY MEDICARE" during the current round [(Insurance.HISrc=Medicare) and ((OrigRnd <> current round) or (OrigRnd=current round and person selected at HX40 or HX60 or HX50=Yes)) for at least one person].

Display 'Not counting insurance you already told me about, at' and 'other' if any sources of insurance are recorded for this RU for the current round. Otherwise, display 'At'.

HX200 (HX1275)

BLAISE NAME: CodeAllOthHI

Question Text:

&HX-3

From which of the sources on card HX-3 did anyone in this household purchase health insurance?

ENTER ALL THAT APPLY.

HELP: F1

Responses: FROM A GROUP OR ASSOCIATION 1

DIRECTLY THROUGH A SCHOOL 2

DIRECTLY FROM AN INSURANCE AGENT 3

DIRECTLY FROM INSURANCE COMPANY 4

DIRECTLY FROM AN HMO 5

FROM A UNION 6

FROM ANYONE'S PREVIOUS EMPLOYER 7

FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER 8

FROM SOME OTHER EMPLOYER 9

UNDER A PLAN OF SOMEONE NOT LIVING HERE 10

DIRECTLY FROM {STATE EXCHANGE NAME-A} 11

OTHER SOURCE 91

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If coded '91' (OTHER SOURCE), alone or in combination with any other code, continue with HX200OS.

Otherwise, go to LOOP_30.

For specifications purposes only: CAPI does not allow 'RF' or 'DK' in combination with any other code.

When source is selected, create direct purchase insurance with the type selected at HX200 [set Insurance.HIPubPriv=Private and Insurance.HISrc=DirectPurchase and Insurance.DirectPurchTp=type selected] [set Create Q and OrigRnd]

Display Instructions: For 'STATE EXCHANGE NAME-A' display exchange name 'A' associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

Display HX200 and HX200OS on the same form pane screen.

HX200OS (HX1280)

BLAISE NAME: OthHIOS

Question Text:

SPECIFY: OTHER SOURCE

Responses: 1 LOOP_30 (HX1285)

Programmer Instructions: Refused and Don't Know disallowed.

Display Instructions: Display HX200 and HX200OS on the same form pane screen.

LOOP_30 (HX1285)

BOX_200 (HX1290)

END_LP30 (HX1295)

BOX_210 (HX1300)

Programmer Instructions: BOX_210 will set a person level flag - Person.HasCovFlag - YES/NO. This flag is set one time and is not reset even when backing up and coming forward again. Once Loop_40 is "on path" it needs to stay on path.

An RU member is WITH any source of public or private health insurance if he/she meets the following conditions:

Round 1:

Person is covered by public insurance, excluding IHS [Insurance.HIPublPriv=Public and Insurance.HISrc <> IHS])

OR

Persons is covered by private insurance [Insurance.HIPublPriv=Private and PersID exists in covered person array]

Note: IHS does not count as covered in Round 1. Being listed as a covered person on any other insurance source during Round 1 counts as "being covered".

Rounds 2-5:

Person is covered by Medicare in the current round [Insurance.HISrc=Medicare and ((OrigRnd <> current round) or (OrigRnd=current round and person selected at HX40 or HX60 or HX50=Yes))]

OR

Person is covered by Medicaid/SCHIP in the current round [Insurance.HISrc=Medicaid and (HX100_01=Yes or PR150_01=Yes or PR160_01=Yes for person)]

OR

Person is covered by Military Health in the current round [Insurance.HISrc=Military and (HX120_01=Yes or PR260_01=Yes or PR270_01=Yes for person)]

OR

Person is covered by Gov't-Hospital/Physician in the current round [Insurance.HISrc=GHP and (person selected HX170 or PR310_01=Yes or PR320_01=Yes for person)]

OR

Person is covered by private insurance created this round [Insurance.HIPublPriv=Private and PersID exists in covered person array and OrigRnd=current round]

OR

Person is covered by private insurance (created in a previous round) with hospital and physician or Medigap benefits and for which they are still covered at least one day during the current round [(Insurance.HIPublPriv=Private) and (PersID exists in covered person array) and (Insurance.HospHI=Yes or Insurance.MedigapHI= Yes) and (OrigRnd <> current round) and (OE20_01=1/DK/RF or OE30_01=1 or OE50_01=Yes for person)]

Note: IHS does not count as covered in Rounds 2-5. Private insurance without hospital/physician benefits or Medigap benefits does not count as covered in Round 2-5. In the OE section, the coverage question, OE130 may or may not have been asked. If not asked, use preloaded value to check for type of coverage provided by that insurance. Being listed as a covered person on any other source counts as "being covered" during the current round.

However, if a person is covered by private insurance and the coverage type is empty, count that as "being covered" during the current round. We want to count anyone with newly added employer, union, direct purchase insurance (anything just created at HX200 in the current round) as covered.

Note: If the RU member had coverage, even if it ended on the first day of the reference period (i.e., reviewed in Rd 2 and ended that first day), the current process would consider them insured.

Otherwise, if an RU member does not meet any of the above conditions, then that RU member is WITHOUT any source of public or private health insurance (set Person.HasCovFlag=No).

Person.HasCovFlag is set only one time. The first time the RU member passes through BOX_210/LOOP_40.

LOOP_40 (HX1305)

HX210 (HX1310)

BLAISE NAME: HospMDCovg

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{I have recorded that {you are/{PERSON} is} covered by {Indian Health Service} {and} {health insurance that may not include hospital and physician benefits}./I have recorded that {you are/{PERSON} is} not currently covered by any kind of health plan or health coverage.}

{Were you/Was {PERSON}} covered at any time {since {PERSON'S START DATE}/between {PERSON'S START DATE} and {PERSON'S END DATE}}, even if just for one day, by any {other} kind of health plan or health coverage that included hospital and physician benefits?

Responses: YES, COVERED 1 HX215 (HX1315)

NO, NOT COVERED 2 END_LP40 (HX1430)

REFUSED RF END_LP40 (HX1430)

DON'T KNOW DK END_LP40 (HX1430)

Display Instructions: Display 'I have recorded … physician benefits.' if RU member being looped on is "COVERED BY INDIAN HEALTH SERVICE" [Insurance.HISrc=IHS and (person selected at HX140 or PR290_01=Yes or PR300_01=Yes for person)] or is listed as a covered person for insurance that does not provide hospital and physician or Medigap coverage during the current round [(Insurance.HIPubPriv=Private) and (PersID exists in covered person array) and (Insurance.HospHI <>Yes and Insurance.MedigapHI <>Yes) and (OrigRnd <> current round)]. Otherwise, display 'I have recorded … health coverage.'

Display 'Indian Health Service' is RU member being looped on is "COVERED BY INDIAN HEALTH SERVICE" during the current round. Otherwise, use a null display.

Display 'health insurance that may not include hospital and physician benefits' if RU member being looped on is listed as a covered person for private insurance that does not include hospital and physician benefits or Medigap benefits. Otherwise, use a null display.

Display 'and' if RU member being looped on has both Indian Health Service and private coverage without hospital and physician or Medigap benefits. Otherwise, use a null display.

Display 'since {PERSON'S START DATE}' if not round 5. Display 'between {PERSON'S START DATE} and {PERSON'S END DATE}' if round 5.

Display 'other' if RU member being looped on is "COVERED BY INDIAN HEALTH SERVICE" or is listed as a covered person for insurance that does not provide hospital and physician or Medigap coverage during the current round. Otherwise, use a null display.

HX215 (HX1315)

BLAISE NAME: SrcHospMDCovg

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

For that coverage, {do you/does {PERSON}} get it through a job, the government or state, is it privately purchased, for example through an insurance company, HMO, or {do you/does {he/she}} get it some other way?

IF NEEDED, SAY:

JOB: Former job/Retiree, Union, Spouse/parent's job, Job with the government, COBRA GOVERNMENT OR STATE:

{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}, Medicare (Parts A+B; Part C), Medicare Advantage, Military health coverage (TRICARE, CHAMPVA, VA); State-provided health coverage PRIVATELY PURCHASED: From an insurance agent, insurance company, HMO, Exchange plan/Marketplace OTHER: Parent or spouse, Group or association, Medicare Supplements

Responses: JOB (CURRENT OR FORMER) 1 HX225 (HX1317)

GOVERNMENT OR STATE 2 HX220 (HX1316)

PRIVATELY PURCHASED 3 BOX_310 (HX1400)

SOME OTHER WAY 4 BOX_310 (HX1400)

Programmer Instructions: DK and RF disallowed.

Display Instructions:

HX220 (HX1316)

BLAISE NAME: CovgRelGovtJob

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Is that coverage related to a job with the government or state?

IF NECESSARY, SAY: Include coverage through former employers and unions, and COBRA plans.

Responses: YES 1 HX225 (HX1317)

NO 2 HX230 (HX1325)

REFUSED RF HX230 (HX1325)

DON'T KNOW DK HX230 (HX1325)

Display Instructions:

HX225 (HX1317)

BLAISE NAME: CovgRelMilit

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Is that plan related to military service in any way?

IF NECESSARY, SAY: Examples of military plans include: VA Care, TRICARE, TRICARE for Life, CHAMPVA, or other military care.

HELP: F1

Responses: YES 1 HX260 (HX1365)

NO 2 BOX_310 (HX1400)

REFUSED RF BOX_310 (HX1400)

DON'T KNOW DK BOX_310 (HX1400)

Programmer Instructions: If coded '1' (YES), create insurance through Military health care for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Military and Insurance.HISrcName=Military Health and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display Instructions:

HX230 (HX1325)

BLAISE NAME: CodeAllGovtCovg

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

& HX-4

From which of the government or state sources on card HX-4 {were you/was {PERSON}} covered by?

ENTER ALL THAT APPLY.

HELP: F1

Responses: MEDICARE 1 BOX_220 (HX1330)

MEDICAID/{STATE NAME FOR MEDICAID} 2 BOX_220 (HX1330)

SCHIP/{STATE NAME FOR SCHIP} 3 BOX_220 (HX1330)

TRICARE 4 BOX_220 (HX1330)

CHAMPVA 5 BOX_220 (HX1330)

VA 6 BOX_220 (HX1330)

OTHER GOVERNMENT PROGRAM PROVIDING HOSPITAL/PHYSICIAN BENEFITS 7 BOX_220 (HX1330)

Programmer Instructions: If coded '1' (MEDICARE), create public insurance through Medicare for this person [set Insurance.HIPublPriv=Public and Insurance.HISrc=Medicare and Insurance.HISrcName=Medicare and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

If coded '2' (MEDICAID) and/or '3' (SCHIP), create public insurance through

Medicaid/SCHIP for this person [set Insurance.HIPublPriv=Public and Insurance.HISrc=Medicaid and Insurance.HISrcName={Medicaid/{STATE NAME FOR MEDICAID}}/{STATE CHIP NAME}and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

If coded '4' (TRICARE), '5' (CHAMPVA), and/or '6' (VA), create public insurance through Military health care for this person [set Insurance.HIPublPriv=Public and Insurance.HISrc=Military and Insurance.HISrcName=Military Health and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

If coded '7' (OTHER GOVERNMENT PROGRAM PROVIDING HOSPITAL/PHYSICIAN BENEFITS), create public insurance through Gov't-Hospital/Physician for this person [set Insurance.PublPriv=Public and Insurance.HISrc =GHP and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd] Note: Insurance.HISrcName is set later.

Display Instructions:

BOX_220 (HX1330)

HX240 (HX1335)

BLAISE NAME: VerfCareDisab

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{Do/Does} {you/{PERSON}} receive Medicare because of a medical condition or a disability?

HELP: F1

Responses: YES 1 BOX_230 (HX1340)

NO 2 BOX_230 (HX1340)

REFUSED RF BOX_230 (HX1340)

DON'T KNOW DK BOX_230 (HX1340)

Display Instructions:

BOX_230 (HX1340)

BOX_240 (HX1345)

BOX_250 (HX1350)

HX250 (HX1355)

BLAISE NAME: VerfCaidStExch

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Is the coverage with {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME} through {STATE EXCHANGE NAME-A} {, [which may also be known as {ALIAS B} {or {ALIAS C}}]}?

Responses: YES 1 BOX_260 (HX1360)

NO 2 BOX_260 (HX1360)

REFUSED RF BOX_260 (HX1360)

DON'T KNOW DK BOX_260 (HX1360)

Programmer Instructions: If coded '1' (YES), set HX_Main.CaidExch = Yes. Else, set HX_Main.CaidExch=No.

Display Instructions: Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the real state name for program) if the state in which interview is being conducted does not use the name 'Medicaid.' For the specific name to use by state, see the plan fill file.

Display 'or STATE CHIP NAME' under all conditions substituting the real name for program. For the specific name to use by state, see the plan fill file.

Display ', [which may also be known as {ALIAS B} {or {ALIAS C}}]' if there is more than one exchange name associated with the state in which interview is being conducted.

Display 'or {ALIAS C}' if there are three exchange names associated with the state in which interview is being conducted.

For 'STATE EXCHANGE NAME-A', 'ALIAS B', and 'ALIAS C', display the exchange name associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

BOX_260 (HX1360)

HX260 (HX1365)

BLAISE NAME: CodeAllVerfMilitPlan

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

What types of military health coverage {do/does} {you/{PERSON}} have? {Do you/Does {he/she}} have TRICARE Standard, TRICARE Prime, TRICARE Extra, TRICARE for Life, CHAMPVA, or VA (Veteran's Administration)?

ENTER ALL THAT APPLY.

HELP: F1

Responses: TRICARE STANDARD 1 BOX_270 (HX1370)

TRICARE PRIME 2 BOX_270 (HX1370)

TRICARE EXTRA 3 BOX_270 (HX1370)

TRICARE FOR LIFE 4 BOX_270 (HX1370)

CHAMPVA 5 BOX_270 (HX1370)

VA (VETERAN'S ADMINISTRATION) 6 BOX_270 (HX1370)

Programmer Instructions: DK and RF disallowed.

Display Instructions:

BOX_270 (HX1370)

BOX_280 (HX1375)

HX270 (HX1380)

BLAISE NAME: VerfGovProgName

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

What is the name of the program from any state or local government agency which provided hospital and physician

Responses: 1 BOX_290 (HX1385)

Programmer Instructions: Set Insurance.HISrcName= 'GOVT-HOS/PHY-{PROGRAM NAME FROM HX270}'.

Set HX_Main.GHPProgName=Yes.

Note: 'GOVT-HOS/PHY-{PROGRAM NAME FROM HX270}' substituting 17 characters of the entry at HX270 should be used for the insurance source name in the context header (where appropriate).

Display Instructions:

BOX_290 (HX1385)

BOX_300 (HX1390)

HX280 (HX1395)

BLAISE NAME: VerfGovProgStExch

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Is the coverage with {PROGRAM NAME FROM HX270}, the program sponsored by a state or local government agency which provided hospital and physician benefits, through {STATE EXCHANGE NAME-A} {, [which may also be known as {ALIAS B} {or {ALIAS C}}]}?

Responses: YES 1 END_LP40 (HX1430)

NO 2 END_LP40 (HX1430)

REFUSED RF END_LP40 (HX1430)

DON'T KNOW DK END_LP40 (HX1430)

Programmer Instructions: If coded '1' (YES), set HX_Main.GHPExchange = Yes. Else, set HX_Main.GHPExchange=No.

Display Instructions: For '{PROGRAM NAME FROM HX270}', display the text entry from HX270.

Display ', [which may also be known as {ALIAS B} {or {ALIAS C}}]' if there is more than one exchange name associated with the state in which interview is being conducted.

Display 'or {ALIAS C}' if there are three exchange names associated with the state in which interview is being conducted.

For 'STATE EXCHANGE NAME-A', 'ALIAS B' and 'ALIAS C' display the exchange name associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

BOX_310 (HX1400)

HX290 (HX1405)

BLAISE NAME: ConfCovg

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

I have recorded health insurance for other members of this household. Was the health coverage {you/{PERSON} had {since {PERSON'S START DATE}/between {PERSON'S START DATE} and {PERSON'S END DATE}} one of these?

USING LIST BELOW, REVIEW SOURCES OF HEALTH INSURANCE ALREADY CREATED FOR OTHER RU MEMBERS.

IF {PERSON} COVERED BY EXISTING INSURANCE, SELECT THAT INSURANCE.

IF {PERSON} NOT COVERED BY ANY OF THESE EXISTING INSURANCE SOURCES, SELECT 'INSURANCE NOT LISTED' TO ADD NEW INSURANCE.

Responses: {POLICYHOLDER} {INSURANCE SOURCE} {PLAN} {COVERED RU MEMBERS}1 1 BOX_320 (HX1410)

{POLICYHOLDER} {INSURANCE SOURCE} {PLAN} {COVERED RU MEMBERS}2 2 BOX_320 (HX1410)

{POLICYHOLDER} {INSURANCE SOURCE} {PLAN} {COVERED RU MEMBERS}3 3 BOX_320 (HX1410)

{POLICYHOLDER} {INSURANCE SOURCE} {PLAN} {COVERED RU MEMBERS}4 4 BOX_320 (HX1410)

{POLICYHOLDER} {INSURANCE SOURCE} {PLAN} {COVERED RU MEMBERS}N 5 BOX_320 (HX1410)

INSURANCE NOT LISTED 99 BOX_330 (HX1411)

Programmer Instructions: RF/DK not allowed.

If not already included in the covered person array, add the person being looped on to the covered person array for the insurance source selected.

Note: Since the persons is being added to an existing insurance source, it is not necessary to set the create Q and OrigRnd here. Those should have been set elsewhere.

Display Instructions: Display the roster in non-proportional text.

Roster 1 - Report

Roster Definition:

This item displays sources of insurance in the insurance array.

Roster Filter:

Display only private insurance that meets one of the of the following two conditions:

Private insurance created this round [Insurance.HIPubPriv=Private and OrigRnd=current round]

OR

Private insurance (created in a previous round) and for which at least one person is still covered at least one day during the current round [(Insurance.HIPubPriv=Private) and (at least one PersID exists in covered person array) and (OrigRnd <> current round) and (OE20_01=1/DK/RF or OE30_01=1 or OE50_01=Yes for that person in the covered person array)]

Display underlined column headers as part of the info pane.

Display eligible insurance formatted into the following roster columns:

Column Header #1: Policyholder

Display the first 25 characters of the full name (Person.FullName) of policyholder for this insurance source (Insurance.Plcyhldr). This includes the full name of any RU or DU member selected as the policyholder. If the policyholder is outside of the DU, display the policyholder name as 'PLCYHLDR NOT IN DU-' followed by the first 6 characters of the entry at HP100. If the policyholder is deceased, display the policyholder name as 'PLCYHLDR DECEASED-' followed by the first 7 characters of the entry at HP110.

Column Header #2: Insurance Source

Display the first 25 characters of the name of the insurance source; e.g., job, union, group name (Insurance.HISrcName)

Column Header #3: Plan

Display the first 18 characters of the plan name of the insurance source (Insurance.Insurer). Leave cell blank if plan name is empty.

Column Header #4: Covered RU Members

Display the first 11 characters of the first names (Pers.FName) of all current RU members listed in the covered person array for this insurance source, excluding any DU member policyholder. Separate each name with a comma. Do not substitute "you" for respondent. Allow up to 38 characters for this column (which would allow for the first 3 covered persons in the first row and then next 3-6 in the second row).

Display 'since {START DATE}' if not round 5. Display 'between {START DATE} and {END DATE}' if round 5.

BOX_320 (HX1410)

BOX_330 (HX1411)

BOX_340 (HX1412)

HX300 (HX1415)

BLAISE NAME: DirectPurchTp

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

&HX-3

From which source on card HX-3 did {you/{PERSON}} purchase or obtain this health insurance coverage?

HELP: F1

Responses: FROM A GROUP OR ASSOCIATION 1 BOX_350 (HX1425)

DIRECTLY THROUGH A SCHOOL 2 BOX_350 (HX1425)

DIRECTLY FROM AN INSURANCE AGENT 3 BOX_350 (HX1425)

DIRECTLY FROM INSURANCE COMPANY 4 BOX_350 (HX1425)

DIRECTLY FROM AN HMO 5 BOX_350 (HX1425)

FROM A UNION 6 BOX_350 (HX1425)

FROM ANYONE'S PREVIOUS EMPLOYER 7 BOX_350 (HX1425)

FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER 8 BOX_350 (HX1425)

FROM SOME OTHER EMPLOYER 9 BOX_350 (HX1425)

UNDER A PLAN OF SOMEONE NOT LIVING HERE 10 BOX_350 (HX1425)

DIRECTLY FROM {STATE EXCHANGE NAME-A} 11 BOX_350 (HX1425)

OTHER SOURCE 91 HX300OS (HX1420)

REFUSED RF BOX_350 (HX1425)

DON'T KNOW DK BOX_350 (HX1425)

Programmer Instructions: When source is selected, create direct purchase insurance with the type selected at HX300 for this person [set Insurance.HIPublPriv=Private and Insurance.HISrc=DirectPurchase and Insurance.DirectPurchTp=type selected] [set Create Q and OrigRnd]

Display Instructions: Display HX300 and HX300OS on the same form pane screen.

For 'STATE EXCHANGE NAME-A' display exchange name 'A' associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

HX300OS (HX1420)

BLAISE NAME: DirectPurchTpOS

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

SPECIFY: OTHER SOURCE

Responses: 1 BOX_350 (HX1425)

Programmer Instructions: Refused and Don't Know disallowed.

Display Instructions: Display HX300 and HX300OS on the same form pane screen.

BOX_350 (HX1425)

END_LP40 (HX1430)

BOX_360 (HX1435)

BOX_370 (HX1440)

BOX_380 (HX1445)

LOOP_50 (HX1450)

HX310 (HX1455)

BLAISE NAME: CareCard

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

CODE WITHOUT ASKING IF ANSWER IS KNOWN.

Can you please take out {your/{PERSON}' s} Medicare card?

We do not need {your/his/her} Medicare number, but would like to record the exact date {your/his/her} Medicare coverage became effective and what type of coverage {you/he/she} {have/has} through Medicare.

Responses: CARD AVAILABLE 1 HX320 (HX1460)

CARD NOT AVAILABLE 2 HX350 (HX1485)

REFUSED RF HX350 (HX1485)

DON'T KNOW DK HX350 (HX1485)

Display Instructions:

HX320 (HX1460)

BLAISE NAME: CodeAllCareCardTp

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Is that card a regular Medicare card, a Railroad Retirement Board card, or some other Medicare card?

Responses: MEDICARE CARD (RED, WHITE AND BLUE) 1

RAILROAD RETIREMENT BOARD CARD (RED, WHITE AND BLUE) 2

SOME OTHER CARD 3

Programmer Instructions: If coded '1' (MEDICARE CARD) or '2' (RAILROAD RETIREMENT BOARD CARD), alone or in combination with any other code continue with HX330_01.

If coded '3' (SOME OTHER CARD) alone, go to HX350.

Note: HX320 is a multi-select item, but the "ENTER ALL THAT APPLY." Instruction is purposely left off the screen.

DK and RF disallowed.

Display Instructions:

HX330_01 (HX1465)

BLAISE NAME: CareEffMM

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

&HX-1

Please tell me the effective date listed on the card.

ENTER MONTH

Responses: 1 HX330_02 (HX1470)

REFUSED RF HX330_02 (HX1470)

DON'T KNOW DK HX330_02 (HX1470)

Display Instructions: Display HX330_01, HX330_02, and HX330_03 on the same form pane.

HX330_02 (HX1470)

BLAISE NAME: CareEffDD

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

& HX-1

[Please tell me the effective date listed on the card.]

ENTER DAY

Responses: 1 HX330_03 (HX1475)

REFUSED RF HX330_03 (HX1475)

DON'T KNOW DK HX330_03 (HX1475)

Display Instructions: Display show card icon and reference and question text in lighter "grayed out" text.

Display HX330_01, HX330_02, and HX330_03 on the same form pane.

HX330_03 (HX1475)

BLAISE NAME: CareEffYYYY

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

& HX-1

[Please tell me the effective date listed on the card.]

ENTER YEAR

Responses: 1 HX340 (HX1480)

REFUSED RF HX340 (HX1480)

DON'T KNOW DK HX340 (HX1480)

Programmer Instructions: Hard checks:

Check effective date entered at HX330_01-HX330_03. Date entered must be on or before (i.e., < or =) the person's reference period end date for this round (EndRefM, EndRefD). In round 5, that is typically Dec. 31 for panel year 2. If not, display the following message: "EFFECTIVE DATE MUST BE BEFORE {PERSON'S REFERENCE PERIOD END DATE}. VERIFY AND RE-ENTER."

Soft range check:

Medicare effective date entered at HX330_01-HX330_03 must be on or after (= or >) birth date of person. If not, display the following message: "UNLIKELY RESPONSE. EFFECTIVE DATE IS PRIOR TO {PERSON}'S DOB {MM/DD/YYYY}. VERIFY AND CORRECT EFFECTIVE DATE. If any part of birth date is unknown, hard check is not invoked.

If Round 1 and if effective date is on or before January 1, {YEAR}, where 'year' is the first calendar year of the panel (FirstPanYear), set SimplePerson.CovdJan1=Yes.

Display Instructions: Display show card icon and reference and question text in lighter "grayed out" text.

Display HX330_01, HX330_02, and HX330_03 on the same form pane.

HX340 (HX1480)

BLAISE NAME: CareCovTp

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

& HX-1

{Are/is} {you/{PERSON}} entitled to hospital (Part A), medical (Part B), or both?

Responses: HOSPITAL ONLY 1 HX390 (HX1510)

MEDICAL AND HOSPITAL 2 HX390 (HX1510)

MEDICAL ONLY 3 HX390 (HX1510)

Display Instructions:

HX350 (HX1485)

BLAISE NAME: CarePartB

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Part A of Medicare covers most hospital expenses. Part B covers many doctor's expenses, including doctor visits, and the premium is usually deducted from {your/{PERSON}'s} Social Security.

{Are/Is} {you/he/she} covered under Part B of Medicare?

Responses: YES 1 HX360_01 (HX1490)

NO 2 HX360_01 (HX1490)

REFUSED RF HX360_01 (HX1490)

DON'T KNOW DK HX360_01 (HX1490)

Display Instructions:

HX360_01 (HX1490)

BLAISE NAME: CareCovBegMM

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

When did {your/{PERSON}'s} Medicare coverage start?

ENTER MONTH

Responses: 1 HX360_02 (HX1495)

REFUSED RF HX360_02 (HX1495)

DON'T KNOW DK HX360_02 (HX1495)

Display Instructions: Display HX360_01 and HX360_02 on the same form pane.

HX360_02 (HX1495)

BLAISE NAME: CareCovBegYYYY

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

[When did {your/{PERSON}'s} Medicare coverage start?]

ENTER YEAR

Responses: 1

REFUSED RF HX370 (HX1500)

DON'T KNOW DK HX370 (HX1500)

Programmer Instructions: If HX360_02 is equal to Panel Year 1 (FirstPanYear) and HX360_01 is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW), continue with HX370. Otherwise (when there is a value for year), go to HX380.

If Round 1 and if effective date entered at HX360_01 and HX360_02 is:

A valid date (i.e., not 'RF (REFUSED) or 'DK' (DON'T KNOW) in the month or year fields and on or before January, {YEAR}, where 'YEAR' is the first calendar year of the panel (FirstPanYear), then set SimplePerson.CovdJan1=Yes

Hard check:

Check effective date entered at HX360_01 and HX360_02. Date entered must be on or before (i.e., < or =) the person's reference period end date for this round (EndRefM, EndRefD). In round 5, that is typically Dec. 31 for panel year 2.. If not, display the following message: "EFFECTIVE DATE MUST BE BEFORE {PERSON'S REFERENCE PERIOD END DATE}. VERIFY AND RE-ENTER."

Soft range check: Medicare effective date entered at HX360_01 and HX360_02 must be on or after (= or >) birth date of person. If not, display the following message: "UNLIKELY RESPONSE. EFFECTIVE DATE IS PRIOR TO {PERSON}'S DOB {MM/DD/YYYY}. VERIFY AND CORRECT EFFECTIVE DATE. If any part of birth date is unknown, hard check is not invoked.

Display Instructions: Display question text in lighter "grayed out" text.

Display HX360_01 and HX360_02 on the same form pane.

HX370 (HX1500)

BLAISE NAME: CareCovJan1

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Did {you/he/she} have Medicare coverage on January 1, {YEAR}?

Responses: YES 1 HX380 (HX1505)

NO 2 HX380 (HX1505)

REFUSED RF HX380 (HX1505)

DON'T KNOW DK HX380 (HX1505)

Programmer Instructions: If Round 1 and if HX370 coded '1' (YES), set SimplePerson.CovdJan1=Yes.

Display Instructions:

HX380 (HX1505)

BLAISE NAME: CareCardConf

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

&HX-1

{Do/Does} {you/{PERSON}} have a Medicare card that looks like this?

Responses: YES 1 HX390 (HX1510)

NO 2 HX390 (HX1510)

REFUSED RF HX390 (HX1510)

DON'T KNOW DK HX390 (HX1510)

Display Instructions:

HX390 (HX1510)

BLAISE NAME: CareMAMC

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{{Are/Is} {you/{PERSON}} currently/As of {PERSON'S END DATE}, {were/was} {you/{PERSON}} enrolled in a Medicare Advantage or managed care plan, such as an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) to receive {your/his/her} Medicare-funded health care? When answering, please include only insurance from Medicare, not any privately purchased or job-related insurance.

HELP: F1

Responses: YES 1 HX400 (HX1515)

NO 2 HX470 (HX1555)

REFUSED RF HX470 (HX1555)

DON'T KNOW DK HX470 (HX1555)

Display Instructions: Display '{Are/Is} {you/{PERSON}} currently' if not round 5. Display 'As of {PERSON'S END DATE}, {were/was} {you/{PERSON}}' if round 5.

HX400 (HX1515)

BLAISE NAME: CareMCName

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

What {is/was} the name of {your/{PERSON}'s} Medicare managed care plan {as of {PERSON'S END DATE}}?

ENTER PLAN NAME

Responses: 1 HX410 (HX1520)

REFUSED RF HX410 (HX1520)

DON'T KNOW DK HX410 (HX1520)

Programmer Instructions: Set Insurance.Insurer to HX400.

Display Instructions: Display 'is' if not round 5. Display 'was' if round 5.

Display 'as of {PERSON'S END DATE}' if round 5. Otherwise, use a null display.

HX410 (HX1520)

BLAISE NAME: CareMCPmed

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{Do/Does}/Did} {you/{PERSON}} have prescribed medicine coverage through {{NAME OF PLAN FROM HX400} {your/his/her} Medicare managed care plan} {as of {PERSON'S END DATE}}?

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If round 1 or round 3, continue with HX420.

Otherwise, go to END_LP50.

Display Instructions: Display '{Do/Does}' if not round 5. Display 'Did' if round 5.

Display '{NAME OF PLAN FROM HX400}' if a plan name was coded at HX400. Display '{your/his/her} Medicare managed care plan' if HX400 is coded RF (REFUSED) or DK (DON'T KNOW).

Display the actual plan name entered at HX400 for 'NAME OF PLAN FROM HX400' if a plan name was entered.

Display 'as of {PERSON'S END DATE}' if round 5. Otherwise, use a null display.

HX420 (HX1525)

BLAISE NAME: CarePayPrem

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Most Medicare beneficiaries pay their Part B premiums through their Social Security checks. In addition, {do/does} {you/{PERSON}} (or anyone in the family) pay anything else for {the coverage with {{NAME OF PLAN FROM HX400}/this Medicare managed care plan}?

[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]

HELP: F1

Responses: YES 1 HX430 (HX1530)

NO 2 END_LP50 (HX1590)

REFUSED RF END_LP50 (HX1590)

DON'T KNOW DK END_LP50 (HX1590)

Display Instructions: Display 'the coverage with {NAME OF PLAN FROM HX400}' if a Medicare plan name was entered at HX400. Display 'this Medicare managed care plan' if HX400 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW).

Display the actual plan name entered at HX400 for 'NAME OF PLAN FROM HX400' if a plan name was entered.

HX430 (HX1530)

BLAISE NAME: HowCarePaid

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

How {do/does} {you/{PERSON}} pay for {your/his/her} {{NAME OF PLAN FROM HX400}/Medicare managed care} premium?

IF NECESSARY, SAY: Is the Medicare Advantage premium paid through {your/his/her} Social Security check, paid directly to the provider, or paid both ways?

Responses: DEDUCTED FROM SOCIAL SECURITY 1 HX440 (HX1535)

PAY DIRECTLY 2 HX440 (HX1535)

BOTH 3 HX440 (HX1535)

REFUSED RF END_LP50 (HX1590)

DON'T KNOW DK END_LP50 (HX1590)

Display Instructions: Display '{NAME OF PLAN FROM HX400}' if a Medicare plan name was entered at HX400. Display 'Medicare managed care' if HX400 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW).

Display the actual plan name entered at HX400 for 'NAME OF PLAN FROM HX400' if a plan name was entered.

HX440 (HX1535)

BLAISE NAME: CareCovgAmt

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

How much {is {your/{PERSON}'s} Social Security deduction/{do/does} {you/{PERSON}} pay in premiums} for {your/his/her} {NAME OF PLAN FROM HX400} plan?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. CODE 'DON'T KNOW'.

ENTER AMOUNT

Responses: 1 HX450 (HX1540)

REFUSED RF HX460 (HX1550)

DON'T KNOW DK HX460 (HX1550)

Programmer Instructions: Allow for entry of dollars and cents.

Display Instructions: Display HX440, HX450 and HX450OS on the same form pane.

Display 'is {your/{PERSON}'s} Social Security deduction' if HX430 is coded '1' (DEDUCTED FROM SOCIAL SECURITY). Display '{do/does} {you/{PERSON}} pay in premiums' if HX430 is coded '2' (PAY DIRECTLY) or '3' (BOTH).

Display '{NAME OF PLAN FROM HX400}' if a Medicare plan name was entered at HX400.

Otherwise (i.e., if HX400 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW)), use a null display.

Display the actual plan name entered at HX400 for 'NAME OF PLAN FROM HX400' if a plan name was entered.

HX450 (HX1540)

BLAISE NAME: CareCovgUnit

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Is that per year, per month, per week, or what?

UNIT OF COVERAGE:

Responses: PER YEAR 1 END_LP50 (HX1590)

EVERY 3 MONTHS (QUARTERLY) 2 END_LP50 (HX1590)

EVERY 2 MONTHS (BIMONTHLY) 3 END_LP50 (HX1590)

PER MONTH 4 END_LP50 (HX1590)

PER WEEK 5 END_LP50 (HX1590)

EVERY 2 WEEKS (BIWEEKLY) 6 END_LP50 (HX1590)

2 TIMES PER YEAR (SEMI-ANNUALLY) 7 END_LP50 (HX1590)

2 TIMES PER MONTH (SEMI-MONTHLY) 8 END_LP50 (HX1590)

OTHER 91 HX450OS (HX1545)

REFUSED RF END_LP50 (HX1590)

DON'T KNOW DK END_LP50 (HX1590)

Display Instructions: Display HX440, HX450 and HX450OS on the same form pane.

HX450OS (HX1545)

BLAISE NAME: CareCovgUnitOS

Question Text:

SPECIFY: UNIT OF COVERAGE

Responses: 1 END_LP50 (HX1590)

REFUSED RF END_LP50 (HX1590)

DON'T KNOW DK END_LP50 (HX1590)

Display Instructions: Display HX440, HX450 and HX450OS on the same form pane.

HX460 (HX1550)

BLAISE NAME: CareCovgRng

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{PLAN NAME: {NAME OF PLAN FROM HX400}}

& HX-5

Which category on card HX-5 best indicates the cost of this plan per month?

Responses: $1 - $50 1 END_LP50 (HX1590)

$51 - $100 2 END_LP50 (HX1590)

$101 - $200 3 END_LP50 (HX1590)

$201 - $300 4 END_LP50 (HX1590)

$301 OR MORE 5 END_LP50 (HX1590)

REFUSED RF END_LP50 (HX1590)

DON'T KNOW DK END_LP50 (HX1590)

Display Instructions: Display 'PLAN NAME: {NAME OF PLAN FROM HX400}' if a Medicare plan name was entered at HX400. Otherwise (i.e., if HX400was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW)), use a null display.

Display the actual plan name entered at HX400 for 'NAME OF PLAN FROM HX400' if a plan name was entered.

HX470 (HX1555)

BLAISE NAME: CarePartD

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

{{Are/Is}/{Were/Was}} {you/{PERSON}} enrolled in Medicare Part D, also known as the Medicare Prescription Drug Plan {as of {PERSON'S END DATE}}?

HELP: F1

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If coded '1' (YES) and round 1 or round 3, continue with HX480.

Otherwise, go to END_LP50.

Display Instructions: Display '{Are/Is}' if not round 5.

Display '{Were/Was}' if round 5.

Display 'as of {PERSON'S END DATE}' if round 5. Otherwise, use a null display.

HX480 (HX1560)

BLAISE NAME: PayPartD

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

Most Medicare beneficiaries pay their Part B premiums through their Social Security checks. In addition, {do/does} {you/{PERSON}} (or anyone in the family) pay anything else for {your/his/her} Medicare Prescription Drug Plan (also known as Part D)?

[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]

HELP: F1

Responses: YES 1 HX490 (HX1565)

NO 2 END_LP50 (HX1590)

REFUSED RF END_LP50 (HX1590)

DON'T KNOW DK END_LP50 (HX1590)

Display Instructions:

HX490 (HX1565)

BLAISE NAME: HowPayPartD

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

How {do/does} {you/{PERSON}} pay for {your/his/her} Part D premium?

IF NECESSARY, SAY: Is the Medicare drug coverage premium paid through {your/his/her} Social Security check, paid directly to the provider, or paid both ways?

Responses: DEDUCTED FROM SOCIAL SECURITY 1 HX500 (HX1570)

PAY DIRECTLY 2 HX500 (HX1570)

BOTH 3 HX500 (HX1570)

REFUSED RF END_LP50 (HX1590)

DON'T KNOW DK END_LP50 (HX1590)

Display Instructions:

HX500 (HX1570)

BLAISE NAME: AmtPayPartD

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

How much {is {your/{PERSON}'s} Social Security deduction/{do/does} {you/{PERSON}} pay in premiums} for {your/his/her} Part D plan?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. CODE 'DON'T KNOW'.

ENTER AMOUNT

Responses: 1 HX510 (HX1575)

REFUSED RF HX520 (HX1585)

DON'T KNOW DK HX520 (HX1585)

Programmer Instructions: Allow for the entry of dollars and cents.

Display Instructions: Display HX500, HX510 and HX510OS on the same form pane.

Display 'is {your/{PERSON}'s} Social Security deduction' if HX490 is coded '1' (DEDUCTED FROM SOCIAL SECURITY). Display '{do/does} {you/{PERSON}} pay in premiums' if HX490 is coded '2' (PAY DIRECTLY) or '3' (BOTH).

HX510 (HX1575)

BLAISE NAME: UnitPayPartD

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

[How much {is {your/{PERSON}'s} Social Security deduction/{do/does} {you/{PERSON}} pay in premiums} for {your/his/her} Part D plan?]

Is that per year, per month, per week, or what?

ENTER UNIT OF COVERAGE:

Responses: PER YEAR 1 END_LP50 (HX1590)

EVERY 3 MONTHS (QUARTERLY) 2 END_LP50 (HX1590)

EVERY 2 MONTHS (BIMONTHLY) 3 END_LP50 (HX1590)

PER MONTH 4 END_LP50 (HX1590)

PER WEEK 5 END_LP50 (HX1590)

EVERY 2 WEEKS (BIWEEKLY) 6 END_LP50 (HX1590)

2 TIMES PER YEAR (SEMI-ANNUALLY) 7 END_LP50 (HX1590)

2 TIMES PER MONTH (SEMI-MONTHLY) 8 END_LP50 (HX1590)

OTHER 91 HX510OS (HX1580)

REFUSED RF END_LP50 (HX1590)

DON'T KNOW DK END_LP50 (HX1590)

Display Instructions: Display HX500, HX510 and HX510OS on the same form pane.

Display the "How much{is {your/{PERSON}'s} Social Security…" in brackets and grayed out text.

Display 'is {your/{PERSON}'s} Social Security deduction' if HX490 is coded '1' (DEDUCTED FROM SOCIAL SECURITY). Display '{do/does} {you/{PERSON}} pay in premiums' if HX490 is coded '2' (PAY DIRECTLY) or '3' (BOTH).

HX510OS (HX1580)

BLAISE NAME: UnitPayPartDOS

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

[How much {is {your/{PERSON}'s} Social Security deduction/{do/does} {you/{PERSON}} pay in premiums} for {your/his/her} Part D plan?]

SPECIFY: OTHER UNIT OF COVERAGE

Responses: 1 END_LP50 (HX1590)

REFUSED RF END_LP50 (HX1590)

DON'T KNOW DK END_LP50 (HX1590)

Display Instructions: Display HX500, HX510 and HX510OS on the same form pane.

Display the "How much{is {your/{PERSON}'s} Social Security…" in brackets and grayed out text.

Display 'is {your/{PERSON}'s} Social Security deduction' if HX490 is coded '1' (DEDUCTED FROM SOCIAL SECURITY). Display '{do/does} {you/{PERSON}} pay in premiums' if HX490 is coded '2' (PAY DIRECTLY) or '3' (BOTH).

HX520 (HX1585)

BLAISE NAME: RngPayPartD

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

& HX-6

Which category on card HX-6 best indicates the cost of this plan per month?

Responses: $1 - $30 1

$31 - $60 2

$61 - $90 3

$91 - $120 4

$121 OR MORE 5

REFUSED RF

DON'T KNOW DK

Display Instructions:

END_LP50 (HX1590)

BOX_390 (HX1595)

BOX_400 (HX1600)

LOOP_55 (HX1601)

HX530 (HX1605)

BLAISE NAME: GovHMO

Context Header: {NAME OF INSURANCE SOURCE}

Question Text:

Under {{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}/{PROGRAM NAME FROM HX160/HX270}, the program sponsored by a state or local government agency which provides hospital and physician benefits,} {{are/is}/{were/was}} {PERSON 1}, {PERSON 2}, {PERSON 3}, {PERSON 4}, {PERSON N} enrolled in an HMO, that is a Health Maintenance Organization {between {START DATE} and {END DATE}}?

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

HELP: F1

Responses: YES, ALL ARE 1 HX550 (HX1615)

YES, SOME ARE 2 HX550 (HX1615)

NO, NONE ARE 3 HX540 (HX1610)

REFUSED RF HX540 (HX1610)

DON'T KNOW DK HX540 (HX1610)

Display Instructions: Roster 1 - Report

Roster definition:

This item uses the insurance array to display RU member's first, middle, and last names (Person.FullName) in the question text. Substitute "you" for the person's name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".

Roster filter:

When looping on Medicaid/SCHIP:

Insurance source is MEDICAID/SCHIP (Insurance.HISrc=Medicaid), and Person is an RU member covered by MEDICAID/SCHIP during the current round (HX100=YES) or (HX230=2 or 3), and [Round 1] or [Round 2-5 and PR150 = EMPTY for everyone].

When looping on Gov't-Hospital/Physician:

Insurance source is GOVT-HOSPITAL/PHYSICIAN (Insurance.HISrc=GHP), and Person is an RU member covered by GOVT-HOSPITAL/PHYSICIAN during the current round (at least one person selected at HX170) or (HX230=7), and [Round 1] or [Round 2-5 and PR310= EMPTY for everyone ].

Display '{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}' if asking about MEDICAID/SCHIP. Display '{PROGRAM NAME FROM HX160/HX270}, the program...benefits,' if asking about GOVT- HOSPITAL/PHYSICIAN.

For '{PROGRAM NAME FROM HX160/HX270}', display the text entry from HX160 or HX270.

Display '(are/is)' if not round 5. Display (were/was)' if round 5.

Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the real state name for the program) if the state in which interview is being conducted does not use the name 'Medicaid'. For the specific name to use by state, see the plan fill file.

Display 'or STATE CHIP NAME' under all conditions (substituting the real state name for program).

For the specific name to use by state, see the plan fill file.

Display '{are/is}' if not round 5. Display '{were/was}' if round 5.

Display 'is' or 'was' if the list includes 1 person who is not the respondent. Otherwise, display 'are' or 'were'.

Display 'between {START DATE} and {END DATE}' if round 5. Otherwise, use a null display.

HX540 (HX1610)

BLAISE NAME: GovPrimaryMD

Context Header: {NAME OF INSURANCE SOURCE}

Question Text:

{Does/Between {START DATE} and {END DATE}, did} {{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}/{PROGRAM NAME FROM HX160/HX270}, the program sponsored by a state or local government agency which provides hospital and physician benefits,} require {PERSON 1}, {PERSON 2}, {PERSON 3}, {PERSON 4}, {PERSON N} to sign up with a certain primary care doctor, group of doctors, or with a certain clinic which they must go to for all of their routine care?

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

HELP: F1

Responses: YES, ALL REQUIRED 1 HX550 (HX1615)

YES, SOME REQUIRED 2 HX550 (HX1615)

NO, NONE REQUIRED 3 HX560 (HX1620)

REFUSED RF HX560 (HX1620)

DON'T KNOW DK HX560 (HX1620)

Programmer Instructions: Note: If coded '3' (NO, NONE REQUIRED), 'RF' (REFUSED), or 'DK' (DON'T KNOW), there is no insurer associated with the current round for MEDICAID/SCHIP or GOVT-HOSPITAL/PHYSICIAN.

Display Instructions: Roster 1 - Report

Roster definition:

Use HX530 definition.

Display RU member's first, middle, and last names (Person.FullName) in the question text. Substitute "you" for the person's name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".

Roster filter:

Use HX530 filter.

Display 'Does' if not round 5. Display 'Between {START DATE} and {END DATE}, did' if round 5.

Display '{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}' if asking about MEDICAID/SCHIP. Display '{PROGRAM NAME FROM HX160/HX270}, the program... benefits,' if asking about GOVT-HOSPITAL/PHYSICIAN.

For '{PROGRAM NAME FROM HX160/HX270}', display the text entry from HX160 or HX270.

Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the real state name for the program) if the state in which interview is being conducted does not use the name 'Medicaid'. For the specific name to use by state, see the plan fill file.

Display 'or STATE CHIP NAME' under all conditions (substituting the real state name for program).

For the specific name to use by state, see the plan fill file.

HX550 (HX1615)

BLAISE NAME: OthGovProgName

Context Header: {NAME OF INSURANCE SOURCE}

Question Text:

What is the name of the {{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}} {HMO/health insurance} {from the program sponsored by a state or local government agency which provides hospital and physician benefits}?

ENTER PLAN NAME

Responses: 1 HX560 (HX1620)

REFUSED RF HX560 (HX1620)

DON'T KNOW DK HX560 (HX1620)

Programmer Instructions: Set Insurance.Insurer= HX550.

Display Instructions: Display '{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}' if asking about MEDICAID/SCHIP. If asking about GOVT-HOSPITAL/PHYSICIAN, use a null display.

Display 'from the....benefits' if asking about GOVT-HOSPITAL/PHYSICIAN. If asking about MEDICAID/SCHIP, use a null display.

Display 'HMO' if HX530 is coded '1' (YES, ALL ARE) or '2' (YES, SOME ARE).

Display 'health insurance' if HX540 is coded '1' (YES, ALL REQUIRED) or '2' (YES, SOME REQUIRED).

Display 'Medicaid' if state in which interview is being conducted uses the name 'MEDICAID'.

Display 'STATE NAME FOR MEDICAID' (substituting the real state name for the program) if the state in which interview is being conducted does not use the name 'MEDICAID'. For the specific name to use by state, see the plan fill file.

Display 'or STATE CHIP NAME' under all conditions (substituting the real state name for program).

For the specific name to use by state, see the plan fill file.

HX560 (HX1620)

BLAISE NAME: GovPayPrem

Context Header: {NAME OF INSURANCE SOURCE}

Question Text:

Is there a monthly premium for {PERSON 1, PERSON 2, PERSON 3, PERSON N} for the coverage through {{NAME OF PLAN FROM HX550}/{{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}/{PROGRAM NAME FROM HX160/HX270}, the program sponsored by a state or local government agency which provides hospital and physician benefits}}?

[Do not include the cost of any copayments, coinsurance or deductibles {you/he/she/they} may have had to pay.]

READ IF NECESSARY: A monthly premium is a fixed amount of money people pay each month to have health coverage. It does not include copays or other expenses such as prescription costs.

HELP: F1

Responses: YES, EVERYONE COVERED PAYS 1 BOX_410 (HX1630)

YES, SOME COVERED PAY 2 BOX_405 (HX1623)

NO, NO ONE COVERED PAYS 3 BOX_420 (HX1670)

REFUSED RF BOX_420 (HX1670)

DON'T KNOW DK BOX_420 (HX1670)

Programmer Instructions: Placeholder for MHOP specifications. This will be deleted once those specifications are available:

If coded '1' (YES, EVERYONE COVERED PAYS) at HX560 (HOME.PRMEDPRE), code PRND.MEDGOVP for each person in the roster at HX570/HX575 as '1' (PAYS FOR COVERAGE DURING THE CURRENT ROUND.)

If coded '3' (NO, NO ONE COVERED PAYS) at HX560 (HOME.PRMEDPRE), code PRND.MEDGOVP for each person in the roster at HX570/HX575 as '2' (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND.)

If coded RF or DK or set to -9 (whether everyone is covered is missing) at HX560 (HOME.PRMEDPRE), code PRND.MEDGOVP equal to the missing value in HOME.PRMEDPRE for each person in the HX570/HX575 roster.

Leave PRND.MEDGOVP blank (no value) for any RU member not on the roster at HX570/HX575.

The HX570/HX575 roster includes all persons with MEDICAID/SCHIP or GOVT-

HOSPITAL/PHYSICIAN program coverage (EPRS.MCAID = 1 or EPRS.GOVTPROG = 1) in the current RU for the current round (but excludes any RU members already reviewed in the PR section - HX560 is not on path if the PR section was asked for the corresponding insurance type).

Display Instructions: Roster 1 - Report

Roster definition:

Use HX530 definition.

Display RU member's first, middle, and last names (Person.FullName) in the question text. Substitute

"you" for the person's name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".

Roster filter:

Use HX530 filter.

Display '{NAME OF PLAN FROM HX550}' if there is a current round insurer associated with the MEDICAID/SCHIP or GOVT- HOSPITAL/PHYSICIAN INSURANCE (Insurance.Insurer <> empty).

Otherwise, display, {{Medicaid/...and physician benefits}'. Display '{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}' if asking about MEDICAID/SCHIP. Display '{PROGRAM NAME FROM HX160/HX270}, the program...benefits' if asking about GOVT-HOSPITAL/PHYSICIAN.

Display the actual plan name entered at HX550 for 'NAME OF PLAN FROM HX550' if a plan name was entered (Insurance.Insurer).

For '{PROGRAM NAME FROM HX160/HX270}', display the text entry from HX160 or HX270.

Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the real state name for the program) if the state in which interview is being conducted does not use the name 'Medicaid'. For the specific name to use by state, see the plan fill file.

Display 'or STATE CHIP NAME' under all conditions (substituting the real state name for program).

For the specific name to use by state, see the plan fill file.

Display 'you' if the respondent is the only person eligible to be displayed.. Display 'he' if only one RU member is eligible to be displayed that person is not the respondent and is male. Display 'she' if only one RU member eligible to be displayed and that person is not the respondent and is female.

Otherwise, display 'they.'

BOX_405 (HX1623)

HX570 (HX1625)

BLAISE NAME: WhoPayPremRosterMed

Context Header: {NAME OF INSURANCE SOURCE}

Question Text:

Who has a monthly premium for that coverage?

PROBE: Anyone else?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 BOX_410 (HX1630)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 BOX_410 (HX1630)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 BOX_410 (HX1630)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 BOX_410 (HX1630)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 BOX_410 (HX1630)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

Placeholder for MHOP specifications. This will be deleted once those specifications are available:

The HX570 roster includes all persons with MEDICAID/SCHIP program coverage (EPRS.MCAID = 1) in the current RU for the current round (but excludes any RU members already reviewed in the PR section - HX570 is not on path if the PR section was asked for the corresponding insurance type).

Code PRND.MEDGOVP as '1' (PAYS FOR COVERAGE DURING THE CURRENT ROUND) for all persons from the HX570 roster who are selected.

Code PRND.MEDGOVP as '2' (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND) for all persons on the HX570 roster who are not selected.

Leave PRND.MEDGOVP blank (no value) for any RU member not on the roster at HX570.

Display Instructions: Roster 2 - no add/edit/delete

Roster definition:

This item uses the insurance array to display RU member's first, middle, and last names (Person.FullName).

Roster filter:

Insurance source is MEDICAID/SCHIP (Insurance.HISrc=Medicaid), and Person is an RU member covered by MEDICAID/SCHIP during the current round (HX100 =YES) or (HX230=2 or 3), and 3. [Round 1] or [Round 2-5 and PR150 = EMPTY for everyone].

HX575 (HX1627)

BLAISE NAME: WhoPayPremRosterGHP

Context Header: {NAME OF INSURANCE SOURCE}

Question Text:

Who has a monthly premium for that coverage?

PROBE: Anyone else?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 BOX_410 (HX1630)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 BOX_410 (HX1630)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 BOX_410 (HX1630)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 BOX_410 (HX1630)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 BOX_410 (HX1630)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

Placeholder for MHOP specifications. This will be deleted once those specifications are available:

The HX575 roster includes all persons with GOVT- HOSPITAL/PHYSICIAN program coverage (EPRS.GOVTPROG = 1) in the current RU for the current round (but excludes any RU members already reviewed in the PR section - HX575 is not on path if the PR section was asked for the corresponding insurance type).

Code PRND.MEDGOVP as '1' (PAYS FOR COVERAGE DURING THE CURRENT ROUND) for all persons from the HX575 roster who are selected.

Code PRND.MEDGOVP as '2' (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND) for all persons on the HX575 roster who are not selected.

Leave PRND.MEDGOVP blank (no value) for any RU member not on the roster at HX575.

Display Instructions: Roster 2 - no add/edit/delete

Roster definition:

This item uses the insurance array to display RU member's first, middle, and last names (Person.FullName).

Roster filter:

Insurance source is GOVT-HOSPITAL/PHYSICIAN (Insurance.HISrc=GHP), and Person is an RU member covered by GOVT-HOSPITAL/PHYSICIAN during the current round (at least one person selected at HX170) or (HX230=7), and 3. [Round 1] or [Round 2-5 and PR310= EMPTY for everyone ].

BOX_410 (HX1630)

HX580 (HX1635)

BLAISE NAME: GovPremAmt

Context Header: {NAME OF INSURANCE SOURCE}

Question Text:

How much is the premium for {the {NAME OF PLAN FROM HX550}/that} coverage?

IF MORE THAN ONE PERSON PAYS A PREMIUM FOR THIS COVERAGE, SAY: Please give me the total amount for premiums paid by all individuals with this coverage.

USE CTRL+Z TO ACCESS CALCULATOR TO ADD ALL PREMIUMS.

ENTER AMOUNT

Responses: 1 HX590 (HX1640)

REFUSED RF HX600 (HX1650)

DON'T KNOW DK HX600 (HX1650)

Programmer Instructions: Allow for the entry of dollars and cents.

Display Instructions: Display HX580, HX590, and HX590OS on the same form pane.

Display 'the {NAME OF PLAN FROM HX550}' if HX550 has an entry other than 'RF' or 'DK' or EMPTY. Otherwise, display, 'that'.

Display the actual plan name entered at HX550 for 'NAME OF PLAN FROM HX550' if a plan name was entered.

HX590 (HX1640)

BLAISE NAME: GovPremUnit

Context Header: {NAME OF INSURANCE SOURCE}

Question Text:

[How much is the premium for {the {NAME OF PLAN FROM HX550}/that} coverage?]

IF MORE THAN ONE PERSON PAYS A PREMIUM FOR THIS COVERAGE, SAY: Please give me the total amount for premiums paid by all individuals with this coverage.

USE CTRL+Z TO ACCESS CALCULATOR TO ADD ALL PREMIUMS.

Is that per year, per month, per week, or what?

ENTER UNIT OF COVERAGE

Responses: PER YEAR 1 HX600 (HX1650)

EVERY 3 MONTHS (QUARTERLY) 2 HX600 (HX1650)

EVERY 2 MONTHS (BIMONTHLY) 3 HX600 (HX1650)

PER MONTH 4 HX600 (HX1650)

PER WEEK 5 HX600 (HX1650)

EVERY 2 WEEKS (BIWEEKLY) 6 HX600 (HX1650)

2 TIMES PER YEAR (SEMI-ANNUALLY) 7 HX600 (HX1650)

2 TIMES PER MONTH (SEMI-MONTHLY) 8 HX600 (HX1650)

OTHER 91 HX590OS (HX1645)

REFUSED RF HX600 (HX1650)

DON'T KNOW DK HX600 (HX1650)

Display Instructions: Display HX580, HX590, and HX590OS on the same form pane.

Display "How much … ADD ALL PREMIUMS." in brackets and grayed out text.

Display 'the {NAME OF PLAN FROM HX550}' if HX550 has an entry other than 'RF' or 'DK' or EMPTY. Otherwise, display, 'that'.

Display the actual plan name entered at HX550 for 'NAME OF PLAN FROM HX550' if a plan name was entered.

HX590OS (HX1645)

BLAISE NAME: GovPremUnitOS

Question Text:

[How much is the premium for {the {NAME OF PLAN FROM HX550}/that} coverage?]

IF MORE THAN ONE PERSON PAYS A PREMIUM FOR THIS COVERAGE, SAY: Please give me the total amount for premiums paid by all individuals with this coverage.

USE CTRL+Z TO ACCESS CALCULATOR TO ADD ALL PREMIUMS.

SPECIFY: UNIT OF COVERAGE

Responses: 1 HX600 (HX1650)

REFUSED RF HX600 (HX1650)

DON'T KNOW DK HX600 (HX1650)

Display Instructions: Display HX580, HX590, and HX590OS on the same form pane.

Display "How much … ADD ALL PREMIUMS." in brackets and grayed out text.

Display 'the {NAME OF PLAN FROM HX550}' if HX550 has an entry other than 'RF' or 'DK' or EMPTY. Otherwise, display, 'that'.

Display the actual plan name entered at HX550 for 'NAME OF PLAN FROM HX550' if a plan name was entered.

HX600 (HX1650)

BLAISE NAME: GovPremSubsdz

Context Header: {NAME OF INSURANCE SOURCE}

Question Text:

{PLAN NAME: {NAME OF PLAN FROM HX550}}

Is the cost of the premium subsidized based on household income?

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If [GOVERNMENT-HOSPITAL/PHYSICIAN] and if [plan is exchange coverage (HX180=1 or HX280=1)] and if [HX560 is coded '1' (YES, EVERYONE COVERED PAYS) or '2' (YES, SOME COVERED PAY)], continue with HX610.

Otherwise, go to END_LP55.

Display Instructions: Display 'PLAN NAME: ...' if HX550 has an entry other than 'RF' or 'DK' or EMPTY.

Otherwise, use a null display.

Display the actual plan name entered at HX550 for 'NAME OF PLAN FROM HX550' if a plan name was entered.

HX610 (HX1665)

BLAISE NAME: GovMetalPlan

Context Header: {NAME OF INSURANCE SOURCE}

Question Text:

Is {the {NAME OF PLAN FROM HX550} plan/this plan} a platinum, gold, silver, bronze or catastrophic plan?

HELP: F1

Responses: PLATINUM PLAN 1 END_LP55 (HX1666)

GOLD PLAN 2 END_LP55 (HX1666)

SILVER PLAN 3 END_LP55 (HX1666)

BRONZE PLAN 4 END_LP55 (HX1666)

CATASTROPHIC PLAN 5 END_LP55 (HX1666)

IF VOLUNTEERED: SOMETHING ELSE 6 END_LP55 (HX1666)

REFUSED RF END_LP55 (HX1666)

DON'T KNOW DK END_LP55 (HX1666)

Display Instructions: Display 'the {NAME OF PLAN FROM HX550} plan' if HX550 has an entry other than 'RF' or 'DK' or EMPTY. Otherwise, display 'this plan'.

Display the actual plan name entered at HX550 for '{NAME OF PLAN FROM HX550}' if a plan name was entered.

END_LP55 (HX1666)

BOX_420 (HX1670)

LOOP_60 (HX1675)

HX620 (HX1680)

BLAISE NAME: CodeAllHICovg

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

& HX-7

Now think again about {your/{POLICYHOLDER}'s} health insurance through {INSURANCE SOURCE NAME}. Looking at card HX-7, what health insurance coverage {{do/does}/did} {you/he/she} have {as of {END DATE}}?

PROBE: Any other health coverage through this plan?

[NOTE: 'DISABILITY', 'WORKER'S COMPENSATION', AND 'ACCIDENT' WILL NOT APPEAR ON THE SHOW CARD.]

ENTER ALL THAT APPLY.

HELP: F1

Responses: HOSPITAL AND PHYSICIAN BENEFITS, 1

INCLUDING COVERAGE THROUGH AN HMO

DENTAL 2

PRESCRIPTION DRUGS 3

VISION 4

MEDICARE SUPPLEMENT/MEDIGAP 5

LONG TERM CARE IN A NURSING HOME 6

EXTRA CASH FOR HOSPITAL STAYS 7

SERIOUS DISEASE OR DREAD DISEASE 8

DISABILITY 9

WORKER'S COMPENSATION 10

ACCIDENT 11

OTHER 91 HX620OS (HX1685)

REFUSED RF BOX_430 (HX1690)

DON'T KNOW DK BOX_430 (HX1690)

Programmer Instructions: If coded '91' (OTHER), alone or in combination with any other code, continue with HX620OS.

Otherwise, go to BOX_430.

For specifications purposes only: CAPI does not allow 'RF' or 'DK' in combination with any other code.

If '1' (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) is one of the selections and '5' (MEDIGAP) is not one of the selections, set Insurance.HospHI=Yes.

If '5' (MEDIGAP) is one of the selections, set Insurance.MedigapHI=Yes

Display Instructions: Display '{do/does}' if [not round 5] and if [insurance being asked about is current (HQ10_01 is coded '1' (COVERED WHOLE TIME) or HQ10_02 is coded '1' (YES, COVERED NOW) for the policyholder (or for oldest PID in the covered person array if policyholder is not a current RU member)]. Otherwise, display 'did'.

Display 'as of {END DATE}' if round 5. Otherwise, use a null display.

Display HX620 and HX620OS on the same form pane.

HX620OS (HX1685)

BLAISE NAME: HICovgOS

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

SPECIFY: HEALTH INSURANCE COVERAGE

Responses: 1 BOX_430 (HX1690)

Display Instructions: Display HX620 and HX620OS on the same form pane.

BOX_430 (HX1690)

HX630 (HX1695)

BLAISE NAME: MedigapName

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

What is the name of the insurance company or HMO from which {you/{POLICYHOLDER}} {receive/receives} the Medicare Supplement or Medigap benefits?

IF MORE THAN ONE NAME, PROBE: What is the main insurance company or HMO from which {you/he/she} {receive/receives} the Medicare Supplement or Medigap benefits?

HELP:F1

NAME OF INSURER

Responses: 1 BOX_440 (HX1700)

REFUSED RF BOX_440 (HX1700)

DON'T KNOW DK BOX_440 (HX1700)

Programmer Instructions: Set Insurance.Insurer = HX630

Display Instructions:

BOX_440 (HX1700)

HX640 (HX1705)

BLAISE NAME: HospHIName

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

What is the name of the insurance company or HMO from which {you/{POLICYHOLDER}} {receive/receives} hospital and physician benefits?

IF MORE THAN ONE NAME, PROBE: What is the main insurance company or HMO from which {you/he/she} {receive/receives} hospital and physician benefits?

HELP:F1

NAME OF INSURER

Responses: 1 BOX_450 (HX1715)

REFUSED RF BOX_450 (HX1715)

DON'T KNOW DK BOX_450 (HX1715)

Programmer Instructions: Set Insurance.Insurer = HX640

Display Instructions:

BOX_450 (HX1715)

BOX_460 (HX1720)

HX650 (HX1725)

BLAISE NAME: HospMetaPlan

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

Is {your/PERSON}'s} {INSURER AT HX640} plan a platinum, gold, silver, bronze or catastrophic plan?

HELP: F1

Responses: PLATINUM PLAN 1 BOX_470 (HX1730)

GOLD PLAN 2 BOX_470 (HX1730)

SILVER PLAN 3 BOX_470 (HX1730)

BRONZE PLAN 4 BOX_470 (HX1730)

CATASTROPHIC PLAN 5 BOX_470 (HX1730)

IF VOLUNTEERED: SOMETHING ELSE 6 BOX_470 (HX1730)

REFUSED RF BOX_470 (HX1730)

DON'T KNOW DK BOX_470 (HX1730)

Display Instructions: Display the actual plan name entered or autocoded at HX640 for '{INSURER AT HX640}' if HX640 has an entry other than 'RF' or 'DK' or EMPTY (Insurance.Insurer). Otherwise, use a null display.

BOX_470 (HX1730)

BOX_480 (HX1735)

HX660 (HX1740)

BLAISE NAME: FamPayPrem

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

For the coverage through {INSURANCE SOURCE NAME}, 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 copayments, 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.]

HELP: F1

Responses: YES, PAY ALL OF PREMIUM/COST 1 BOX_490 (HX1745)

YES, PAY SOME OF PREMIUM/COST 2 BOX_490 (HX1745)

YES, BUT DON'T KNOW IF PAY ALL OR 3 BOX_490 (HX1745)

SOME OF PREMIUM/COST

NO, DO NOT PAY 4 BOX_510 (HX1775)

REFUSED RF BOX_510 (HX1775)

DON'T KNOW DK BOX_510 (HX1775)

Display Instructions:

BOX_490 (HX1745)

HX670 (HX1750)

BLAISE NAME: PlcyhlderPayAmt

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

How much {{do/does}/did} {you/{POLICYHOLDER}} pay for the {INSURANCE SOURCE NAME} coverage?

ENTER AMOUNT

Responses: 1 HX680 (HX1755)

REFUSED RF BOX_500 (HX1765)

DON'T KNOW DK BOX_500 (HX1765)

Programmer Instructions: Allow the entry of dollars and cents.

Display Instructions: Display HX670, HX680, and HX680OS on the same form pane.

Display '{do/does}' if [not round 5] and if [insurance being asked about is current (HQ10_01 is coded '1' (COVERED WHOLE TIME) or HQ10_02 is coded '1' (YES, COVERED NOW) for the policyholder (or for oldest PID on the covered person array if policyholder is not a current RU member)]. Otherwise, display 'did'.

HX680 (HX1755)

BLAISE NAME: PlcyhlderPayUnit

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

{Is/Was} that per year, per month, per week, or what?

UNIT OF COVERAGE:

Responses: PER YEAR 1 BOX_500 (HX1765)

EVERY 3 MONTHS (QUARTERLY) 2 BOX_500 (HX1765)

EVERY 2 MONTHS (BIMONTHLY) 3 BOX_500 (HX1765)

PER MONTH 4 BOX_500 (HX1765)

PER WEEK 5 BOX_500 (HX1765)

EVERY 2 WEEKS (BIWEEKLY) 6 BOX_500 (HX1765)

2 TIMES PER YEAR (SEMI-ANNUALLY) 7 BOX_500 (HX1765)

2 TIMES PER MONTH (SEMI-MONTHLY) 8 BOX_500 (HX1765)

OTHER 91 HX680OS (HX1760)

REFUSED RF BOX_500 (HX1765)

DON'T KNOW DK BOX_500 (HX1765)

Display Instructions: Display HX670, HX680, and HX680OS on the same form pane.

Display 'Is' if [not round 5] and if [insurance being asked about is current (HQ10_01 is coded '1' (COVERED WHOLE TIME) or HQ10_02 is coded '1' (YES, COVERED NOW) for the policyholder (or for oldest PID on the covered person array if policyholder is not a current RU member)]. Otherwise, display 'Was'.

HX680OS (HX1760)

BLAISE NAME: PlcyhlderPayUnitOS

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

SPECIFY: UNIT OF COVERAGE

Responses: 1 BOX_500 (HX1765)

REFUSED RF BOX_500 (HX1765)

DON'T KNOW DK BOX_500 (HX1765)

Display Instructions: Display HX670, HX680, and HX680OS on the same form pane.

BOX_500 (HX1765)

HX690 (HX1770)

BLAISE NAME: HospPremSubsdz

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

Is the cost of the premium subsidized based on family income?

Responses: YES 1 BOX_510 (HX1775)

NO 2 BOX_510 (HX1775)

REFUSED RF BOX_510 (HX1775)

DON'T KNOW DK BOX_510 (HX1775)

Display Instructions:

BOX_510 (HX1775)

BOX_520 (HX1780)

HX700 (HX1785)

BLAISE NAME: AnnDeductAmt

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

Is the {family} annual deductible for medical care for this plan less than {$1,350/$2,700} or is it {$1,350/$2,700} or more? If there is a separate deductible for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.

HELP: F1

Responses: LESS THAN {$1,350/$2,700} 1 END_LP60 (HX1795)

{$1,350/$2,700} OR MORE 2 HX710 (HX1790)

NO ANNUAL DEDUCTIBLE 3 END_LP60 (HX1795)

REFUSED RF END_LP60 (HX1795)

DON'T KNOW DK END_LP60 (HX1795)

Display Instructions: Use a null display for 'family' and display '$1,350' in the question text and '$1,350' in the response category options if this insurance meets the following conditions:

[The policyholder is the only covered person (PersID of Insurance.Plcyhldr = only PersID in covered person array)

OR

The policyholder is deceased and there is exactly one covered person (Insurance.Plcyhldr=901 and only one PersID in covered person array)]

AND

Insurance does not cover any persons outside the RU (Insurance.CovPersOutRU<>Yes).

Otherwise, display 'family' and '$2,700' in the question text and '$2,700' in the response category options.

Note: The amounts to be used will need to be verified yearly and adjusted in HX and OE.

HX710 (HX1790)

BLAISE NAME: PlanHasHSA

Context Header: {POLICYHOLDER FIRST MIDDLE LAST NAME} INSURANCE THROUGH {NAME OF INSURANCE SOURCE}

Question Text:

With this plan, is there a special account or fund that can be used to pay for medical expenses? The accounts are sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Personal Care accounts, Personal Medical funds, or Choice funds, and are different from Flexible Spending Accounts.

HELP: F1

Responses: YES 1 END_LP60 (HX1795)

NO 2 END_LP60 (HX1795)

REFUSED RF END_LP60 (HX1795)

DON'T KNOW DK END_LP60 (HX1795)

Display Instructions:

END_LP60 (HX1795)

BOX_530 (HX1800)

HX720 (HX1805)

BLAISE NAME: AnyFSA

Question Text:

Does anyone in this household have a Flexible Spending Account for health expenses?

IF NECESSARY, SAY: These accounts are offered by some employers to allow employees to set aside pre-tax dollars of their own money for their use throughout the year to reimburse themselves for their own or their family members' out-of- pocket expenses for health care. With this type of account, any money remaining in the account at the end of the year, following a short grace period, is lost to the employee.

Responses: YES 1 HX730 (HX1810)

NO 2 BOX_540 (HX1820)

REFUSED RF BOX_540 (HX1820)

DON'T KNOW DK BOX_540 (HX1820)

Display Instructions:

HX730 (HX1810)

BLAISE NAME: WhoFSARoster

Question Text:

Who has a Flexible Spending Account (FSA) for health expenses?

PROBE: Anyone else?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1 HX740_01 (HX1815)

{FIRST NAME [MIDDLE NAME] LAST NAME}2 2 HX740_01 (HX1815)

{FIRST NAME [MIDDLE NAME] LAST NAME}3 3 HX740_01 (HX1815)

{FIRST NAME [MIDDLE NAME] LAST NAME}4 4 HX740_01 (HX1815)

{FIRST NAME [MIDDLE NAME] LAST NAME}N 5 HX740_01 (HX1815)

Programmer Instructions: Roster behavior:

1. Multiple select allowed. Interviewer may select one or more from the listed members.

Display Instructions: Roster 2 - no add/edit/delete

Roster definition:

This item displays the RU-MEMBERS-ROSTER (Person.FullName) for selection of RU members.

Roster filter:

Display all persons age 16 or older or in age categories 4-9.

HX740_01 (HX1815)

BLAISE NAME: FSAAmt

Question Text:

How much {do/does} {you/{PERSON 1}} contribute per year to {your/his/her} FSA?

ENTER AMOUNT

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded grid type 1: forced navigation including HX740_01, HX740_02, HX740_03, HX740_ 04, HX740_N.

After grid completion, continue with BOX_540.

SOFT RANGE:

$10-$2550

If amount entered is greater than $2550, display the following message: "AMOUNT CONTRIBUTED IS HIGHER THAN EXPECTED FOR ONE PERSON. VERIFY AND CORRECT IF NEEDED."

If amount entered is less than $10, display the following message: "AMOUNT CONTRIBUTED IS LOWER THAN EXPECTED FOR ONE PERSON. VERIFY AND CORRECT IF NEEDED."

Note: The upper soft range limit needs to be verified yearly to determine if it should be adjusted.

Display Instructions: Roster 1 - Report no add/edit/delete

Format the following columns on the form pane.

Col#1 Header: RU Member

Instructions: Display RU members' First Middle and Last name (Person.FullName). This column should be protected - no edit/add/delete

Col#2 Header: Amount

Instructions: Entry field to enter an amount. Allow whole dollars only, no cents. Display '$' and '.00' mask.

Roster Filter:

Display all persons selected at HX730

Display variable question text. Replace "How much {do/does} {you/{PERSON 1}} contribute per year to {your/his/her} FSA?" with:

HX740_02: What about {PERSON 2}?

HX740_03: What about {PERSON 3}?

HX740_04: What about {PERSON N}? How much does {he/she} contribute per year to {his/her} FSA?

HX740_N: Repeat question text HX740_02-HX740_N for as many RU members that fit the roster filter criteria.

BOX_540 (HX1820)

LOOP_70 (HX1821)

BOX_550 (HX1822)

HX750 (HX1835)

BLAISE NAME: CovPrev2Year

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

I have recorded that {you/{PERSON}} {were/was} without insurance on January 1, {YEAR}. {Were/Was} {you/he/she} covered by a health insurance plan or program at any time in the years {YEAR} or {YEAR}?

Responses: YES 1 END_LP70 (HX1865)

NO 2 END_LP70 (HX1865)

REFUSED RF END_LP70 (HX1865)

DON'T KNOW DK END_LP70 (HX1865)

Display Instructions: (For specifications purposes only; CAPI handles automatically): in the question text, "… on January 1, {YEAR}," 'YEAR' is the first calendar year of the panel (FirstPanYear). In the question text, "… at any time in the years {YEAR} or {YEAR}?" CAPI displays the two years prior to the first calendar year of the panel. (For panel 23 for example, this would be '2016 or 2017?').

HX760 (HX1860)

BLAISE NAME: CovMorePrev2Year

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:

I have recorded that {you/{PERSON}} {had health insurance coverage for (READ TYPES OF INSURANCE BELOW) coverage} {and} {{were/was} covered under the Indian Health Service} on January 1, {YEAR}. {Were/Was} {you/he/she} ever covered by {any other kind of/a more comprehensive health insurance} plan or program that paid for medical and doctor's bills at any time in the years {YEAR} or {YEAR}?

{TYPE OF COVERAGE IN HX620} {TYPE OF COVERAGE IN HX620}

{TYPE OF COVERAGE IN HX620} {TYPE OF COVERAGE IN HX620}

{TYPE OF COVERAGE IN HX620} {TYPE OF COVERAGE IN HX620}

{TYPE OF COVERAGE IN HX620} {TYPE OF COVERAGE IN HX620}

{TYPE OF COVERAGE IN HX620} {TYPE OF COVERAGE IN HX620}

Responses: YES 1 END_LP70 (HX1865)

NO 2 END_LP70 (HX1865)

REFUSED RF END_LP70 (HX1865)

DON'T KNOW DK END_LP70 (HX1865)

Display Instructions: Roster 1 - Report no add/edit/delete

Roster Definition: This item uses the insurance array to display the types of coverage the RU member may have had if they have private insurance without hospital and physician benefits or Medigap. If person is only covered by IHS, the roster display is null and nothing is displayed for "TYPE OF COVERAGE IN HX620".

Roster Filter:

Display the coverage listed at HX620 for every insurance where:

1. Person confirmed as policyholder (HP80 is coded '1' (YES)) or selected as policyholder (selected at HP90) or selected as a dependent (selected at HP170) for at least one private insurance source with coverage on January 1 (Insurance.HIPublPriv=Private and SimplePerson.CovdJan1=Yes) and
   
   
2. This insurance did not include hospital/physician benefits or Medigap benefits [HX620 was not coded '1' or '5' (Insurance.HospHI<>Yes and Insurance.MedigapHI<>Yes)].

Display 'had health...(BELOW)' if person confirmed as policyholder (HP80 is coded '1' (YES)) or selected as policyholder (selected at HP90) or selected as a dependent (selected at HP170) for at least one private insurance source with coverage on January 1 (Insurance.HIPublPriv=Private and SimplePerson.CovdJan1=Yes). Otherwise, use a null display.

Display '{were/was} covered under the Indian Health Service' if person was covered by IHS on January 1 [selected at HX140 (for IHS coverage) and SimplePerson.CovdJan1=Yes]. Otherwise, use a null display.

Display 'and' if person has both private and IHS as described in previous two paragraphs.

Display "any other kind of" if person selected at HX140 (for IHS coverage). Otherwise, display "a more comprehensive health insurance". (For specifications purposes only; CAPI handles automatically): in the question text, "… on January 1, {YEAR}," 'YEAR' is the first calendar year of the panel (FirstPanYear). In the question text, "… at any times in the years {YEAR} or {YEAR}?. " CAPI displays the two years prior to the first calendar year of the panel. (For panel 23 for example, this would be '2016 or 2017?')

For "TYPE OF COVERAGE IN HX620" display:

'Dental' if HX620 was coded '2' for this insurance.

'Prescription Drugs' if HX620 was coded '3' for this insurance.

'Vision' if HX620 was coded '4' for this insurance.

'Long Term Care in a Nursing Home' if HX620 was coded '6' for this insurance.

'Extra Cash for Hospital Stays' if HX620 was coded '7' for this insurance.

'Serious Disease or Dread Disease' if HX620 was coded '8' for this insurance.

'Disability' if HX620 was coded '9' for this insurance.

'Worker's Compensation' if HX620 was coded '10' for this insurance.

'Accident' if HX620 was coded '11' for this insurance.

'The text from HX620OS if HX620 was coded '91' for this insurance.

'Refused Coverage' if HX620 was coded 'RF' for this insurance.

'Don't Know Coverage' if HX620 was coded 'DK' for this insurance.

END_LP70 (HX1865)

BOX_560 (HX1870)

HX770 (HX1875)

BLAISE NAME: FamProbPayBill

Question Text:

When answering the next questions, think about money that your household has spent on out of pocket expenses for medical care. We do not want you to count health insurance premiums, over the counter drugs, or costs that you will be reimbursed for.

In the past 12 months did anyone in the household have problems paying or were unable to pay any medical bills? Include bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home or home care.

Responses: YES 1 HX780 (HX1880)

NO 2 HX780 (HX1880)

REFUSED RF HX780 (HX1880)

DON'T KNOW DK HX780 (HX1880)

Display Instructions:

HX780 (HX1880)

BLAISE NAME: FamPayOverTime

Question Text:

Does anyone in your household currently have any medical bills that are being paid off over time? This could include medical bills being paid off with a credit card, through personal loans, or bill paying arrangements with hospitals or other providers. The bills can be from earlier years as well as this year.

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If HX770 is coded '2' (NO), go to BOX_570. Otherwise, continue with HX790.

Display Instructions:

HX790 (HX1885)

BLAISE NAME: FamUnablePay

Question Text:

Does anyone in your household currently have any medical bills that you are unable to pay at all?

Responses: YES 1 BOX_570 (HX1890)

NO 2 BOX_570 (HX1890)

REFUSED RF BOX_570 (HX1890)

DON'T KNOW DK BOX_570 (HX1890)

Display Instructions:

BOX_570 (HX1890)

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