Private Health Insurance Detail (HP) Section
---------------------------------------------------- | NOTE: FOR ‘CATEGORY NAME FROM HX03 OR HX23’, | | DISPLAY THE FOLLOWING: | | | | - ‘PROFESSIONAL ASSOCIATION’ IF CODED ‘1’ AT HX03 | | - ‘SMALL BUSINESS GROUP’ IF CODED ‘2’ AT HX03 | | - ‘UNION’ IF CODED ‘3’ AT HX03 | | - ‘HEALTH INSURANCE PURCHASING ALLIANCE’ IF CODED | | ‘4’ AT HX03 | | - ‘INSURANCE AGENT’ IF CODED ‘5’ AT HX03 | | - ‘INSURANCE COMPANY’ IF CODED ‘6’ AT HX03 | | - ‘HMO’ IF CODED ‘7’ AT HX03 | | - ‘PREVIOUS EMPLOYER’ IF CODED ‘8’ AT HX03 | | - ‘PREVIOUS EMPLOYER (COBRA)’ IF CODED ‘9’ AT HX03| | - THE TEXT ENTERED AT HX03OV IF CODED ‘91’ AT HX03| | - ‘SOURCE THE INSURANCE WAS PURCHASED FROM FOR | | THAT BUSINESS’ IF CODED ‘-7’ OR ‘-8’ AT HX03 | | | | - ‘GROUP OR ASSOCIATION’ IF CODED ‘1’ AT HX23 | | - ‘HEALTH INSURANCE PURCHASING ALLIANCE’ IF CODED | | ‘2’ AT HX23 | | - ‘SCHOOL’ IF CODED ‘3’ AT HX23 | | - ‘INSURANCE AGENT’ IF CODED ‘4’ AT HX23 | | - ‘INSURANCE COMPANY’ IF CODED ‘5’ AT HX23 | | - ‘HMO’ IF CODED ‘6’ AT HX23 | | - ‘UNION’ IF CODED ‘7’ AT HX23 | | - ‘ANYONE’S PREVIOUS EMPLOYER (COBRA)’ IF CODED | | ‘8’ AT HX23 | | - ‘ANYONE’S PREVIOUS EMPLOYER (NOT COBRA)’ IF | | CODED ‘9’ AT HX23 | | - ‘SPOUSE’S/DECEASED SPOUSE’S PREVIOUS EMPLOYER’ | | IF CODED ‘10’ AT HX23 | | - ‘SOME OTHER EMPLOYER’ IF CODED ‘11’ AT HX23 | | - ‘PLAN OF SOMEONE NOT LIVING HERE’ IF CODED ‘12’ | | AT HX23 | | - THE TEXT ENTERED AT HX23OV IF CODED ‘91’ AT HX23| | - ‘SOURCE THAT PROVIDED THE DIRECTLY PURCHASED | | INSURANCE’ IF CODED ‘-7’ OR ‘-8’ | -----------------------------------------------------
---------------------------------------------------- | NOTE: FOR ROUND 5, THE END DATE IS DISPLAYED IN | | THE CONTEXT HEADER FOR QUESTIONS HP04 - HP18. | -----------------------------------------------------
BOX_01 ======
---------------------------------------------------- | IF LOOPING ON ANY ESTABLISHMENT FLAGGED IN THE | | EMPLOYMENT (EM) SECTION AS 'PROVIDES HEALTH | | INSURANCE' AND NOT FLAGGED AS ‘SELF-EMPLOYED’ | | WITH A FIRM-SIZE-1, GO TO LOOP_01 | ----------------------------------------------------
---------------------------------------------------- | IF LOOPING ON AN HX03 CATEGORY OR IF LOOPING ON | | AN HX23 CATEGORY (EXCEPT CODE ‘3’ (DIRECTLY FROM | | A SCHOOL)), GO TO HP03 | ----------------------------------------------------
---------------------------------------------------- | IF LOOPING ON CODE '3' (DIRECTLY FROM A SCHOOL) | | AT HX23, CONTINUE WITH HP01 | ----------------------------------------------------
HP01 ====
INSURANCE SOURCE: {CATEGORY NAME FROM HX23}
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1 ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 {BOX_11} REF ................................... -7 DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HP02 ====
INSURANCE SOURCE: {CATEGORY NAME FROM HX23}
Would this insurance cover health services outside of a school clinic?
YES .................................... 1 NO ..................................... 2 {BOX_11} REF ................................... -7 DK .................................... -8
HP03 ====
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1 HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 {BOX_11}
[Code One]
---------------------------------------------------- | IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG | | ITEM FOR SOURCE CLEAN-UP. | ----------------------------------------------------
LOOP_01 =======
---------------------------------------------------- | FOR EACH OF THE FOLLOWING: | | | | ESTABLISHMENT 1 | | ESTABLISHMENT 2 | | ESTABLISHMENT 3 | | ESTABLISHMENT 4 | | | | ASK BOX_01A-END_LP01 | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP-01 COLLECTS DETAILED | | INFORMATION ABOUT INSURANCE PROVIDED THROUGH AN | | EMPLOYER OR THE ESTABLISHMENT NAMES OF THE | | INSURANCE SOURCE COLLECTED IN EITHER HX03 OR HX23.| | IF LOOPING ON INSURANCE PROVIDED FROM AN EMPLOYER | | ONLY ONE LOOP CYCLE IS COMPLETED. | | | | IF LOOPING ON INSURANCE PROVIDED THROUGH AN | | INSURANCE SOURCE COLLECTED IN HX03 OR HX23, THE | | FIRST LOOP CYCLE COLLECTS THE MAIN ESTABLISHMENT | | NAME OF THE INSURANCE SOURCE. SUBSEQUENT CYCLES, | | IF ANY, ARE DETERMINED BY THE RESPONSE TO HP18. | | IF HP18 IS CODED '1' (YES), THE LOOP CYCLES AGAIN | | TO COLLECT THE NEXT ESTABLISHMENT NAME. IF HP18 | | IS NOT ASKED OR IS CODED '2' (NO), '-7' (REFUSED),| | OR '-8' (DON'T KNOW), THE LOOP ENDS. | ----------------------------------------------------
BOX_01A =======
---------------------------------------------------- | IF LOOPING ON ANY ESTABLISHMENT FLAGGED IN | | EMPLOYMENT AS 'PROVIDES HEALTH INSURANCE' AND NOT | | FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE-1, | | GO TO HP09 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH HP04 | ----------------------------------------------------
HP04 ==== {PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
Please give me the name of one of the {(INSURANCE SOURCE)} {from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent}.
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT | HP04_02. STREET | HP04_03. CITY |
---|---|---|
1. Establishment | [Enter Truncated Street Address] | [Enter Truncated City] |
2. Establishment | [Enter Truncated Street Address] | [Enter Truncated City] |
3. Establishment | [Enter Truncated Street Address] | [Enter Truncated City] |
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL | | ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE | | INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS | | DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS | | ‘EMPLOYER’ AND ‘SELF-EMPLOYED’ WITH A FIRM-SIZE-1 | | THAT ARE COMING FROM THE HX03 SERIES). | ----------------------------------------------------
---------------------------------------------------- | ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS: | | | | 1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT | | ALREADY LISTED OR SELECT ‘NONE OF THE ABOVE’. | | 2. ONLY ONE SELECTION MAY BE MADE. | | 3. INTERVIEWER CANNOT ADD AT THIS SCREEN. | | ESTABLISHMENTS ARE ‘ADDED’ BY USING ‘NONE OF | | THE ABOVE’. | | 4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E.,| | CTRL/D). | ---------------------------------------------------- ---------------------------------------------------- | DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON | | THIS ROSTER. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘(INSURANCE SOURCE)’ IF NOT LOOPING ON | | CODE ‘5’ (INSURANCE AGENT) AT HX03 OR CODE ‘4’ | | (INSURANCE AGENT) AT HX23. | | | | DISPLAY ‘from which anyone in the family purchased| | this insurance’ IF NOT LOOPING ON CODE ‘5’ | | (INSURANCE AGENT) AT HX03 OR CODES ‘4’ (INSURANCE | | AGENT) OR ‘12’ (UNDER PLAN OF SOMEONE NOT LIVING | | HERE) AT HX23. | | | | DISPLAY ‘which covers anyone in the family’ IF | | LOOPING ON CODE ‘12’ (UNDER PLAN OF SOMEONE NOT | | LIVING HERE) AT HX23. | | | | DISPLAY ‘insurance company for the insurance | | purchased from an agent’ IF LOOPING ON CODE ‘5’ | | (INSURANCE AGENT) AT HX03 OR CODE ‘4’ (INSURANCE | | AGENT) AT HX23. | ----------------------------------------------------
---------------------------------------------------- | NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS | | HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO | | THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON | | (I.E., JOBHOLDER WHEN COMING FROM AN HX03 | | CATEGORY), CAPI DISPLAYS THE PERSON AND START | | DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, | | CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. | | OTHERWISE, CAPI DISPLAYS THE START DATE. | ----------------------------------------------------
---------------------------------------------------- | IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT| | LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' | | IS SELECTED, GO TO HP07 | ----------------------------------------------------
---------------------------------------------------- | IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT | | LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT | | LIVING HERE) AT HX23, GO TO HP06 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH HP05 | ----------------------------------------------------
HP05 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
Is the address of (ESTABLISHMENT):
{ESTABLISHMENT STREET ADDRESS LINE1.} {ESTABLISHMENT STREET ADDRESS LINE2.} {ESTABLISHMENT CITY......., ST, ZIP..} {EST. TEL #}
ADDRESS AND TELEPHONE CORRECT .......... 1 {BOX_02} ADD NEW ADDRESS FOR ESTABLISHMENT}...... 2 ABOVE ADDRESS/TELEPHONE NEEDS CORRECTION .......................... 3 {HP08} SELECTED WRONG ESTABLISHMENT/ADDRESS ... 4 REF ................................... -7 {BOX_02} DK .................................... -8 {BOX_02}
[Code One]
---------------------------------------------------- | IF CODED '4' (SELECTED WRONG ESTABLISHMENT/ | | ADDRESS), CAPI REDISPLAYS HP04 SO THE INTERVIEWER | | CAN SELECT THE CORRECT ESTABLISHMENT. | ----------------------------------------------------
HP06 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
What is the {new} address of (ESTABLISHMENT)?
ENTER COMPLETE (NAME AND) ADDRESS AND VERIFY SPELLING. IF ESTABLISHMENT HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON PURCHASED INSURANCE.
Current Info: [ESTABLISHMENT] [STREET ADDRESS1] [STREET ADDRESS2] [CITY] [STATE] [ZIP CODE] [TELEPHONE]
ESTABLISHMENT (HP06_01): [_____________] STREET ADDRESS1 (HP06_02): [_____________] STREET ADDRESS2 (HP06_03): [_____________] CITY (HP06_04): [_____________] STATE (HP06_05): [_____________] ZIP CODE (HP06_06): [_____________] TELEPHONE (HP06_07): [_____________]
PRESS F1 FOR LIST OF STATE ABBREVIATIONS.
---------------------------------------------------- | DISPLAY 'new' IF HP05 IS CODED '2' (ADD NEW | | ADDRESS FOR ESTABLISHMENT). OTHERWISE, USE A | | NULL DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | NOTE: SINCE TYPE OF COVERAGE INFORMATION IS NOT | | COLLECTED UNTIL AFTER WE COLLECT ADDRESS | | INFORMATION, WE WILL BE COLLECTING ADDRESS | | INFORMATION FOR SOME ESTABLISHMENTS THAT WILL NOT | | BE PART OF THE HIPS SAMPLE. | ----------------------------------------------------
---------------------------------------------------- | WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- | | ROSTER. | ---------------------------------------------------- ---------------------------------------------------- | GO TO BOX_02 | ----------------------------------------------------
---------------------------------------------------- | NOTE: WE NOW PLAN TO COLLECT FULL ADDRESS | | INFORMATION FOR SOURCES OF HEALTH INSURANCE IN | | ROUND 2 AND BEYOND. THIS ALLOWS US TO CONTINUE TO| | UNIQUE ESTABLISHMENTS AND ALLOWS FOR MAXIMUM | | FLEXIBILITY (E.G., IF WE WANT TO HIPS AGAIN). | ----------------------------------------------------
HP07 ====
{STR-DT} {END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
You mentioned that someone in the family receives health insurance from the plan of someone not living here. How does that policyholder get this insurance?
INTERVIEWER: RECORD ESTABLISHMENT NAME BELOW. ADDRESS INFORMATION IS NOT NECESSARY.
[Enter Establishment Name]
---------------------------------------------------- | NOTE: ONLY CATEGORY ‘12’ (UNDER PLAN OF SOMEONE | | NOT LIVING HERE) OF HX23 IS ASKED HP07. | ----------------------------------------------------
---------------------------------------------------- | WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- | | ROSTER. DISPLAY ADDRESS AS ‘NOT NECESSARY'. | ----------------------------------------------------
---------------------------------------------------- | GO TO BOX_02 | ----------------------------------------------------
HP08 ====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
CORRECT ADDRESS OR TELEPHONE FOR: (ESTABLISHMENT)
PRESS ENTER TO CONFIRM ENTRY OF INDIVIDUAL FIELD. RE-TYPE ENTIRE LINE FOR INCORRECT FIELD.
Current Info: [ESTABLISHMENT] [STREET ADDRESS1] [STREET ADDRESS2] [CITY] [STATE] [ZIP CODE] [TELEPHONE]
ESTABLISHMENT (HP08_01): [_____________] STREET ADDRESS1 (HP08_02): [_____________] STREET ADDRESS2 (HP08_03): [_____________] CITY (HP08_04): [_____________] STATE (HP08_05): [_____________] ZIP CODE (HP08_06): [_____________] TELEPHONE (HP08_07): [_____________]
PRESS F1 FOR LIST OF STATE ABBREVIATIONS.
BOX_02 ======
---------------------------------------------------- | IF HX03 IS CODED '1' OR '2' FLAG ESTABLISHMENT AS | | 'GROUP'. | | IF HX03 IS CODED '3', FLAG ESTABLISHMENT AS | | 'UNION'. | | IF HX03 IS CODED '4', FLAG ESTABLISHMENT AS | | 'HEALTH ALLIANCE'. | | IF HX03 IS CODED '5', FLAG ESTABLISHMENT AS | | 'INSURANCE COMPANY-FROM AN AGENT'. | | IF HX03 IS CODED '6', FLAG ESTABLISHMENT AS | | 'INSURANCE COMPANY'. | | IF HX03 IS CODED '7', FLAG ESTABLISHMENT AS 'HMO'.| | IF HX03 IS CODED '8', FLAG ESTABLISHMENT AS | | 'PREVIOUS EMPLOYER, NOT COBRA'. | | IF HX03 IS CODED '9', FLAG ESTABLISHMENT AS | | 'COBRA'. | | IF HX03 IS CODED '91', FLAG ESTABLISHMENT AS | | 'UNKNOWN TYPE-COLLECTED AT OTHER'. | | | | IF HX23 IS CODED '1', FLAG ESTABLISHMENT AS | | 'GROUP'. | | IF HX23 IS CODED '2', FLAG ESTABLISHMENT AS | | 'HEALTH ALLIANCE'. | | IF HX23 IS CODED '3', FLAG ESTABLISHMENT AS | | 'SCHOOL'. | | IF HX23 IS CODED '4', FLAG ESTABLISHMENT AS | | 'INSURANCE COMPANY-FROM AN AGENT’. | | IF HX23 IS CODED '5', FLAG ESTABLISHMENT AS | | 'INSURANCE COMPANY'. | | IF HX23 IS CODED '6', FLAG ESTABLISHMENT AS | | 'HMO'. | | IF HX23 IS CODED '7', FLAG ESTABLISHMENT AS | | 'UNION'. | | IF HX23 IS CODED '8', FLAG ESTABLISHMENT AS | | 'COBRA'. | | IF HX23 IS CODED '9', FLAG ESTABLISHMENT AS | | 'PREVIOUS EMPLOYER, NOT COBRA'. | | IF HX23 IS CODED '10', FLAG ESTABLISHMENT AS | | 'SPOUSE PREVIOUS EMPLOYER'. | | IF HX23 IS CODED '11', FLAG ESTABLISHMENT AS | | 'EMPLOYER'. | | IF HX23 IS CODED '12', FLAG ESTABLISHMENT AS | | 'UNKNOWN TYPE-OUTSIDE RU'. | | IF HX23 IS CODED ‘91’, FLAG ESTABLISHMENT AS | | ‘UNKNOWN TYPE - COLLECTED AT OTHER’. | ----------------------------------------------------
BOX_03 ======
---------------------------------------------------- | IF LOOPING ON AN HX23 CATEGORY, GO TO HP11 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH HP09 | ----------------------------------------------------
HP09 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
{(Are/Is)/As of (END DATE), was} (PERSON) the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
YES .................................... 1 {LOOP_02} NO ..................................... 2 REF ................................... -7 DK .................................... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
---------------------------------------------------- | DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY ‘As of| | (END DATE), was’ IF ROUND 5. | ----------------------------------------------------
---------------------------------------------------- | NOTE: PERSON REFERS TO JOBHOLDER. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '1' (YES), FLAG JOBHOLDER AS | | 'POLICYHOLDER'. | ----------------------------------------------------
HP10 ====
{NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Who {is/was} the primary insured person or policyholder of this health coverage through (ESTABLISHMENT) {on (END DATE)}?
TO SCROLL, USE ARROW KEYS. TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{EMPLOYER/JOBHOLDER PAIR 1} {EMPLOYER/JOBHOLDER PAIR 2} {EMPLOYER/JOBHOLDER PAIR 3}
JOBHOLDER/EMPLOYER IS LISTED ........... 1 {END_LP01} JOBHOLDER/EMPLOYER IS NOT LISTED ....... 2 {END_LP01} REF ................................... -7 {END_LP01} DK .................................... -8 {END_LP01}
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code One]
---------------------------------------------------- | DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF | | ROUND 5. DISPLAY ‘on (END DATE)’ IF ROUND 5. | | OTHERWISE, USE NULL DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PAIRS | | ON THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT | | MEET BOTH OF THE FOLLOWING CONDITIONS: | | | | - ESTABLISHMENT IS FLAGGED AS AN 'EMPLOYER' THAT | | IS ALSO FLAGGED AS ‘PROVIDES HEALTH INSURANCE’ | | AND | | - PERSON IS A JOBHOLDER AT THE JOB PROVIDED BY | | ESTABLISHMENT | ----------------------------------------------------
---------------------------------------------------- | IF CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T | | KNOW), FLAG FOR EVENT CLEANUP. | ----------------------------------------------------
HP11 ====
{NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Who {is/was} the primary insured person or policyholder of this health coverage through (ESTABLISHMENT) {on (END DATE)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] .. [2. First Name,[Middle Name],Last Name-35] .. [3. First Name,[Middle Name],Last Name-35] .. REF .............................. .... -7 DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
---------------------------------------------------- | DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF | | ROUND 5. DISPLAY ‘on (END DATE)’ IF ROUND 5. | | OTHERWISE, USE NULL DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS | | ON THE DU-MEMBERS-ROSTER. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND | | 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON | | THIS ROSTER. | ----------------------------------------------------
---------------------------------------------------- | IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND | | 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO | | LOOP_02 | ----------------------------------------------------
---------------------------------------------------- | IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN | | COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER| | NOT LISTED IN DU’, GO TO HP11B | ----------------------------------------------------
---------------------------------------------------- | IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE| | OR IN COMBINATION WITH OTHER NAMES AND/OR | | ‘POLICYHOLDER DECEASED’, CONTINUE WITH HP11A | ----------------------------------------------------
HP11A =====
{NAME OF ESTABLISHMENT........} {STR-DT} {END-DT}
INTERVIEWER: ENTER NAME OR DESCRIPTION OF POLICYHOLDER WHO IS NOT IN THE DU:
[Enter Specify-15] ....................
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
---------------------------------------------------- | NOTE: WHENEVER THIS POLICYHOLDER IS BEING ASKED | | ABOUT IN THE REMAINDER OF HP, HQ, HX, AND OE, THE | | POLICYHOLDER NAME IN THE CONTEXT HEADER WILL BE | | DISPLAYED AS ‘PLCYHLDR NOT IN DU-’ FOLLOWED BY | | THE 15 CHARACTER ENTRY AT HP11A. | ----------------------------------------------------
---------------------------------------------------- | IF 'POLICYHOLDER DECEASED' SELECTED AT HP11, | | CONTINUE WITH HP11B | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO LOOP_02 | ----------------------------------------------------
HP11B =====
{NAME OF ESTABLISHMENT........} {STR-DT} {END-DT}
INTERVIEWER: ENTER NAME OF DECEASED POLICYHOLDER:
[Enter Specify-40] ....................
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
---------------------------------------------------- | FLAG POLICYHOLDER AS ‘DECEASED’. | ----------------------------------------------------
---------------------------------------------------- | NOTE: WHENEVER THE POLICYHOLDER IS BEING ASKED | | ABOUT IN THE REMAINDER OF HP, HQ, HX, AND OE, THE | | POLICYHOLDER NAME IN THE CONTEXT HEADER WILL BE | | DISPLAYED AS ‘PLCYHLDR DECEASED-’ FOLLOWED BY THE | | FIRST 15 CHARACTERS OF THE ENTRY AT HP11B. | ----------------------------------------------------
LOOP_02 =======
---------------------------------------------------- | FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON- | | PAIRS-ROSTER, ASK BOX_04-END_LP02 | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION | | ABOUT THE POLICYHOLDER AND DEPENDENTS FOR EACH | | ESTABLISHMENT-PERSON. THIS LOOP CYCLES ON EACH | | ESTABLISHMENT-PERSON-PAIR CREATED AT HP09 AND HP11| | DURING THE CURRENT ROUND FOR THE ESTABLISHMENT | | BEING CYCLED ON IN LOOP_01. | ----------------------------------------------------
BOX_04 ======
---------------------------------------------------- | IF LOOPING ON AN ESTABLISHMENT FLAGGED IN | | EMPLOYMENT AS ‘PROVIDES HEALTH INSURANCE’, GO TO | | BOX_07 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH BOX_05 | ----------------------------------------------------
BOX_05 ======
---------------------------------------------------- | IF HX23 IS CODED ‘8’ (PREVIOUS EMPLOYER-COBRA), | | ‘9’ (PREVIOUS EMPLOYER-NOT COBRA), ‘10’ (SPOUSE | | PREVIOUS EMPLOYER), OR ‘11’ (OTHER EMPLOYER) | | CONTINUE WITH BOX_06 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_07 | ----------------------------------------------------
BOX_06 ======
---------------------------------------------------- | IF POLICYHOLDER WAS FLAGGED AT HP11 AS 'DECEASED',| | CODE HP12 AS '4' (DECEASED) AUTOMATICALLY BY CAPI | | AND GO TO HP13 | ----------------------------------------------------
---------------------------------------------------- | IF POLICYHOLDER IS NOT A CURRENT RU MEMBER, GO TO | | BOX_07 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH HP12 | ----------------------------------------------------
HP12 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
(Are/Is) (POLICYHOLDER) currently employed at this job, retired from this job, previously employed at this job, or is it some other situation?
CURRENTLY EMPLOYED ..................... 1 {HP13} RETIRED ................................ 2 {HP13} PREVIOUSLY EMPLOYED .................... 3 {HP13} DECEASED ............................... 4 {HP13} OTHER ................................. 91 REF ................................... -7 {HP13} DK .................................... -8 {HP13}
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
[Code One]
---------------------------------------------------- | EDIT: CODE ‘4’ (DECEASED) CANNOT BE SELECTED FOR | | A POLICYHOLDER WHO IS A CURRENT RU MEMBER. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '4' (DECEASED), FLAG POLICYHOLDER AS | | 'DECEASED'. | ----------------------------------------------------
HP12OV ======
ENTER OTHER:
[Enter Other Specify] .................. REF ................................... -7 DK .................................... -8
HP13 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
{(Are/Is)/(Were/Was)} (POLICYHOLDER) a federal government employee at this job?
YES ................................... 1 NO .................................... 2 REF ................................... -7 DK .................................... -8
PRESS F1 FOR DEFINITION OF FEDERAL GOVERNMENT.
---------------------------------------------------- | DISPLAY '(Are/Is)' IF HP12 IS CODED ‘1’ (CURRENTLY| | EMPLOYED). OTHERWISE, DISPLAY '(Were/Was)'. | ----------------------------------------------------
BOX_07 ======
---------------------------------------------------- | IF ESTABLISHMENT THAT PROVIDES INSURANCE IS | | FLAGGED AS: | | | | 'EMPLOYER' AND JOB SUBTYPE IS NOT 'CURRENT MAIN', | | 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE | | PERIOD', 'RETIREMENT JOB', OR UNION | | OR | | 'EMPLOYER' AND JOB SUBTYPE IS 'FORMER MAIN', | | 'FORMER MISCELLANEOUS' OR 'LAST JOB OUTSIDE | | REFERENCE PERIOD' AND JOB IS ALSO FLAGGED AS 'NOT | | RETIRED FROM’ | | OR | | ‘PREVIOUS EMPLOYER, NOT COBRA’ (I.E., HX03-CODE | | ‘8’; HX23-CODE ‘9’) | | OR | | ‘EMPLOYER’ (I.E., HX23-CODE ‘11’) AND HP12 IS NOT | | CODED ‘1’ (CURRENTLY EMPLOYED) | | OR | | ‘SPOUSE PREVIOUS EMPLOYER’ (I.E., HX23-CODE ‘10’) | | OR | | ‘UNKNOWN TYPE-OUTSIDE RU’ (I.E., HX23-CODE ‘12’) | | OR | | ‘UNKNOWN TYPE-COLLECTED AT OTHER’ (I.E., HX23- | | CODE ‘91’), | | | | CONTINUE WITH HP14 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO HP15 | ----------------------------------------------------
---------------------------------------------------- | NOTE: FROM THE TAPES AND OBSERVATIONS, IT BECAME | | OBVIOUS THAT MANY SOURCES OF INSURANCE WERE BEING | | SENT THROUGH HP14 WHEN IT WAS INAPPROPRIATE. | | THEREFORE, BOX_07 HAS BEEN REVISED TO SEND ONLY | | SOURCES OF INSURANCE IDENTIFIED AS EMPLOYER (BUT | | NOT CURRENT OR COBRA) OR UNKNOWN THROUGH HP14. | ----------------------------------------------------
HP14 ==== {POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Some employer insurance can be continued after leaving the company by continuing to pay the premium. This is sometimes referred to as a COBRA plan.
{Is/Was} (POLICYHOLDER)’s (ESTABLISHMENT) insurance like that {on (END DATE)}?
YES .................................... 1 NO ..................................... 2 REF ................................... -7 DK .................................... -8
PRESS F1 FOR DEFINITION OF COBRA.
---------------------------------------------------- | DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF | | ROUND 5. DISPLAY ‘on (END DATE)’ IF ROUND 5. | | OTHERWISE, USE NULL DISPLAY. | ----------------------------------------------------
HP15 ==== {POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Was anyone {living here} covered as a dependent under (POLICYHOLDER)'s health coverage through (ESTABLISHMENT) at any time {since (START DATE)/between (START DATE) and (END DATE)}?
YES .................................... 1 NO ..................................... 2 {HP17} REF ................................... -7 {HP17} DK .................................... -8 {HP17}
PRESS F1 FOR DEFINITION OF DEPENDENT.
---------------------------------------------------- | DISPLAY 'living here' IF LOOPING ON CODE ‘12’ | | (OUTSIDE RU) AT HX23. | | | | DISPLAY ‘since (START DATE)’ IF NOT ROUND 5. | | DISPLAY ‘between (START DATE) and (END DATE)’ IF | | ROUND 5. | ----------------------------------------------------
HP16 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Who is that?
PROBE: Was anyone else covered as a dependent {since (START DATE)/between (START DATE) and (END DATE)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] [2. First Name,[Middle Name],Last Name-35] [3. First Name,[Middle Name],Last Name-35] REF ................................... -7 DK .................................... -8
[Code All That Apply]
---------------------------------------------------- | DISPLAY ‘since (START DATE)’ IF NOT ROUND 5. | | DISPLAY ‘between (START DATE) and (END DATE)’ IF | | ROUND 5. | ----------------------------------------------------
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS | | ON THE RU-MEMBERS-ROSTER, EXCLUDING THE NAME OF | | THE POLICYHOLDER (I.E., PERSON IN THIS | | ESTABLISHMENT-PERSON-PAIR BEING ASKED ABOUT) FOR | | THIS INSURANCE. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'PERSON NOT LISTED IN RU' AS LAST ENTRY ON| | THIS ROSTER. | ----------------------------------------------------
---------------------------------------------------- | IF 'PERSON NOT LISTED IN RU' IS SELECTED, FLAG | | INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR | | AS 'COVERING PERSON NOT LISTED IN RU'. | ----------------------------------------------------
---------------------------------------------------- | GO TO BOX_08 | ----------------------------------------------------
HP17 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
{Does/Between (START DATE) and (END DATE), did} (POLICYHOLDER)'s health coverage through (ESTABLISHMENT) cover as dependents any persons who do not live here?
YES .................................... 1 NO ..................................... 2 REF ................................... -7 DK .................................... -8
PRESS F1 FOR DEFINITION OF DEPENDENT.
---------------------------------------------------- | DISPLAY ‘Does’ IF NOT ROUND 5. DISPLAY ‘Between | | (START DATE) and (END DATE), did’ IF ROUND 5. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '1' (YES), FLAG INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT | | LISTED IN RU' IN HP16. | ----------------------------------------------------
BOX_08 ======
---------------------------------------------------- | IF THERE ARE NO POLICYHOLDERS OR DEPENDENTS WHO | | ARE CURRENT RU MEMBERS, THAT IS, POLICYHOLDER IS A| | DU MEMBER BUT NOT A CURRENT RU MEMBER, OR IS | | FLAGGED AS 'NOT LISTED IN DU' OR 'POLICYHOLDER | | DECEASED' AND INSURANCE ALSO FLAGGED ONLY AS | | 'COVERING PERSON NOT IN RU', GO TO END_LP02 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH LOOP_03 | ----------------------------------------------------
LOOP_03 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- | | PERS-TRPLS-ROSTER, ASK BOX-09-END_LP03 | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_03 COLLECTS TIME PERIOD | | COVERAGE FOR ALL CURRENT RU MEMBERS COVERED BY THE| | INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR. | | THIS LOOP CYCLES ON CURRENT RU MEMBERS WHO ARE | | SELECTED AS DEPENDENTS AT HP16 AND THE RU MEMBER | | WHO IS FLAGGED AS THE POLICYHOLDER FOR THIS | | INSURANCE. | ----------------------------------------------------
BOX_09 ======
---------------------------------------------------- | ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION. | | | | AT COMPLETION OF TIME PERIOD COVERED DETAIL (HQ) | | SECTION, CONTINUE WITH END_LP03 | ----------------------------------------------------
END_LP03 ========
---------------------------------------------------- | CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- | | COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS | | STATED IN THE LOOP DEFINITION. | ----------------------------------------------------
---------------------------------------------------- | IF NO OTHER PERSONS MEET THE STATED CONDITIONS, | | END LOOP_03 AND CONTINUE WITH END_LP02 | ----------------------------------------------------
END_LP02 ========
---------------------------------------------------- | CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-| | PAIRS-ROSTER WHO MEETS THE CONDITIONS STATED IN | | THE LOOP DEFINITION. | ----------------------------------------------------
---------------------------------------------------- | IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END | | LOOP_02 AND CONTINUE WITH BOX_10 | ----------------------------------------------------
BOX_10 ======
---------------------------------------------------- | IF LOOPING ON AN ESTABLISHMENT FLAGGED IN | | EMPLOYMENT AS 'PROVIDES HEALTH INSURANCE' AND NOT | | FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE-1, GO | | TO END_LP01 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH HP18 | ----------------------------------------------------
HP18 ====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
INSURANCE SOURCE: {CATEGORY NAME FROM HX03 OR HX23}
Aside from (POLICYHOLDER)’s (ESTABLISHMENT) insurance, is there another health insurance plan that anyone in the family obtains from (a/an) (INSURANCE SOURCE)?
YES .................................... 1 NO ..................................... 2 REF ................................... -7 DK .................................... -8
END_LP01 ========
---------------------------------------------------- | IF HP18 IS CODED '1' (YES), CYCLE TO COLLECT NEXT | | ESTABLISHMENT NAME. | ----------------------------------------------------
---------------------------------------------------- | IF HP18 IS NOT ASKED OR IS CODED '2' (NO), '-7' | | (REFUSED), OR '-8' (DON'T KNOW) END LOOP_01 AND | | CONTINUE WITH BOX_11 | ----------------------------------------------------
BOX_11 ======
---------------------------------------------------- | RETURN TO THE HEALTH INSURANCE (HX) SECTION. | ----------------------------------------------------