Old Employment and Private Related Insurance (OE) Section
BOX_01 ======
---------------------------------------------------- | IF ONE OR MORE RU MEMBERS STILL HOLD A 'CURRENT | | MAIN' OR 'CURRENT MISCELLANEOUS' JOB THIS ROUND | | THAT WAS REPORTED DURING THE PREVIOUS ROUND AS | | PROVIDING HEALTH INSURANCE ON THE DATE OF THE | | PREVIOUS ROUND'S INTERVIEW, THAT IS: | | | | IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE | | RU MEET THE FOLLOWING CONDITIONS: | | - RJ01 OR RJ06 WAS CODED '1' (YES) DURING THIS | | ROUND FOR THIS PAIR, AND | | - PERSON IS A JOBHOLDER AT ESTABLISHMENT, AND | | - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS | | INSURANCE, AND | | - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING | | THE PREVIOUS ROUND AS 'PROVIDES HEALTH | | INSURANCE' AND, | | - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT | | COVERED PERSON ON THE DATE OF THE PREVIOUS | | ROUND'S INTERVIEW (HQ01 WAS CODED '1' (WHOLE | | TIME) OR HQ02 WAS CODED '1' (YES) IN THE | | PREVIOUS ROUND), AND | | - JOB AT ESTABLISHMENT IS NOT FLAGGED AS 'SELF- | | EMPLOYED' WITH A FIRM-SIZE-1, | | | | CONTINUE WITH LOOP_01 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_10 | ----------------------------------------------------
---------------------------------------------------- | NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT | | IN THE RU ON THE PREVIOUS ROUND’S INTERVIEW DATE, | | THE FIFTH CONDITION IN THE ABOVE BOX CAN BE MET | | IF AT LEAST ONE DEPENDENT WAS COVERED BY | | POLICYHOLDER’S INSURANCE ON THE PREVIOUS ROUND’S | | INTERVIEW DATE. THE LOOP WILL CYCLE ON THE | | POLICYHOLDER’S NAME. | ----------------------------------------------------
---------------------------------------------------- | NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE | | POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, | | INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT | | ROUND’S INTERVIEW DATE, BUT WHERE THE | | ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO | | ARE STILL RU MEMBERS MAY STILL QUALIFY FOR | | LOOP_01. | ----------------------------------------------------
LOOP_01 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- | | PAIRS-ROSTER, ASK OE01 - END_LP01. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: | | | | LOOP_01 COLLECTS INFORMATION ABOUT THE | | CONTINUATION OF INSURANCE COVERAGE THROUGH A | | 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS' JOB THAT| | WAS COLLECTED IN THE PREVIOUS ROUND. THIS LOOP | | CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE| | FOLLOWING CONDITIONS: | | | | - RJ01 OR RJ06 WAS CODED '1' (YES) DURING THIS | | ROUND FOR THIS PAIR, AND | | - PERSON IS A JOBHOLDER AT ESTABLISHMENT, AND | | - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS | | INSURANCE, AND | | - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING | | THE PREVIOUS ROUND AS 'PROVIDES HEALTH | | INSURANCE' AND, | | - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT | | COVERED PERSON ON THE DATE OF THE PREVIOUS | | ROUND'S INTERVIEW (HQ01 WAS CODED '1' (WHOLE | | TIME) OR HQ02 WAS CODED '1' (YES) IN THE | | PREVIOUS ROUND), AND | | - JOB AT ESTABLISHMENT IS NOT FLAGGED AS 'SELF- | | EMPLOYED' WITH A FIRM-SIZE-1 | -----------------------------------------------------
OE01 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health insurance. {(Are/Is)/(Were/Was)} (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of {today,} (END DATE)?
YES ................................... 1 {BOX_02} NO .................................... 2 REF ................................... -7 {END_LP01} DK .................................... -8 {END_LP01}
---------------------------------------------------- | DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY | | ‘(Was/Were)’ IF ROUND 5. | | | | DISPLAY ‘today,’ IF NOT ROUND 5. OTHERWISE, USE A| | NULL DISPLAY. | ----------------------------------------------------
OE02 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
On what date did (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) end?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
---------------------------------------------------- | EDIT (FOR ROUND 5 ONLY): COMPLETE DATE ENTERED | | CANNOT BE AFTER 12/31/2004. IF A DATE AFTER | | 12/31/2004 IS ENTERED, DISPLAY THE FOLLOWING | | MESSAGE: ‘DATE CANNOT BE AFTER 12/31/2004. IF | | INSURANCE ENDED AFTER 12/31/2004, USE CTRL/B TO | | BACK-UP AND CHANGE RESPONSE TO OE01. | ----------------------------------------------------
---------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T| | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE02OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_02 | ----------------------------------------------------
OE02OV ======
Can you just tell me if (POLICYHOLDER) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 PART OF THE MONTH ..................... 2 REF ................................... -7 DK .................................... -8
[Code One]
BOX_02 ======
---------------------------------------------------- | IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT | | THE PREVIOUS ROUND'S INTERVIEW DATE BY THE | | INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, | | AUTOMATICALLY CODE OE03 AS ‘1’ (YES) AND GO TO | | BOX_03 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH OE03 | ----------------------------------------------------
OE03 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT).
{Are/Were} they all covered by this health insurance {until {{OE02 DATE}/it ended}/on (END-DT)}?
TO SCROLL, USE ARROW KEYS. TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT} {PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT} {PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
YES ................................... 1 NO .................................... 2 REF ................................... -7 DK .................................... -8
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- | | PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY | | THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: | | - PERSON WAS COVERED AT THE PREVIOUS ROUND'S | | INTERVIEW DATE BY THE INSURANCE FROM THIS | | ESTABLISHMENT-PERSON-PAIR, INCLUDING THE | | POLICYHOLDER | | - PERSON IS AN RU MEMBER | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'Are' IF OE01 IS CODED ‘1’ (YES). | | DISPLAY 'Were' IF OE01 IS CODED ‘2’ (NO) OR IF | | CURRENT ROUND IS ROUND 5. | | | | DISPLAY 'until {OE02 DATE}' IF OE01 IS CODED ‘2’ | | (NO). | | DISPLAY 'on (END-DT)' IF OE01 IS CODED ‘1’ (YES). | | | | DISPLAY THE DATE RECORDED AT OE02 FOR ‘OE02 DATE’.| | IF THE MONTH AND DAY FIELD AT OE02 IS CODED ‘-7’ | | (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’| | FOR ‘OE02 DATE’. | ----------------------------------------------------
BOX_03 ======
---------------------------------------------------- | IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND | | TO THE END DATE OF THE CURRENT ROUND, THAT IS: | | | | IF OE01 IS CODED '1' (YES) AND OE03 IS CODED '1' | | (YES), | | | | FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING | | THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH| | THE REFERENCE PERIOD END DATE AND | | | | GO TO BOX_05 | ----------------------------------------------------
---------------------------------------------------- | IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND | | TO PART OF THE CURRENT ROUND, THAT IS: | | | | IF OE01 IS CODED '2' (NO) AND OE03 IS CODED '1' | | (YES), | | | | FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING | | THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH| | THE DATE RECORDED AT OE02 AND | | | | GO TO BOX_05 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE (I.E., OE03 CODED ‘2’ (NO), ‘-7’ | | (REFUSED), OR ‘-8’ (DON'T KNOW)), | | CONTINUE WITH OE04 | ----------------------------------------------------
OE04 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Who {is/was} no longer covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {until {{OE02 DATE}/it ended}/on (END-DT)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65] [2. First Name, [Middle Name], Last Name-65] [3. First Name, [Middle Name], Last Name-65]
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- | | PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY | | THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: | | - PERSON WAS COVERED AT THE PREVIOUS ROUND'S | | INTERVIEW DATE BY THE INSURANCE FROM THIS | | ESTABLISHMENT-PERSON-PAIR, INCLUDING THE | | POLICYHOLDER | | - PERSON IS AN RU MEMBER | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'is' IF OE01 IS CODED ‘1’ (YES). | | DISPLAY 'was' IF OE01 IS CODED ‘2’ (NO) OR IF | | CURRENT ROUND IS ROUND 5. | | | | DISPLAY 'until {OE02 DATE}' IF OE01 IS CODED ‘2’ | | (NO). | | DISPLAY 'on (END-DT)' IF OE01 IS CODED ‘1’ (YES). | | | | DISPLAY THE DATE RECORDED AT OE02 FOR ‘OE02 DATE’.| | IF THE MONTH AND DAY FIELD AT OE02 IS CODED ‘-7’ | | (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’| | FOR ‘OE02 DATE’. | ----------------------------------------------------
---------------------------------------------------- | IF FAMILY STILL HAS INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED '1' | | (YES)), FLAG INSURANCE FOR ALL PERSONS NOT | | SELECTED AT OE04 AS CONTINUOUS COVERAGE FROM THE | | REFERENCE PERIOD START DATE UNTIL THE REFERENCE | | PERIOD END DATE. | ----------------------------------------------------
---------------------------------------------------- | IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH | | THIS ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED '2' | | (NO), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED | | AT OE04 AS 'CONTINUOUS COVERAGE' FROM THE | | REFERENCE PERIOD START DATE UNTIL DATE RECORDED | | AT OE02. | ----------------------------------------------------
LOOP_02 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- | | PERS-TRPLS-ROSTER, ASK OE05 - END_LP02. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_02 COLLECTS THE DATE ON | | WHICH THE INSURANCE COVERAGE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER| | WHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCE| | PERIOD END DATE OR THE DATE REPORTED IN OE02. | | THIS LOOP CYCLES ON PERSONS SELECTED AT OE04. | ----------------------------------------------------
OE05 ====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
On what date did the health insurance through (ESTABLISHMENT) end for (PERSON)?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
---------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T| | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE05OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_04 | ----------------------------------------------------
OE05OV ======
Can you just tell me if (PERSON) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 PART OF THE MONTH ..................... 2 REF ................................... -7 DK .................................... -8
[Code One]
BOX_04 ======
---------------------------------------------------- | FLAG INSURANCE FOR PERSON AS 'CONTINUOUS COVERAGE'| | THROUGH THE COMPLETE DATE RECORDED AT OE05 AND | | OE05OV. | ----------------------------------------------------
END_LP02 ========
---------------------------------------------------- | 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_02 AND CONTINUE WITH BOX_05 | ----------------------------------------------------
BOX_05 ======
---------------------------------------------------- | IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY | | THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,| | (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU | | MEMBERS NOT COVERED BY THIS INSURANCE ON THE | | PREVIOUS ROUND’S INTERVIEW DATE, BUT EXCLUDES RU | | MEMBERS JUST MARKED AS NO LONGER COVERED IN OE04),| | CONTINUE WITH OE06 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE08A | ----------------------------------------------------
OE06 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, have any persons living here, we have not yet mentioned, been covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?
YES ................................... 1 NO .................................... 2 {OE08A} REF ................................... -7 {OE08A} DK .................................... -8 {OE08A}
PRESS F1 FOR DEFINITION OF DEPENDENT.
---------------------------------------------------- | DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. | | DISPLAY ‘Between (START DATE) and (END DATE)’ IF | | ROUND 5. | ----------------------------------------------------
OE07 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Who {has been/was} covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {since (START DATE)/between (START DATE) and (END DATE)} that we have not yet mentioned?
PROBE: Who else {has been/was} covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {since (START DATE)/between (START DATE) and (END DATE)} that we have not yet mentioned?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65] [2. First Name, [Middle Name], Last Name-65] [3. First Name, [Middle Name], Last Name-65]
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS| | ON THE RU-MEMBERS-ROSTER WHO WERE NOT COVERED BY | | THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- | | PAIR ON THE PREVIOUS ROUND'S INTERVIEW DATE. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY ON| | THIS ROSTER. | ----------------------------------------------------
---------------------------------------------------- | WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- | | COVRD-PERS-TRPLS-ROSTER. | ----------------------------------------------------
---------------------------------------------------- | IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG | | INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR | | AS ‘COVERING PERSON NOT LISTED IN RU’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT| | ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) | | and (END DATE)’ IF ROUND 5. | ----------------------------------------------------
LOOP_03 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- | | PERS-TRPLS-ROSTER, ASK OE08 - END_LP03. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_03 COLLECTS THE COVERAGE | | START DATE FOR ALL PERSONS NEWLY COVERED DURING | | THE CURRENT ROUND BY THE INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON | | PERSONS SELECTED AT OE07. | ----------------------------------------------------
OE08 ====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
On what date did the health insurance through (ESTABLISHMENT) begin for (PERSON)?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
---------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T| | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE08OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_06 | ----------------------------------------------------
OE08OV ======
Can you just tell me if (PERSON) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 PART OF THE MONTH ..................... 2 REF ................................... -7 DK .................................... -8
[Code One]
---------------------------------------------------- | EDIT: COMPLETE DATE AT OE08 MUST BE < THAN | | COMPLETE DATE AT OE02 IF A DATE IS RECORDED AT | | OE02 OR < THAN REFERENCE PERIOD END DATE IF NO | | DATE IS RECORDED AT OE02. | ----------------------------------------------------
BOX_06 ======
---------------------------------------------------- | IF FAMILY STILL HAS INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED '1' | | (YES)), FLAG INSURANCE FOR THIS PERSON AS | | 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE08 | | UNTIL THE REFERENCE PERIOD END DATE. | ----------------------------------------------------
---------------------------------------------------- | IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH | | ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED '2' (NO))| | FLAG INSURANCE FOR THIS PERSON AS 'CONTINUOUS | | COVERAGE' FROM DATE RECORDED AT OE08 UNTIL DATE | | RECORDED AT OE02. | ----------------------------------------------------
END_LP03 ========
---------------------------------------------------- | CYCLE ON NEXT PERSON IN 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 GO TO BOX_07 | ----------------------------------------------------
OE08A =====
{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 OE07 | ----------------------------------------------------
BOX_07 ======
---------------------------------------------------- | IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THE| | INSURANCE THROUGH THE ESTABLISHMENT-PERSON-PAIR | | ON THE CURRENT ROUND’S INTERVIEW DATE, THAT IS, | | OE01 IS CODED ‘1’ (YES), CONTINUE WITH BOX_07A | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO END_LP01 | ----------------------------------------------------
BOX_07A =======
---------------------------------------------------- | IF ROUND 3, CONTINUE WITH OE09A | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE09 | ----------------------------------------------------
OE09A =====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
For the coverage through (ESTABLISHMENT), does anyone in the family pay all of the premium or cost, some of the premium or cost, or none of the premium or cost?
[Do not include the cost of any 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.]
YES, PAY ALL OF PREMIUM/COST ........... 1 YES, PAY SOME OF PREMIUM/COST .......... 2 YES, BUT DON'T KNOW IF PAY ALL OR SOME OF PREMIUM/COST ........................ 3 NO, DO NOT PAY ......................... 4 {OE09AAA} REF ................................... -7 {OE09} DK .................................... -8 {OE09}
[Code One]
PRESS F1 FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
---------------------------------------------------- | NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE | | DISPLAYED HERE FOR THE INSURANCE FROM A | | SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM | | DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF | | THE SOURCE, NOT THE NAME OF THE EMPLOYER OR | | DIRECTLY PURCHASED CATEGORY. | ----------------------------------------------------
OE09AA ======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
How much (do/does) (POLICYHOLDER) pay for the (ESTABLISHMENT) coverage?
PROBE: Is that per year, per month, per week, or what?
[Enter Amount in Dollars] .............. REF ................................... -7 {BOX_08A} DK .................................... -8 {BOX_08A}
---------------------------------------------------- | NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE | | DISPLAYED HERE FOR THE INSURANCE FROM A | | SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM | | DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF | | THE SOURCE, NOT THE NAME OF THE EMPLOYER OR | | DIRECTLY PURCHASED CATEGORY. | ----------------------------------------------------
OE09AAOV1 =========
ENTER UNIT OF COVERAGE:
PER YEAR ............................... 1 {BOX_08A} QUARTERLY/EVERY 3 MONTHS ............... 2 {BOX_08A} BIMONTHLY/EVERY 2 MONTHS ............... 3 {BOX_08A} PER MONTH .............................. 4 {BOX_08A} PER WEEK ............................... 5 {BOX_08A} BIWEEKLY/EVERY 2 WEEKS ................. 6 {BOX_08A} SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 {BOX_08A} SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 {BOX_08A} OTHER ................................. 91 REF ................................... -7 {BOX_08A} DK .................................... -8 {BOX_08A}
[Code One]
OE09AAOV2 =========
ENTER OTHER:
[Enter Other Specify] .................. REF ................................... -7 DK .................................... -8
BOX_08A =======
----------------------------------------------------- | IF OE09A IS CODED ‘1’ (YES, PAY ALL OF PREMIUM/ | | COST), GO TO OE09 | -----------------------------------------------------
----------------------------------------------------- | OTHERWISE, CONTINUE WITH OE09AAA | -----------------------------------------------------
OE09AAA =======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
Who {else} pays {some of/for} the premium or cost of this insurance?
FEDERAL GOVERNMENT .................... 1 STATE GOVERNMENT ...................... 2 LOCAL GOVERNMENT ...................... 3 SOME GOVERNMENT ....................... 4 EMPLOYER .............................. 5 UNION ................................. 6 OTHER ................................. 91 REF ................................... -7 DK .................................... -8
[Code All That Apply]
---------------------------------------------------- | DISPLAY ‘else’ IF OE09A IS CODED ‘2’ (YES, PAY | | SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON'T KNOW | | IF PAY ALL OR SOME OF PREMIUM/COST). OTHERWISE, | | USE A NULL DISPLAY | | | | DISPLAY ‘some of’ IF OE09A IS CODED ‘2’ (YES, PAY | | SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON'T KNOW | | IF PAY ALL OR SOME OF PREMIUM/COST). DISPLAY ‘for’| | IF OE09A IS CODED ‘4’ (NO, DO NOT PAY). | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION | | WITH ANY OTHER CODE, CONTINUE WITH OE09AAAOV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE09 | ----------------------------------------------------
OE09AAAOV =========
ENTER OTHER:
[Enter Other Specify] .................. REF ................................... -7 DK .................................... -8
OE09 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
{Last time we recorded that (POLICYHOLDER) (were/was) covered by (READ INSURER NAME(S) BELOW).}
{Since (START DATE), has there been/Between (START DATE) and (END DATE), was there} any change in the plan name of the health insurance (POLICYHOLDER) {has/had} through (ESTABLISHMENT)?
TO SCROLL, USE ARROW KEYS. TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT} {INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT} {INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
YES ................................... 1 NO .................................... 2 {END_LP01} REF ................................... -7 {END_LP01} DK .................................... -8 {END_LP01}
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL | | INSURERS IN THE RU-ESTB-PERSON-INSURER-TRIPLES- | | ROSTER THAT ARE FLAGGED AS 'SUPPLYING HOSPITAL AND| | PHYSICIAN BENEFITS' AND/OR 'SUPPLYING MEDICARE | | SUPPLEMENT/MEDIGAP BENEFITS' AND ARE ASSOCIATED | | WITH THE INSURANCE THROUGH THIS ESTABLISHMENT- | | PERSON-PAIR. | -----------------------------------------------------
----------------------------------------------------- | DISPLAY FIRST PARAGRAPH AND THE ROSTER OF INSURER | | NAMES IF THE INSURANCE THROUGH THIS ESTABLISHMENT- | | PERSON-PAIR HAD ANY INSURERS FLAGGED AS PROVIDING | | MEDIGAP OR HOSPITAL/PHYSICIAN BENEFITS AT ANY TIME | | DURING THE PREVIOUS ROUND. | -----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘Since (START DATE), has there been’ AND | | ‘has’ IF NOT ROUND 5. DISPLAY ‘Between (START | | DATE) and (END DATE), was there’ AND ‘had’ IF | | ROUND 5. | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T | | KNOW), FLAG PREVIOUS ROUND’S INSURER AS CURRENT | | ROUND’S INSURER FOR THIS ESTABLISHMENT-PERSON- | | PAIR. | ----------------------------------------------------
OE10 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
SHOW CARD OE-1.
What type of health insurance {(do/does)/did} (POLICYHOLDER) {now} have through (ESTABLISHMENT)'s new plan {on (END DATE)}?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ... 1 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 REF ................................... -7 DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.]
---------------------------------------------------- | DISPLAY ‘(do/does)’ IF NOT ROUND 5. DISPLAY ‘did’| | IF ROUND 5. | | | | DISPLAY ‘now’ IF NOT ROUND 5. OTHERWISE, USE A | | NULL DISPLAY. | | | | DISPLAY ‘on (END DATE)’ IF ROUND 5. OTHERWISE, | | USE A NULL DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '91' (OTHER), ALONE OR IN COMBINATION | | WITH ANY OTHER CODES, CONTINUE WITH OE10OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_08 | ----------------------------------------------------
OE10OV ======
ENTER OTHER:
[Enter Other Specify] .................. REF ................................... -7 DK .................................... -8
BOX_08 ======
---------------------------------------------------- | IF OE10 IS CODED '1' (HOSPITAL AND PHYSICIAN | | BENEFITS) OR ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), | | ALONE OR WITH ANY OTHER COMBINATION OF CODES, | | CONTINUE WITH OE11 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO END_LP01 | ----------------------------------------------------
---------------------------------------------------- | NOTE: ALL ESTABLISHMENTS WHICH ARE BEING LOOPED | | ON HERE ARE EMPLOYERS. THEREFORE, IT IS NOT | | NECESSARY TO AUTOMATICALLY CODE OE11 IF THE | | ESTABLISHMENT IS AN INSURANCE CO. OR HMO (BECAUSE | | WE KNOW IT IS NOT). | ----------------------------------------------------
OE11 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
What is the new plan name for (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) which provides the {hospital and physician benefits/Medicare Supplement or Medigap benefit}?
IF MORE THAN ONE NAME, PROBE: What is the main new plan name? RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE {HOSPITAL AND PHYSICIAN/MEDIGAP} BENEFITS FOR THIS PAIR.
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, CODE 2 (HMO).
NAME OF INSURER: [Enter Insurer] TYPE: 1 = INSURANCE COMPANY 2 = HMO 3 = COMPANY IS SELF-INSURED
PRESS F1 FOR DEFINITION OF INSURANCE CO/HMO/SELF-INSURED CO.
----------------------------------------------------- | DISPLAY 'hospital and physician benefits' AND | | ‘HOSPITAL’ IF OE10 IS CODED ‘1’ (HOSPITAL AND | | PHYSICIAN BENEFITS), BUT NOT CODED ‘5’ (MEDICARE | | SUPPLEMENT/MEDIGAP). DISPLAY 'Medicare supplement | | or Medigap benefits' AND ‘MEDIGAP’ IF OE10 IS CODED| | ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP). | -----------------------------------------------------
----------------------------------------------------- | WRITE INSURER(S) TO THE RU-ESTAB-PERSON-INSURER- | | TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR. | -----------------------------------------------------
---------------------------------------------------- | FLAG INSURER(S) COLLECTED AT OE11 AS CURRENT | | ROUND’S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- | | PAIR. | ----------------------------------------------------
----------------------------------------------------- | IF OE10 IS CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP) | | FLAG INSURANCE CO./HMO AS 'SUPPLYING MEDICARE | | SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES | | HOSPITAL/PHYSICIAN BENEFITS)’ FOR THE CURRENT | | ROUND. | -----------------------------------------------------
---------------------------------------------------- | IF OE10 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN | | BENEFITS), BUT NOT ‘5’ (MEDICARE SUPPLEMENT/ | | MEDIGAP), FLAG INSURANCE CO./HMO AS 'SUPPLYING | | HOSPITAL/PHYSICIAN BENEFITS' FOR THE CURRENT | | ROUND. | ----------------------------------------------------
LOOP_04 =======
---------------------------------------------------- | FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- | | TRIPLES-ROSTER, ASK OE11A - END_LP04. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_04 COLLECTS OTHER POLICY | | NAMES AND MANAGED CARE INFORMATION FOR INSURERS | | COLLECTED AT OE11. THIS LOOP CYCLES ON TRIPLES | | THAT MEET THE FOLLOWING CONDITIONS: | | | | - ESTABLISHMENT-PERSON-PAIR PROVIDES THE INSURANCE| | BEING ASKED ABOUT | | - INSURER IS ENTERED AT OE11 | ----------------------------------------------------
OE11A =====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
Is there any other name for the {INSURANCE COMPANY OR HMO NAME} policy, such as Option A, $100 Deductible Plan, 90/80 Plan, Gold Plan, or High Option Plan?
YES, ANOTHER NAME ...................... 1 NO OTHER NAME .......................... 2 {BOX_09A} REF ................................... -7 {BOX_09A} DK .................................... -8 {BOX_09A}
PRESS F1 FOR DEFINITION OF LOW OPTION/HIGH OPTION.
[Code One]
---------------------------------------------------- | DISPLAY THE NAME OF THE INSURANCE CO/HMO | | RECORDED IN OE11_01 WHICH IS BEING LOOPED ON | | FOR ‘INSURANCE...NAME.’ | ----------------------------------------------------
OE11AOV =======
ENTER OTHER NAME:
[Enter Policy Name] .................... REF ................................... -7 DK .................................... -8
BOX_09A =======
---------------------------------------------------- | IF INSURER BEING LOOPED ON IS CODED ‘2’ (HMO) IN | | OE11_02, CONTINUE WITH OE11B | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_09 | ----------------------------------------------------
OE11B =====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not part of (POLICYHOLDER)’s HMO, even if (POLICYHOLDER) (do/does) not have a referral?
YES .................................... 1 {END_LP04} NO ..................................... 2 {END_LP04} REF ................................... -7 {END_LP04} DK .................................... -8 {END_LP04}
BOX_09 ======
---------------------------------------------------- | ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER| | | | AT COMPLETION OF MANAGED CARE (MC) SECTION, | | CONTINUE WITH END_LP04 | ----------------------------------------------------
END_LP04 ========
---------------------------------------------------- | CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- | | INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS | | STATED IN THE LOOP DEFINITION. | ----------------------------------------------------
---------------------------------------------------- | IF NO OTHER INSURERS MEET THE STATED CONDITIONS, | | END LOOP_04 AND CONTINUE WITH END_LP01 | ----------------------------------------------------
END_LP01 ========
---------------------------------------------------- | CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-| | PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN | | THE LOOP DEFINITION. | ----------------------------------------------------
---------------------------------------------------- | IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END | | LOOP_01 AND CONTINUE WITH BOX_10 | ----------------------------------------------------
BOX_10 ======
---------------------------------------------------- | IF ONE OR MORE RU MEMBERS DOES NOT STILL HOLD A | | 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS' JOB THIS| | ROUND THAT WAS REPORTED DURING THE PREVIOUS ROUND | | AS PROVIDING HEALTH INSURANCE ON THE DATE OF THE | | PREVIOUS ROUND'S INTERVIEW, THAT IS: | | | | IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE | | RU MEET THE FOLLOWING CONDITIONS: | | - RJ01 OR RJ06 WAS CODED '2' (NO), '-7' (REFUSED),| | '-8' (DON'T KNOW) DURING THIS ROUND FOR THIS | | PAIR, AND | | - PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND | | - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS | | INSURANCE, AND | | - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING | | THE PREVIOUS ROUND AS 'PROVIDES HEALTH | | INSURANCE' AND, | | - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT | | COVERED PERSON ON THE DATE OF THE PREVIOUS | | ROUND'S INTERVIEW (HQ01 WAS CODED '1' (WHOLE | | TIME) OR HQ02 WAS CODED '1' (YES) IN THE | | PREVIOUS ROUND), AND | | - JOB AT ESTABLISHMENT IS NOT FLAGGED AS 'SELF- | | EMPLOYED' WITH A FIRM-SIZE-1, | | | | CONTINUE WITH LOOP_05 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_19 | ----------------------------------------------------
---------------------------------------------------- | NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT | | IN THE RU ON THE PREVIOUS ROUND’S INTERVIEW DATE, | | THE FIFTH CONDITION IN THE ABOVE BOX CAN BE MET | | IF AT LEAST ONE DEPENDENT WAS COVERED BY | | POLICYHOLDER’S INSURANCE ON THE PREVIOUS ROUND’S | | INTERVIEW DATE. COVERAGE FOR THE POLICYHOLDER IS | | ASSUMED IN THAT CASE AND THE LOOP WILL CYCLE ON | | THE POLICYHOLDER’S NAME. | ----------------------------------------------------
---------------------------------------------------- | NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE | | POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, | | INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT | | ROUND’S INTERVIEW DATE, BUT WHERE THE | | ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO | | ARE STILL RU MEMBERS MAY STILL QUALIFY FOR | | LOOP_05. | ----------------------------------------------------
LOOP_05 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- | | PAIRS-ROSTER, ASK OE12-END_LP05. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: | | | | LOOP_05 COLLECTS INFORMATION ABOUT THE | | CONTINUATION OF INSURANCE COVERAGE THROUGH A | | NO LONGER HELD 'CURRENT MAIN' OR 'CURRENT | | MISCELLANEOUS' JOB THAT WAS COLLECTED IN THE | | PREVIOUS ROUND. THIS LOOP CYCLES ON | | ESTABLISHMENT-PERSON-PAIRS THAT MEET THE | | FOLLOWING CONDITIONS: | | | | - RJ01 OR RJ06 WAS CODED '2' (NO), '-7' (REFUSED),| | '-8' (DON'T KNOW) DURING THIS ROUND FOR THIS | | PAIR, AND | | - PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND | | - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS | | INSURANCE, AND | | - ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING | | THE PREVIOUS ROUND AS 'PROVIDES HEALTH | | INSURANCE' AND, | | - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT | | COVERED PERSON ON THE DATE OF THE PREVIOUS | | ROUND'S INTERVIEW (HQ01 WAS CODED '1' (WHOLE | | TIME) OR HQ02 WAS CODED '1' (YES) IN THE | | PREVIOUS ROUND), AND | | - JOB AT ESTABLISHMENT IS NOT FLAGGED AS 'SELF- | | EMPLOYED' WITH A FIRM-SIZE-1. | -----------------------------------------------------
OE12 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health insurance. {(Are/Is)/(Were/Was)} (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of {today,} (END DATE)?
YES ................................... 1 {OE16} NO .................................... 2 REF ................................... -7 {END_LP05} DK .................................... -8 {END_LP05}
---------------------------------------------------- | DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY | | ‘(Was/Were)’ IF ROUND 5. | | | | DISPLAY ‘today,’ IF NOT ROUND 5. OTHERWISE, USE A| | NULL DISPLAY. | ----------------------------------------------------
OE13 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Did the health insurance (POLICYHOLDER) had through (ESTABLISHMENT) continue for any period of time after (POLICYHOLDER) stopped working at (ESTABLISHMENT)?
YES ................................... 1 NO .................................... 2 {OE15} REF ................................... -7 {OE15} DK .................................... -8 {OE15}
OE14 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Did that health insurance continue through COBRA?
YES ................................... 1 NO .................................... 2 REF ................................... -7 DK .................................... -8
PRESS F1 FOR DEFINITION OF COBRA.
OE15 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
On what date did (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) end?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
---------------------------------------------------- | EDIT (FOR ROUND 5 ONLY): COMPLETE DATE ENTERED | | CANNOT BE AFTER 12/31/2004. IF A DATE AFTER | | 12/31/2004 IS ENTERED, DISPLAY THE FOLLOWING | | MESSAGE: ‘DATE CANNOT BE AFTER 12/31/2004. IF | | INSURANCE ENDED AFTER 12/31/2004, USE CTRL/B TO | | BACK-UP AND CHANGE RESPONSE TO OE12. | ----------------------------------------------------
---------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T| | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE15OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_11 | ----------------------------------------------------
OE15OV ======
Can you just tell me if (POLICYHOLDER) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 {BOX_11} PART OF THE MONTH ..................... 2 {BOX_11} REF ................................... -7 {BOX_11} DK .................................... -8 {BOX_11}
[Code One]
OE16 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Is (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) now extended through COBRA?
YES ................................... 1 NO .................................... 2 REF ................................... -7 DK .................................... -8
PRESS F1 FOR DEFINITION OF COBRA.
BOX_11 ======
---------------------------------------------------- | IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT | | THE PREVIOUS ROUND'S INTERVIEW DATE BY THE | | INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, | | AUTOMATICALLY CODE OE17 AS ‘1’ (YES) AND GO TO | | BOX_12 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH OE17 | ----------------------------------------------------
OE17 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT).
{Are/Were} they all covered by this health insurance {until {{OE15 DATE}/it ended}/on (END-DT)}?
TO SCROLL, USE ARROW KEYS. TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT} {PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT} {PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
YES ................................... 1 NO .................................... 2 REF ................................... -7 DK .................................... -8
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- | | PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY | | THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: | | - PERSON WAS COVERED AT THE PREVIOUS ROUND'S | | INTERVIEW DATE BY THE INSURANCE FROM THIS | | ESTABLISHMENT-PERSON-PAIR, INCLUDING THE | | POLICYHOLDER | | - PERSON IS AN RU MEMBER | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'Are' IF OE12 IS CODED ‘1’ (YES). | | DISPLAY 'Were' IF OE12 IS CODED ‘2’ (NO) OR IF | | CURRENT ROUND IS ROUND 5. | | | | DISPLAY 'until {OE15 DATE}' IF OE12 IS CODED ‘2’ | | (NO). DISPLAY 'on (END-DT)' IF OE12 IS CODED ‘1’ | | (YES). | | | | DISPLAY THE DATE RECORDED AT OE15 FOR ‘OE15 DATE’.| | IF THE MONTH AND DAY FIELD AT OE15 IS CODED ‘-7’ | | (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’| | FOR ‘OE15 DATE’. | ----------------------------------------------------
BOX_12 ======
---------------------------------------------------- | IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND | | TO THE END DATE OF THE CURRENT ROUND, THAT IS: | | | | IF OE12 IS CODED '1' (YES) AND OE17 IS CODED '1' | | (YES), | | | | FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING | | THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH| | THE REFERENCE PERIOD END DATE AND | | | | GO TO BOX_14 | ----------------------------------------------------
---------------------------------------------------- | IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND | | TO PART OF THE CURRENT ROUND, THAT IS: | | | | IF OE12 IS CODED '2' (NO) AND OE17 IS CODED '1' | | (YES), | | | | FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING | | THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH| | THE DATE RECORDED AT OE15 AND | | | | GO TO BOX_14 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE (I.E., OE17 CODED ‘2’ (NO), ‘-7’ | | (REFUSED), OR ‘-8’ (DON'T KNOW)), CONTINUE WITH | | OE18 | ----------------------------------------------------
OE18 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Who {is/was} no longer covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {until {{OE15 DATE}/it ended}/ on (END-DT)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65] [2. First Name, [Middle Name], Last Name-65] [3. First Name, [Middle Name], Last Name-65]
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- | | PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY | | THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: | | - PERSON WAS COVERED AT THE PREVIOUS ROUND'S | | INTERVIEW DATE BY THE INSURANCE FROM THIS | | ESTABLISHMENT-PERSON-PAIR, INCLUDING THE | | POLICYHOLDER | | - PERSON IS AN RU MEMBER | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'is' IF OE12 IS CODED ‘1’ (YES). | | DISPLAY 'was' IF OE12 IS CODED ‘2’ (NO) OR IF | | CURRENT ROUND IS ROUND 5. | | | | DISPLAY 'until {OE15 DATE}' IF OE12 IS CODED ‘2’ | | (NO). DISPLAY 'on (END-DT)' IF OE12 IS CODED ‘1’ | | (YES). | | | | DISPLAY THE DATE RECORDED AT OE15 FOR ‘OE15 DATE’.| | IF THE MONTH AND DAY FIELD AT OE15 IS CODED ‘-7’ | | (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’| | FOR ‘OE15 DATE’. | ----------------------------------------------------
---------------------------------------------------- | IF FAMILY STILL HAS INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED '1' | | (YES)), FLAG INSURANCE FOR ALL PERSONS NOT | | SELECTED AT OE18 AS 'CONTINUOUS COVERAGE' FROM THE| | REFERENCE PERIOD START DATE UNTIL THE REFERENCE | | PERIOD END DATE. | ----------------------------------------------------
---------------------------------------------------- | IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH | | THIS ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED '2',| | (NO)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED| | AT OE18 AS CONTINUOUS COVERAGE FROM THE REFERENCE | | PERIOD START DATE UNTIL DATE RECORDED AT OE15. | ----------------------------------------------------
LOOP_06 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- | | PERS-TRPLS-ROSTER, ASK OE19 - END_LP06. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_06 COLLECTS THE DATE ON | | WHICH THE INSURANCE COVERAGE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER| | WHOSE COVERAGE ENDED PRIOR TO THE REFERENCE PERIOD| | END DATE OR THE DATE REPORTED IN OE15. THIS LOOP | | CYCLES ON PERSONS SELECTED AT OE18. | ----------------------------------------------------
OE19 ====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
On what date did the health insurance through (ESTABLISHMENT) end for (PERSON)?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
---------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T| | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE19OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_13 | ----------------------------------------------------
OE19OV ======
Can you just tell me if (PERSON) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 PART OF THE MONTH ..................... 2 REF ................................... -7 DK .................................... -8
[Code One]
BOX_13 ======
---------------------------------------------------- | FLAG INSURANCE FOR PERSON AS 'CONTINUOUS COVERAGE'| | THROUGH THE COMPLETE DATE RECORDED AT OE19 AND | | OE19OV. | ----------------------------------------------------
END_LP06 ========
---------------------------------------------------- | 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_06 AND CONTINUE WITH BOX_14 | ----------------------------------------------------
BOX_14 ======
---------------------------------------------------- | IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY | | THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,| | (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU | | MEMBERS NOT COVERED BY THIS INSURANCE ON THE | | PREVIOUS ROUND’S INTERVIEW DATE, EXCLUDES RU | | MEMBERS JUST MARKED AS NO LONGER COVERED IN OE18),| | CONTINUE WITH OE20 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE22A | ----------------------------------------------------
OE20 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, have any persons living here, that we have not yet mentioned, been covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?
YES ................................... 1 NO .................................... 2 {OE22A} REF ................................... -7 {OE22A} DK .................................... -8 {OE22A}
PRESS F1 FOR DEFINITION OF DEPENDENT.
---------------------------------------------------- | DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. | | DISPLAY ‘Between (START DATE) and (END DATE)’ IF | | ROUND 5. | ----------------------------------------------------
OE21 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Who {has been/was} covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {since (START DATE)/between (START DATE) and (END DATE)} that we have not yet mentioned?
PROBE: Who else {has been/was} covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {since (START DATE)/between (START DATE) and (END DATE)} that we have not yet mentioned?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65] [2. First Name, [Middle Name], Last Name-65] [3. First Name, [Middle Name], Last Name-65]
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS| | ON THE RU-MEMBERS-ROSTER WHO WERE NOT COVERED BY | | THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- | | PAIR ON THE PREVIOUS ROUND'S INTERVIEW DATE. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY ON| | THIS ROSTER. | ----------------------------------------------------
---------------------------------------------------- | WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- | | COVRD-PERS-TRPLS-ROSTER. | ----------------------------------------------------
---------------------------------------------------- | IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG | | INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR | | AS ‘COVERING PERSON NOT LISTED IN RU’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT| | ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) | | and (END DATE)’ IF ROUND 5. | ----------------------------------------------------
LOOP_07 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- | | PERS-TRPLS-ROSTER, ASK OE22 - END_LP07. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_07 COLLECTS THE COVERAGE | | START DATE FOR ALL PERSONS NEWLY COVERED DURING | | THE CURRENT ROUND BY THE INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON | | PERSONS SELECTED AT OE21. | ----------------------------------------------------
OE22 ====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
On what date did the health insurance through (ESTABLISHMENT) begin for (PERSON)?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
---------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T| | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE22OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_15 | ----------------------------------------------------
OE22OV ======
Can you just tell me if (PERSON) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 PART OF THE MONTH ..................... 2 REF ................................... -7 DK .................................... -8
[Code One]
---------------------------------------------------- | EDIT: COMPLETE DATE AT OE22 MUST BE < THAN | | COMPLETE DATE AT OE15 IF A DATE IS RECORDED AT | | OE15 OR < THAN REFERENCE PERIOD END DATE IF NO | | DATE IS RECORDED AT OE15. | ----------------------------------------------------
BOX_15 ======
---------------------------------------------------- | IF FAMILY STILL HAS INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED '1' | | (YES)), FLAG INSURANCE FOR THIS PERSON AS | | 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE22 | | UNTIL THE REFERENCE PERIOD END DATE. | ----------------------------------------------------
---------------------------------------------------- | IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH | | THIS ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED '2' | | (NO)), FLAG INSURANCE FOR THIS PERSON AS | | 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE22 | | UNTIL DATE RECORDED AT OE15. | ----------------------------------------------------
END_LP07 ========
---------------------------------------------------- | 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_07 AND GO TO BOX_16 | ----------------------------------------------------
OE22A =====
{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 OE21 | ----------------------------------------------------
BOX_16 ======
---------------------------------------------------- | IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THE| | INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR | | ON THE CURRENT ROUND’S INTERVIEW DATE, THAT IS, | | OE12 IS CODED ‘1’(YES), CONTINUE WITH BOX_16A | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO END_LP05 | ----------------------------------------------------
BOX_16A =======
---------------------------------------------------- | IF ROUND 3, CONTINUE WITH OE23A | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE23 | ----------------------------------------------------
OE23A =====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
For the coverage through (ESTABLISHMENT), does anyone in the family pay all of the premium or cost, some of the premium or cost, or none of the premium or cost?
[Do not include the cost of any 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.]
YES, PAY ALL OF PREMIUM/COST ........... 1 YES, PAY SOME OF PREMIUM/COST .......... 2 YES, BUT DON'T KNOW IF PAY ALL OR SOME OF PREMIUM/COST ........................ 3 NO, DO NOT PAY ......................... 4 {OE23AAA} REF ................................... -7 {OE23} DK .................................... -8 {OE23}
[Code One]
PRESS F1 FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
---------------------------------------------------- | NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE | | DISPLAYED HERE FOR THE INSURANCE FROM A | | SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM | | DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF | | THE SOURCE, NOT THE NAME OF THE EMPLOYER OR | | DIRECTLY PURCHASED CATEGORY. | ----------------------------------------------------
OE23AA ======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
How much (do/does) (POLICYHOLDER) pay for the (ESTABLISHMENT) coverage?
PROBE: Is that per year, per month, per week, or what?
[Enter Amount in Dollars] .............. REF ................................... -7 {BOX_17A} DK .................................... -8 {BOX_17A}
---------------------------------------------------- | NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE | | DISPLAYED HERE FOR THE INSURANCE FROM A | | SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM | | DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF | | THE SOURCE, NOT THE NAME OF THE EMPLOYER OR | | DIRECTLY PURCHASED CATEGORY. | ----------------------------------------------------
OE23AAOV1 =========
ENTER UNIT OF COVERAGE:
PER YEAR ............................... 1 {BOX_17A} QUARTERLY/EVERY 3 MONTHS ............... 2 {BOX_17A} BIMONTHLY/EVERY 2 MONTHS ............... 3 {BOX_17A} PER MONTH .............................. 4 {BOX_17A} PER WEEK ............................... 5 {BOX_17A} BIWEEKLY/EVERY 2 WEEKS ................. 6 {BOX_17A} SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 {BOX_17A} SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 {BOX_17A} OTHER ................................. 91 REF ................................... -7 {BOX_17A} DK .................................... -8 {BOX_17A}
[Code One]
OE23AAOV2 =========
ENTER OTHER:
[Enter Other Specify] .................. REF ................................... -7 DK .................................... -8
BOX_17A =======
----------------------------------------------------- | IF OE23A IS CODED ‘1’ (YES, PAY ALL OF PREMIUM/ | | COST), GO TO OE23 | -----------------------------------------------------
----------------------------------------------------- | OTHERWISE, CONTINUE WITH OE23AAA | -----------------------------------------------------
OE23AAA =======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
Who {else} pays {some of/for} the premium or cost of this insurance?
FEDERAL GOVERNMENT .................... 1 STATE GOVERNMENT ...................... 2 LOCAL GOVERNMENT ...................... 3 SOME GOVERNMENT ....................... 4 EMPLOYER .............................. 5 UNION ................................. 6 OTHER ................................. 91 REF ................................... -7 DK .................................... -8
[Code All That Apply]
---------------------------------------------------- | DISPLAY ‘else’ IF OE23A IS CODED ‘2’ (YES, PAY | | SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON'T KNOW | | IF PAY ALL OR SOME OF PREMIUM/COST). OTHERWISE, | | USE A NULL DISPLAY | | | | DISPLAY ‘some of’ IF OE23A IS CODED ‘2’ (YES, PAY | | SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON'T KNOW | | IF PAY ALL OR SOME OF PREMIUM/COST). DISPLAY ‘for’| | IF OE23A IS CODED ‘4’ (NO, DO NOT PAY). | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION | | WITH ANY OTHER CODE, CONTINUE WITH OE23AAAOV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE23 | ----------------------------------------------------
OE23AAAOV =========
ENTER OTHER:
[Enter Other Specify] .................. REF ................................... -7 DK .................................... -8
OE23 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
{Last time we recorded that (POLICYHOLDER) (were/was) covered by (READ INSURER NAME(S) BELOW).}
{Since (START DATE), has there been/Between (START DATE) and (END DATE), was there} any change in the plan name of the health insurance (POLICYHOLDER) {has/had} through (ESTABLISHMENT)?
TO SCROLL, USE ARROW KEYS. TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT} {INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT} {INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
YES ................................... 1 NO .................................... 2 {END_LP05} REF ................................... -7 {END_LP05} DK .................................... -8 {END_LP05}
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL | | INSURERS IN THE RU-ESTB-PERSON-INSURER-TRIPLES- | | ROSTER THAT ARE FLAGGED AS 'SUPPLYING HOSPITAL AND| | PHYSICIAN BENEFITS' AND/OR 'SUPPLYING MEDICARE | | SUPPLEMENT/MEDIGAP BENEFITS' AND ARE ASSOCIATED | | WITH THE INSURANCE THROUGH THIS ESTABLISHMENT- | | PERSON-PAIR. | -----------------------------------------------------
---------------------------------------------------- | DISPLAY FIRST PARAGRAPH AND THE ROSTER OF INSURER | | NAMES IF THE INSURANCE THROUGH THIS ESTABLISHMENT-| | PERSON-PAIR HAD ANY INSURERS FLAGGED AS PROVIDING | | MEDIGAP OR HOSPITAL/PHYSICIAN BENEFITS AT ANY TIME| | DURING THE PREVIOUS ROUND. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘Since (START DATE), has there been’ AND | | ‘has’ IF NOT ROUND 5. DISPLAY ‘Between (START | | DATE) and (END DATE), was there’ AND ‘had’ IF | | ROUND 5. | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T | | KNOW), FLAG PREVIOUS ROUND’S INSURER AS CURRENT | | ROUND’S INSURER FOR THIS ESTABLISHMENT-PERSON- | | PAIR. | ----------------------------------------------------
OE24 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
SHOW CARD OE-1.
What type of health insurance {(do/does)/did} (POLICYHOLDER) {now} have through (ESTABLISHMENT)'s new plan {on (END DATE)}?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ... 1 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 REF ................................... -7 DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.]
---------------------------------------------------- | DISPLAY ‘(do/does)’ IF NOT ROUND 5. DISPLAY ‘did’| | IF ROUND 5. | | | | DISPLAY ‘now’ IF NOT ROUND 5. OTHERWISE, USE A | | NULL DISPLAY. | | | | DISPLAY ‘on (END DATE)’ IF ROUND 5. OTHERWISE, | | USE A NULL DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '91' (OTHER), ALONE OR IN COMBINATION | | WITH ANY OTHER CODES, CONTINUE WITH OE24OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_17 | ----------------------------------------------------
OE24OV ======
ENTER OTHER:
[Enter Other Specify] .................. REF ................................... -7 DK .................................... -8
BOX_17 ======
---------------------------------------------------- | IF OE24 IS CODED '1' (HOSPITAL AND PHYSICIAN | | BENEFITS) OR ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), | | ALONE OR WITH ANY OTHER COMBINATION OF CODES, | | CONTINUE WITH OE25 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO END_LP05 | ----------------------------------------------------
---------------------------------------------------- | NOTE: ALL ESTABLISHMENTS WHICH ARE BEING LOOPED | | ON HERE ARE EMPLOYERS. THEREFORE, IT IS NOT | | NECESSARY TO AUTOMATICALLY CODE OE25 IF THE | | ESTABLISHMENT IS AN INSURANCE CO. OR HMO (BECAUSE | | WE KNOW IT IS NOT). | ----------------------------------------------------
OE25 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
What is the new plan name for (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) which provides the {hospital and physician benefits/Medicare supplement or Medigap benefit}?
IF MORE THAN ONE NAME, PROBE: What is the main new plan name? RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE {HOSPITAL AND PHYSICIAN/MEDIGAP} BENEFITS FOR THIS PAIR.
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, CODE 2 (HMO).
NAME OF INSURER: [Enter Insurer] TYPE: 1 = INSURANCE COMPANY 2 = HMO 3 = COMPANY IS SELF-INSURED
PRESS F1 FOR DEFINITION OF INSURANCE CO/HMO/SELF-INSURED CO.
----------------------------------------------------- | DISPLAY 'hospital and physician benefits' AND | | ‘HOSPITAL’ IF OE24 IS CODED ‘1’ (HOSPITAL AND | | PHYSICIAN BENEFITS), BUT NOT CODED ‘5’ (MEDICARE | | SUPPLEMENT/MEDIGAP). DISPLAY 'Medicare supplement | | or Medigap benefits' AND ‘MEDIGAP’ IF OE24 IS CODED| | ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP). | -----------------------------------------------------
---------------------------------------------------- | WRITE INSURER(S) TO THE RU-ESTB-PERSON-INSURER- | | TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR. | ----------------------------------------------------
---------------------------------------------------- | FLAG INSURER(S) COLLECTED AT OE25 AS CURRENT | | ROUND’S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- | | PAIR. | ----------------------------------------------------
---------------------------------------------------- | IF OE24 IS CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP)| | FLAG INSURANCE CO./HMO AS 'SUPPLYING MEDICARE | | SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES | | HOSPITAL/PHYSICIAN BENEFITS)’ FOR THE CURRENT | | ROUND. | ----------------------------------------------------
---------------------------------------------------- | IF OE24 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN | | BENEFITS), BUT NOT ‘5’ (MEDICARE SUPPLEMENT/ | | MEDIGAP), FLAG INSURANCE CO./HMO AS 'SUPPLYING | | HOSPITAL/PHYSICIAN BENEFITS' FOR THE CURRENT | | ROUND. | ----------------------------------------------------
LOOP_08 =======
---------------------------------------------------- | FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- | | TRIPLES-ROSTER, ASK OE25AA - END_LP08. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_08 COLLECTS OTHER POLICY | | NAMES AND MANAGED CARE INFORMATION FOR INSURERS | | COLLECTED AT OE25. THIS LOOP CYCLES ON TRIPLES | | THAT MEET THE FOLLOWING CONDITIONS: | | | | - ESTABLISH-PERSON PAIR PROVIDES THE INSURANCE | | BEING ASKED ABOUT | | - INSURER IS ENTERED AT OE25 | ----------------------------------------------------
OE25AA ======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
Is there any other name for the {INSURANCE COMPANY OR HMO NAME} policy, such as Option A, $100 Deductible Plan, 90/80 Plan, Gold Plan, or High Option Plan?
YES, ANOTHER NAME ...................... 1 NO OTHER NAME .......................... 2 {BOX_18A} REF ................................... -7 {BOX_18A} DK .................................... -8 {BOX_18A}
PRESS F1 FOR DEFINITION OF LOW OPTION/HIGH OPTION.
[Code One]
---------------------------------------------------- | DISPLAY THE NAME OF THE INSURANCE CO/HMO | | RECORDED IN OE25_01 WHICH IS BEING LOOPED ON | | FOR ‘INSURANCE...NAME.’ | ----------------------------------------------------
OE25AAOV ========
ENTER OTHER NAME:
[Enter Policy Name] .................... REF ................................... -7 DK .................................... -8
BOX_18A =======
---------------------------------------------------- | IF INSURER BEING LOOPED ON IS CODED ‘2’ (HMO) IN | | OE25_02, CONTINUE WITH OE25B | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_18 | ----------------------------------------------------
OE25B =====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not part of (POLICYHOLDER)’s HMO, even if (POLICYHOLDER) (do/does) not have a referral?
YES .................................... 1 {END_LP08} NO ..................................... 2 {END_LP08} REF ................................... -7 {END_LP08} DK .................................... -8 {END_LP08}
BOX_18 ======
---------------------------------------------------- | ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER| | | | AT COMPLETION OF MANAGED CARE (MC) SECTION, | | CONTINUE WITH END_LP08 | ----------------------------------------------------
END_LP08 ========
---------------------------------------------------- | CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- | | INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS | | STATED IN THE LOOP DEFINITION. | ----------------------------------------------------
---------------------------------------------------- | IF NO OTHER INSURERS MEET THE STATED CONDITIONS, | | END LOOP_08 AND CONTINUE WITH END_LP05 | ----------------------------------------------------
END_LP05 ========
---------------------------------------------------- | CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-| | PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN | | THE LOOP DEFINITION. | ----------------------------------------------------
---------------------------------------------------- | IF NO OTHER PAIRS MEET THE STATED CONDITIONS, | | END LOOP_05 AND CONTINUE WITH BOX_19 | ----------------------------------------------------
BOX_19 ======
---------------------------------------------------- | IF ONE OR MORE OR RU MEMBERS WAS COVERED BY | | INSURANCE THROUGH A NON-CURRENT EMPLOYER FROM THE | | PREVIOUS ROUND, AN EMPLOYER FLAGGED AS ‘SELF- | | EMPLOYED’ WITH A FIRM-SIZE-1, OR A DIRECT PURCHASE| | SOURCE ON THE PREVIOUS ROUND’S INTERVIEW DATE, | | THAT IS: | | | | IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE | | RU MEETS THE FOLLOWING CONDITIONS: | | - ESTABLISHMENT IS ONE OF THE FOLLOWING TYPES: | | - FLAGGED AS A DIRECT PURCHASE SOURCE | | - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE-1, | | FLAGGED DURING THE PREVIOUS ROUND AS | | ‘PROVIDES HEALTH INSURANCE’, OR | | - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE- | | GREATER-THAN-1, FLAGGED DURING THE PREVIOUS | | ROUND AS ‘PROVIDES HEALTH INSURANCE’, AND | | HAD ONE OF THE FOLLOWING JOB SUBTYPES DURING | | THE PREVIOUS ROUND: | | - ‘FORMER MAIN WITHIN REFERENCE PERIOD’ | | - ‘FORMER MISCELLANEOUS JOB WITHIN REFERENCE | | PERIOD’ | | - ‘LAST JOB OUTSIDE REFERENCE PERIOD’ | | - ‘RETIREMENT JOB’ | | - PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT,| | IF THE ESTABLISHMENT IS ONE OF THE SECOND 2 | | TYPES NOTED ABOVE; | | - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS | | INSURANCE; | | - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT| | COVERED PERSON ON THE DATE OF THE PREVIOUS | | ROUND’S INTERVIEW (HQ WAS CODED ‘1’ (WHOLE | | TIME) OR HQ02 WAS CODED ‘1’ (YES) IN THE | | PREVIOUS ROUND); | | | | CONTINUE WITH LOOP_09 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_29 | ---------------------------------------------------- ---------------------------------------------------- | NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT | | IN THE RU ON THE PREVIOUS ROUND’S INTERVIEW DATE, | | THE LAST CONDITION IN THE ABOVE BOX CAN BE MET | | IF AT LEAST ONE DEPENDENT WAS COVERED BY | | POLICYHOLDER’S INSURANCE ON THE PREVIOUS ROUND’S | | INTERVIEW DATE. THE LOOP WILL CYCLE ON THE | | POLICYHOLDER’S NAME. | ----------------------------------------------------
---------------------------------------------------- | NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE | | POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, | | INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT | | ROUND’S INTERVIEW DATE, BUT WHERE THE | | ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO | | ARE STILL RU MEMBERS MAY STILL QUALIFY FOR | | LOOP_09. | ----------------------------------------------------
---------------------------------------------------- | NOTE: FOR DIRECT PURCHASE AND SELF-EMPLOYED-FIRM-| | SIZE-1, THE CONTEXT HEADER SHOULD DISPLAY THE NAME| | OF THE SOURCE PROVIDING THE INSURANCE RATHER THAN | | THE NAME OF THE DIRECT PURCHASE CATEGORY OR THE | | SELF-EMPLOYED-FIRM-SIZE-1 EMPLOYER NAME OR TYPE OF| | PURCHASE CATEGORY. FOR EMPLOYERS WHICH ARE NOT | | SELF-EMPLOYED WITH FIRM-SIZE-1, USE THE JOBHOLDER | | NAME AND EMPLOYER NAME IN THE CONTEXT HEADER. | ----------------------------------------------------
LOOP_09 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- | | PAIRS-ROSTER, ASK BOX_19A - END_LP09 | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_09 COLLECTS INFORMATION | | ABOUT THE CONTINUATION OF INSURANCE COVERAGE | | THROUGH A NON-CURRENT EMPLOYER FROM THE PREVIOUS | | ROUND, AN EMPLOYER FLAGGED AS ‘SELF-EMPLOYED’ WITH| | A FIRM-SIZE-1, OR A DIRECT PURCHASE SOURCE THAT | | WAS COLLECTED IN THE PREVIOUS ROUND. THIS LOOP | | CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET | | THE FOLLOWING CONDITIONS: | | | | - ESTABLISHMENT IS ONE OF THE FOLLOWING TYPES: | | - FLAGGED AS A DIRECT PURCHASE SOURCE | | - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE-1, | | FLAGGED DURING THE PREVIOUS ROUND AS ‘PROVIDES| | HEALTH INSURANCE’, OR | | - FLAGGED AS AN ‘EMPLOYER’ WITH FIRM-SIZE- | | GREATER-THAN-1, FLAGGED DURING THE PREVIOUS | | ROUND AS ‘PROVIDES HEALTH INSURANCE’, AND HAD | | ONE OF THE FOLLOWING JOB SUBTYPES DURING THE | | PREVIOUS ROUND: | | - ‘FORMER MAIN WITHIN REFERENCE PERIOD’ | | - ‘FORMER MISCELLANEOUS JOB WITHIN REFERENCE | | PERIOD’ | | - ‘LAST JOB OUTSIDE REFERENCE PERIOD’ | | - ‘RETIREMENT JOB’ | | - PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT, | | IF THE ESTABLISHMENT IS ONE OF THE SECOND 2 | | TYPES NOTED ABOVE; | | - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS | | INSURANCE; | | - THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT | | COVERED PERSON ON THE DATE OF THE PREVIOUS | | ROUND’S INTERVIEW (HQ WAS CODED ‘1’ (WHOLE TIME)| | OR HQ02 WAS CODED ‘1’ (YES) IN THE PREVIOUS | | ROUND) | ----------------------------------------------------
BOX_19A =======
---------------------------------------------------- | IF THE POLICYHOLDER OF THIS ESTABLISHMENT-PERSON- | | PAIR IS FLAGGED AS ‘POLICYHOLDER NOT LISTED IN RU | | (DU)’ OR ‘POLICYHOLDER DECEASED’, CONTINUE WITH | | OE25A | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE26 | ----------------------------------------------------
OE25A =====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT........} {STR-DT} {END-DT}
INTERVIEWER: IF (POLICYHOLDER)’S NAME IS LISTED ON THE ROSTER BELOW, SELECT IT. IF NOT, SELECT ‘NAME NOT ON ROSTER’ AND CONTINUE.
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] .
[Code One]
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS | | ON THE DU-MEMBERS-ROSTER. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'NAME NOT ON ROSTER' AS LAST ENTRY ON THIS| | ROSTER. | ----------------------------------------------------
---------------------------------------------------- | IF A DU MEMBER’S NAME IS SELECTED FROM THE | | ROSTER, REPLACE THIS NAME AS THE CURRENT | | POLICYHOLDER OF THIS ESTABLISHMENT-PERSON-PAIR. | | IF ‘NAME NOT ON ROSTER’ SELECTED LEAVE THE | | POLICYHOLDER NAME OF THIS ESTABLISHMENT-PERSON- | | PAIR AS IS. | ----------------------------------------------------
OE26 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT........} {STR-DT} {END-DT}
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health insurance. {(Are/Is)/(Were/Was)} (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) as of {today,} (END DATE)?
YES .................................... 1 NO ..................................... 2 {OE28} REF ................................... -7 {END_LP09} DK .................................... -8 {END_LP09}
---------------------------------------------------- | DISPLAY ‘(Are/Is)’ IF NOT ROUND 5. DISPLAY | | ‘(Was/Were)’ IF ROUND 5. | | | | DISPLAY ‘today,’ IF NOT ROUND 5. OTHERWISE, USE A| | NULL DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '1' (YES) AND THIS ESTABLISHMENT-PERSON- | | PAIR IS AN ESTABLISHMENT FLAGGED AS 'SELF- | | EMPLOYED' WITH FIRM-SIZE-1, CONTINUE WITH OE27 | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘1’ (YES) AND ESTABLISHMENT-PERSON-PAIR | | IS NOT AN ESTABLISHMENT WITH FIRM-SIZE-1, GO TO | | BOX_20 | ----------------------------------------------------
OE27 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT........} {STR-DT} {END-DT}
Is this insurance still through (POLICYHOLDER)’s self-employed business?
YES .................................... 1 {BOX_20} NO ..................................... 2 {BOX_20} REF ................................... -7 {BOX_20} DK .................................... -8 {BOX_20}
PRESS F1 FOR DEFINITION OF SELF-EMPLOYED.
OE28 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT........} {STR-DT} {END-DT}
On what date did (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) end?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
---------------------------------------------------- | EDIT (FOR ROUND 5 ONLY): COMPLETE DATE ENTERED | | CANNOT BE AFTER 12/31/2004. IF A DATE AFTER | | 12/31/2004 IS ENTERED, DISPLAY THE FOLLOWING | | MESSAGE: ‘DATE CANNOT BE AFTER 12/31/2004. IF | | INSURANCE ENDED AFTER 12/31/2004, USE CTRL/B TO | | BACK-UP AND CHANGE RESPONSE TO OE26. | ----------------------------------------------------
---------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T| | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE28OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_20 | ----------------------------------------------------
OE28OV ======
Can you just tell me if (POLICYHOLDER) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 PART OF THE MONTH ..................... 2 REF ................................... -7 DK .................................... -8
[Code One]
BOX_20 ======
---------------------------------------------------- | IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT | | THE PREVIOUS ROUND'S INTERVIEW DATE BY THE | | INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, | | AUTOMATICALLY CODE OE29 AS ‘1’ (YES) AND GO TO | | BOX_21 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH OE29 | ----------------------------------------------------
OE29 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT).
{Are/Were} they all covered by this health insurance {until {{OE28 DATE}/it ended}/on (END-DT)}?
TO SCROLL, USE ARROW KEYS. TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT} {PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT} {PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
YES ................................... 1 NO .................................... 2 REF ................................... -7 DK .................................... -8
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- | | PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY | | THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: | | - PERSON WAS COVERED AT THE PREVIOUS ROUND'S | | INTERVIEW DATE BY THE INSURANCE FROM THIS | | ESTABLISHMENT-PERSON-PAIR, INCLUDING THE | | POLICYHOLDER | | - PERSON IS AN RU MEMBER | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'Are' IF OE26 IS CODED ‘1’ (YES). | | DISPLAY 'Were' IF OE26 IS CODED ‘2’ (NO) OR IF | | CURRENT ROUND IS ROUND 5. | | | | DISPLAY 'until {OE28 DATE}' IF OE26 IS CODED ‘2’ | | (NO). DISPLAY 'on (END-DT)' IF OE26 IS CODED ‘1’ | | (YES). | | | | DISPLAY THE DATE RECORDED AT OE28 FOR ‘OE28 DATE’.| | IF THE MONTH AND DAY FIELD AT OE28 IS CODED ‘-7’ | | (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’| | FOR ‘OE28 DATE’. | ----------------------------------------------------
BOX_21 ======
---------------------------------------------------- | IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND | | TO THE END DATE OF THE CURRENT ROUND, THAT IS: | | | | IF OE26 IS CODED '1' (YES) AND OE29 IS CODED '1' | | (YES), | | | | FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING | | THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH| | THE REFERENCE PERIOD END DATE AND | | | | GO TO BOX_23 | ----------------------------------------------------
---------------------------------------------------- | IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND | | TO PART OF THE CURRENT ROUND, THAT IS: | | | | IF OE26 IS CODED '2' (NO) AND OE29 IS CODED '1' | | (YES). | | | | FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING | | THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH| | THE DATE RECORDED AT OE28 AND | | | | GO TO BOX_23 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE (I.E., OE29 CODED ‘2’ (NO), ‘-7’ | | (REFUSED), OR ‘-8’ (DON'T KNOW)), CONTINUE WITH | | OE30 | ----------------------------------------------------
OE30 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Who {is/was} no longer covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {{until {OE28 DATE}/it ended}/ on (END-DT)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65] [2. First Name, [Middle Name], Last Name-65] [3. First Name, [Middle Name], Last Name-65]
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- | | PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY | | THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: | | - PERSON WAS COVERED AT THE PREVIOUS ROUND'S | | INTERVIEW DATE BY THE INSURANCE FROM THIS | | ESTABLISHMENT-PERSON-PAIR, INCLUDING THE | | POLICYHOLDER | | - PERSON IS AN RU MEMBER | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'is' IF OE26 IS CODED ‘1’ (YES). | | DISPLAY 'was' IF OE26 IS CODED ‘2’ (NO) OR IF | | CURRENT ROUND IS ROUND 5. | | | | DISPLAY 'until {OE28 DATE}' IF OE26 IS CODED ‘2’ | | (NO). | | DISPLAY 'on (END-DT)' IF OE26 IS CODED ‘1’ (YES). | | | | DISPLAY THE DATE RECORDED AT OE28 FOR ‘OE28 DATE’.| | IF THE MONTH AND DAY FIELD AT OE28 IS CODED ‘-7’ | | (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’| | FOR ‘OE28 DATE’. | ----------------------------------------------------
---------------------------------------------------- | IF FAMILY STILL HAS INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED '1' | | (YES)), FLAG INSURANCE FOR ALL PERSONS NOT | | SELECTED AT OE30 AS 'CONTINUOUS COVERAGE' FROM THE| | REFERENCE PERIOD START DATE UNTIL THE REFERENCE | | PERIOD END DATE. | ---------------------------------------------------- ---------------------------------------------------- | IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH | | THIS ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED '2' | | (NO)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED| | AT OE30 AS CONTINUOUS COVERAGE FROM THE REFERENCE | | PERIOD START DATE UNTIL DATE RECORDED AT OE28 | ----------------------------------------------------
LOOP_10 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- | | PERS-TRPLS-ROSTER, ASK OE31 - END_LP10. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_10 COLLECTS THE DATE ON | | WHICH THE INSURANCE COVERAGE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER| | WHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCE| | PERIOD END DATE OR THE DATE REPORTED IN OE28. | | THIS LOOP CYCLES ON PERSONS SELECTED AT OE30. | -----------------------------------------------------
OE31 ====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT........} {STR-DT} {END-DT}
On what date did the health insurance through (ESTABLISHMENT) end for (PERSON)?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
---------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T| | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE31OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_22 | ----------------------------------------------------
OE31OV ======
Can you just tell me if (PERSON) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 PART OF THE MONTH ..................... 2 REF ................................... -7 DK .................................... -8
[Code One]
BOX_22 ======
---------------------------------------------------- | FLAG INSURANCE FOR PERSON AS 'CONTINUOUS COVERAGE'| | THROUGH THE COMPLETE DATE RECORDED AT OE31 AND | | OE31OV. | ----------------------------------------------------
END_LP10 ========
---------------------------------------------------- | 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_10 AND CONTINUE WITH BOX_23 | ----------------------------------------------------
BOX_23 ======
---------------------------------------------------- | IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY | | THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,| | (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU | | MEMBERS NOT COVERED BY THIS INSURANCE ON THE | | PREVIOUS ROUND’S INTERVIEW DATE, BUT EXCLUDES RU | | MEMBERS JUST MARKED AS NO LONGER COVERED IN OE30),| | CONTINUE WITH OE32 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE34A | ----------------------------------------------------
OE32 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT........} {STR-DT} {END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, have any persons living here, we have not yet mentioned, been covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?
YES ................................... 1 NO .................................... 2 {OE34A} REF ................................... -7 {OE34A} DK .................................... -8 {OE34A}
PRESS F1 FOR DEFINITION OF DEPENDENT.
---------------------------------------------------- | DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. | | DISPLAY ‘Between (START DATE) and (END DATE)’ IF | | ROUND 5. | ----------------------------------------------------
OE33 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT........} {STR-DT} {END-DT}
Who {has been/was} covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {since (START DATE)/between (START DATE) and (END DATE)} that we have not yet mentioned?
PROBE: Who else {has been/was} covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {since (START DATE)/between (START DATE) and (END DATE)} that we have not yet mentioned?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65] [2. First Name, [Middle Name], Last Name-65] [3. First Name, [Middle Name], Last Name-65]
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS| | ON THE RU-MEMBERS-ROSTER WHO WERE NOT COVERED BY | | THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- | | PAIR ON THE PREVIOUS ROUND'S INTERVIEW DATE. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY ON| | THIS ROSTER. | ----------------------------------------------------
---------------------------------------------------- | WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- | | COVRD-PERS-TRPLS-ROSTER. | ----------------------------------------------------
---------------------------------------------------- | IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG | | INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR | | AS ‘COVERING PERSON NOT LISTED IN RU’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT| | ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) | | and (END DATE)’ IF ROUND 5. | ----------------------------------------------------
LOOP_11 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- | | PERS-TRPLS-ROSTER, ASK OE34 - END_LP11. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_11 COLLECTS THE COVERAGE | | START DATE FOR ALL PERSONS NEWLY COVERED DURING | | THE CURRENT ROUND BY THE INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON | | PERSONS SELECTED AT OE33. | ----------------------------------------------------
OE34 ====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
On what date did the health insurance through (ESTABLISHMENT) begin for (PERSON)?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
----------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T | | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE34OV | -----------------------------------------------------
----------------------------------------------------- | OTHERWISE, GO TO BOX_24 | -----------------------------------------------------
OE34OV ======
Can you just tell me if (PERSON) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 PART OF THE MONTH ..................... 2 REF ................................... -7 DK .................................... -8
[Code One]
---------------------------------------------------- | EDIT: COMPLETE DATE AT OE34 MUST BE < THAN | | COMPLETE DATE AT OE28 IF A DATE IS RECORDED AT | | OE28 OR < THAN REFERENCE PERIOD END DATE IF NO | | DATE IS RECORDED AT OE28. | ----------------------------------------------------
BOX_24 ======
---------------------------------------------------- | IF FAMILY STILL HAS INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED '1' | | (YES)), FLAG INSURANCE FOR THIS PERSON AS | | 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE34 | | UNTIL THE REFERENCE PERIOD END DATE. | ----------------------------------------------------
---------------------------------------------------- | IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH | | THIS ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED '2' | | (NO)), FLAG INSURANCE FOR THIS PERSON AS | | 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE34 | | UNTIL DATE RECORDED AT OE28. | ----------------------------------------------------
END_LP11 ========
---------------------------------------------------- | 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_11 AND GO TO BOX_25 | ----------------------------------------------------
OE34A =====
{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 OE33 | ----------------------------------------------------
BOX_25 ======
---------------------------------------------------- | IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THE| | INSURANCE THROUGH THE ESTABLISHMENT-PERSON-PAIR ON| | THE CURRENT ROUND’S INTERVIEW DATE, THAT IS, OE26 | | IS CODED '1'(YES), CONTINUE WITH BOX_25A | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO END_LP09 | ----------------------------------------------------
BOX_25A =======
---------------------------------------------------- | IF ROUND 3, CONTINUE WITH OE35A | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE35 | ----------------------------------------------------
OE35A =====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
For the coverage through (ESTABLISHMENT), does anyone in the family pay all of the premium or cost, some of the premium or cost, or none of the premium or cost?
[Do not include the cost of any 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.]
YES, PAY ALL OF PREMIUM/COST ........... 1 YES, PAY SOME OF PREMIUM/COST .......... 2 YES, BUT DON'T KNOW IF PAY ALL OR SOME OF PREMIUM/COST ........................ 3 NO, DO NOT PAY ......................... 4 {OE35AAA} REF ................................... -7 {OE35} DK .................................... -8 {OE35}
[Code One]
PRESS F1 FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
---------------------------------------------------- | NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE | | DISPLAYED HERE FOR THE INSURANCE FROM A | | SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM | | DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF | | THE SOURCE, NOT THE NAME OF THE EMPLOYER OR | | DIRECTLY PURCHASED CATEGORY. | ----------------------------------------------------
OE35AA ======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
How much (do/does) (POLICYHOLDER) pay for the (ESTABLISHMENT) coverage?
PROBE: Is that per year, per month, per week, or what?
[Enter Amount in Dollars] .............. REF ................................... -7 {BOX_26A} DK .................................... -8 {BOX_26A}
---------------------------------------------------- | NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE | | DISPLAYED HERE FOR THE INSURANCE FROM A | | SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM | | DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF | | THE SOURCE, NOT THE NAME OF THE EMPLOYER OR | | DIRECTLY PURCHASED CATEGORY. | ----------------------------------------------------
OE35AAOV1 =========
ENTER UNIT OF COVERAGE:
PER YEAR ............................... 1 {BOX_26A} QUARTERLY/EVERY 3 MONTHS ............... 2 {BOX_26A} BIMONTHLY/EVERY 2 MONTHS ............... 3 {BOX_26A} PER MONTH .............................. 4 {BOX_26A} PER WEEK ............................... 5 {BOX_26A} BIWEEKLY/EVERY 2 WEEKS ................. 6 {BOX_26A} SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 {BOX_26A} SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 {BOX_26A} OTHER ................................. 91 REF ................................... -7 {BOX_26A} DK .................................... -8 {BOX_26A}
[Code One]
OE35AAOV2 =========
ENTER OTHER:
[Enter Other Specify] .................. REF ................................... -7 DK .................................... -8
BOX_26A =======
----------------------------------------------------- | IF OE35A IS CODED ‘1’ (YES, PAY ALL OF PREMIUM/ | | COST), GO TO OE35 | -----------------------------------------------------
----------------------------------------------------- | OTHERWISE, CONTINUE WITH OE35AAA | -----------------------------------------------------
OE35AAA =======
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
Who {else} pays {some of/for} the premium or cost of this insurance?
FEDERAL GOVERNMENT .................... 1 STATE GOVERNMENT ...................... 2 LOCAL GOVERNMENT ...................... 3 SOME GOVERNMENT ....................... 4 EMPLOYER .............................. 5 UNION ................................. 6 OTHER ................................. 91 REF ................................... -7 DK .................................... -8
[Code All That Apply]
---------------------------------------------------- | DISPLAY ‘else’ IF OE35A IS CODED ‘2’ (YES, PAY | | SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON'T KNOW | | IF PAY ALL OR SOME OF PREMIUM/COST). OTHERWISE, | | USE A NULL DISPLAY | | | | DISPLAY ‘some of’ IF OE35A IS CODED ‘2’ (YES, PAY | | SOME OF PREMIUM/COST) OR ‘3’ (YES, BUT DON'T KNOW | | IF PAY ALL OR SOME OF PREMIUM/COST). DISPLAY ‘for’| | IF OE35A IS CODED ‘4’ (NO, DO NOT PAY). | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION | | WITH ANY OTHER CODE, CONTINUE WITH OE35AAAOV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE35 | ----------------------------------------------------
OE35AAAOV =========
ENTER OTHER:
[Enter Other Specify] .................. REF ................................... -7 DK .................................... -8
OE35 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT........} {STR-DT} {END-DT}
{Last time we recorded that (POLICYHOLDER) (were/was) covered by (READ INSURER NAME(S) BELOW).}
{Since (START DATE), has there been/Between (START DATE) and (END DATE), was there} any change in the plan name of the health insurance (POLICYHOLDER) {has/had} through (ESTABLISHMENT)?
TO SCROLL, USE ARROW KEYS. TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT} {INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT} {INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT}
YES ................................... 1 NO .................................... 2 {END_LP09} REF ................................... -7 {END_LP09} DK .................................... -8 {END_LP09}
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL | | INSURERS IN THE RU-ESTB-PERSON-INSURER-TRIPLES- | | ROSTER THAT ARE FLAGGED AS 'SUPPLYING HOSPITAL AND| | PHYSICIAN BENEFITS' AND/OR 'SUPPLYING MEDICARE | | SUPPLEMENT/MEDIGAP BENEFITS' AND ARE ASSOCIATED | | WITH THE INSURANCE THROUGH THIS ESTABLISHMENT- | | PERSON-PAIR. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY FIRST PARAGRAPH AND THE ROSTER OF INSURER | | NAMES IF THE INSURANCE THROUGH THIS ESTABLISHMENT-| | PERSON-PAIR HAD ANY INSURERS FLAGGED AS PROVIDING | | MEDIGAP OR HOSPITAL/PHYSICIAN BENEFITS AT ANY TIME| | DURING THE PREVIOUS ROUND. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘Since (START DATE), has there been’ AND | | ‘has’ IF NOT ROUND 5. DISPLAY ‘Between (START | | DATE) and (END DATE), was there’ AND ‘had’ IF | | ROUND 5. | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T | | KNOW), FLAG PREVIOUS ROUND’S INSURER AS CURRENT | | ROUND’S INSURER FOR THIS ESTABLISHMENT-PERSON- | | PAIR. | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘1’ (YES) AND ESTABLISHMENT IS FLAGGED AS| | AN INSURANCE CO. OR HMO, CONTINUE WITH OE36 | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘1’ (YES) AND ESTABLISHMENT IS NOT | | FLAGGED AS AN INSURANCE CO. OR HMO, GO TO OE37 | ----------------------------------------------------
OE36 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT........} {STR-DT} {END-DT}
What is the new plan name of (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?
[Enter Plan Name/Establishment Name] ..............
---------------------------------------------------- | WRITE ESTABLISHMENT NAME CORRECTION TO THE RU- | | ESTABLISHMENT-PERSONS-PAIRS-ROSTER. THIS IS THE | | CORRECTED ESTABLISHMENT NAME. | ----------------------------------------------------
---------------------------------------------------- | FLAG INSURER ENTERED ABOVE AS CURRENT ROUND’S | | INSURER FOR THIS POLICYHOLDER-ESTABLISHMENT PAIR. | ----------------------------------------------------
---------------------------------------------------- | NOTE: IF A SOURCE OF INSURANCE WAS DIRECTLY | | PURCHASED FROM AN HMO OR INSURANCE COMPANY, THE | | ESTABLISHMENT NAME IS THE SAME AS THE INSURER | | NAME. THEREFORE, ANY CHANGE IN PLAN NAME | | AUTOMATICALLY DICTATES A CHANGE IN THE | | ESTABLISHMENT NAME. | ----------------------------------------------------
OE37 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
SHOW CARD OE-1.
What type of health insurance {(do/does)/did} (POLICYHOLDER) {now} have through (ESTABLISHMENT)'s new plan {on (END DATE)}?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ... 1 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 REF ................................... -7 DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.]
---------------------------------------------------- | DISPLAY ‘(do/does)’ IF NOT ROUND 5. DISPLAY ‘did’| | IF ROUND 5. | | | | DISPLAY ‘now’ IF NOT ROUND 5. OTHERWISE, USE A | | NULL DISPLAY. | | | | DISPLAY ‘on (END DATE)’ IF ROUND 5. OTHERWISE, | | USE A NULL DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '91' (OTHER), ALONE OR IN COMBINATION | | WITH ANY OTHER CODES, CONTINUE WITH OE37OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_26 | ----------------------------------------------------
OE37OV ======
ENTER OTHER:
[Enter Other Specify] .................. REF ................................... -7 DK .................................... -8
BOX_26 ======
---------------------------------------------------- | IF OE37 IS CODED '1' (HOSPITAL AND PHYSICIAN | | BENEFITS) OR ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), | | ALONE OR WITH ANY OTHER COMBINATION OF CODES, | | CONTINUE WITH BOX_27 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO END_LP09 | ----------------------------------------------------
BOX_27 ======
---------------------------------------------------- | IF ESTABLISHMENT ALREADY FLAGGED AS ‘INSURANCE | | CO.’ OR ‘HMO’, AUTOMATICALLY CODE OE38 WITH | | APPROPRIATE RESPONSES AND GO TO LOOP_12 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH OE38 | ----------------------------------------------------
OE38 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
What is the new plan name for (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) which provides the {hospital and physician benefits/Medicare supplement or Medigap benefits}?
IF MORE THAN ONE NAME, PROBE: What is the main new plan name? RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE {HOSPITAL AND PHYSICIAN/MEDIGAP} BENEFITS FOR THIS PAIR.
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, CODE 2 (HMO).
NAME OF INSURER: [Enter Insurer] TYPE: 1 = INSURANCE COMPANY 2 = HMO 3 = COMPANY IS SELF-INSURED
PRESS F1 FOR DEFINITION OF INSURANCE CO/HMO/SELF-INSURED CO.
----------------------------------------------------- | DISPLAY 'hospital and physician benefits' AND | | ‘HOSPITAL’ IF OE37 IS CODED ‘1’ (HOSPITAL AND | | PHYSICIAN BENEFITS), BUT NOT CODED ‘5’ (MEDICARE | | SUPPLEMENT/MEDIGAP). DISPLAY 'Medicare supplement | | or Medigap benefits' AND ‘MEDIGAP’ IF OE37 IS CODED| | ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP). | -----------------------------------------------------
----------------------------------------------------- | WRITE INSURER(S) TO THE RU-ESTAB-PERSON-INSURER- | | TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR | -----------------------------------------------------
---------------------------------------------------- | FLAG INSURER(S) COLLECTED AT OE38 AS CURRENT | | ROUND’S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- | | PAIR. | ----------------------------------------------------
---------------------------------------------------- | IF OE37 IS CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP)| | FLAG INSURANCE CO./HMO AS 'SUPPLYING MEDICARE | | SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES | | HOSPITAL/PHYSICIAN BENEFITS)’ FOR THE CURRENT | | ROUND. | ----------------------------------------------------
---------------------------------------------------- | IF OE37 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN | | BENEFITS), BUT NOT ‘5’ (MEDICARE SUPPLEMENT/ | | MEDIGAP), FLAG INSURANCE CO./HMO AS 'SUPPLYING | | HOSPITAL/PHYSICIAN BENEFITS' FOR THE CURRENT | | ROUND. | ----------------------------------------------------
LOOP_12 =======
---------------------------------------------------- | FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- | | TRIPLES-ROSTER, ASK OE38A - END_LP12. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_12 COLLECTS OTHER POLICY | | NAMES AND MANAGED CARE INFORMATION FOR INSURERS | | COLLECTED AT OE38. THIS LOOP CYCLES ON TRIPLES | | THAT MEET THE FOLLOWING CONDITIONS: | | | | - ESTABLISHMENT-PERSON-PAIR PROVIDES THE INSURANCE| | BEING ASKED ABOUT | | - INSURER IS ENTERED AT OE38 | ----------------------------------------------------
OE38A =====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT}
Is there any other name for the {INSURANCE COMPANY OR HMO NAME} policy, such as Option A, $100 Deductible Plan, 90/80 Plan, Gold Plan, or High Option Plan?
YES, ANOTHER NAME ...................... 1 NO OTHER NAME .......................... 2 {BOX_28A} REF ................................... -7 {BOX_28A} DK .................................... -8 {BOX_28A}
PRESS F1 FOR DEFINITION OF LOW OPTION/HIGH OPTION.
[Code One]
---------------------------------------------------- | DISPLAY THE NAME OF THE INSURANCE CO/HMO | | RECORDED IN OE38_01 WHICH IS BEING LOOPED ON | | FOR ‘INSURANCE...NAME.’ | ----------------------------------------------------
OE38AOV =======
ENTER OTHER NAME:
[Enter Policy Name] .................... REF ................................... -7 DK .................................... -8
BOX_28A =======
---------------------------------------------------- | IF INSURER BEING LOOPED ON IS CODED ‘2’ (HMO) IN | | OE38_02, CONTINUE WITH OE38B | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_28 | ----------------------------------------------------
OE38B =====
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
Will (POLICYHOLDER)’s plan pay for any of the costs of visits to doctors who are not part of (POLICYHOLDER)’s HMO, even if (POLICYHOLDER) (do/does) not have a referral?
YES .................................... 1 {END_LP12} NO ..................................... 2 {END_LP12} REF ................................... -7 {END_LP12} DK .................................... -8 {END_LP12}
BOX_28 ======
---------------------------------------------------- | ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER| | | | AT COMPLETION OF MANAGED CARE (MC) SECTION, | | CONTINUE WITH END_LP12 | ----------------------------------------------------
END_LP12 ========
---------------------------------------------------- | CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- | | INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS | | STATED IN THE LOOP DEFINITION. | ----------------------------------------------------
---------------------------------------------------- | IF NO OTHER INSURERS MEET THE STATED CONDITIONS, | | END LOOP_12 AND CONTINUE WITH END_LP09 | ----------------------------------------------------
END_LP09 ========
---------------------------------------------------- | CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-| | PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN | | THE LOOP DEFINITION. | ----------------------------------------------------
---------------------------------------------------- | IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END | | LOOP_09 AND CONTINUE WITH BOX_29 | ----------------------------------------------------
BOX_29 ======
---------------------------------------------------- | IF ONE OR MORE RU MEMBERS WAS A COVERED PERSON BY | | AN ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS | | ROUND’S INTERVIEW DATE WHERE THE ESTABLISHMENT IS | | A PRIVATE SOURCE OF INSURANCE AND THE POLICYHOLDER| | IS FLAGGED AS ‘POLICYHOLDER/DEPENDENT IN DIFFERENT| | RUS’ AT THE CURRENT ROUND’S INTERVIEW DATE, | | CONTINUE WITH LOOP_13 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_33 | ----------------------------------------------------
---------------------------------------------------- | NOTE: WHEN A POLICYHOLDER LEAVES AN RU, WE WILL | | NEVER ASK RJ AND THAT POLICYHOLDER WILL NEVER | | QUALIFY FOR LOOPS 01, 05, OR 09. WE CREATED A | | NEW LOOP, LOOP_13 THAT WILL HANDLE THE SITUATIONS | | WHERE THE POLICYHOLDER HAS LEFT THE RU AND LEFT | | DEPENDENTS BEHIND, OR THE SITUATION WHERE THE | | DEPENDENTS HAVE LEFT THE RU (WITHOUT THE | | POLICYHOLDER). THIS SITUATION WILL BE FLAGGED AS | | ‘POLICYHOLDER/DEPENDENT IN DIFFERENT RUs’. THIS | | FLAG CAN BE ASSOCIATED WITH ANY ESTABLISHMENT- | | PERSON-PAIR IN A PARTICULAR RU WHERE THEY ARE | | COVERED PERSONS, BUT THE POLICYHOLDER IS IN | | ANOTHER RU. THIS FLAG SHOULD NEVER EXIST ON A | | PAIR IN AN RU WHERE THE POLICYHOLDER OF THE PAIR | | IS IN THE SAME RU AS ALL OF THE DEPENDENTS OR | | WHERE THE POLICYHOLDER OF THE PAIR WAS ORIGINALLY | | CREATED AS ‘POLICYHOLDER NOT IN RU/DU’ OR | | ‘POLICYHOLDER DECEASED’. | ----------------------------------------------------
LOOP_13 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- | | PAIRS-ROSTER, ASK OE39 - END_LP13. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: | | | | LOOP_13 COLLECTS INFORMATION ABOUT THE | | CONTINUATION OF INSURANCE COVERAGE THROUGH AN | | ESTABLISHMENT-PERSON-PAIR WHERE THE POLICYHOLDER | | OR THE ELIGIBLE DEPENDENT(S) HAVE MOVED FROM THE | | RU. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS| | THAT MEET THE FOLLOWING CONDITIONS: | | | | - THE ESTABLISHMENT IS A PRIVATE SOURCE OF | | INSURANCE | | - THE ESTABLISHMENT-PERSON-PAIR IS FLAGGED AS | | ‘POLICYHOLDER/DEPENDENT MOVED’ AT THE CURRENT | | ROUND’S INTERVIEW DATE FOR THIS RU | | - AT LEAST ONE RU MEMBER WAS A COVERED PERSON FOR | | THIS ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS | | ROUND’S INTERVIEW DATE | | - POLICYHOLDER IS NOT A CURRENT RU MEMBER | ----------------------------------------------------
OE39 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)’s (ESTABLISHMENT) health insurance. {Is/Was} anyone in the family, living here{ now}, covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of {today,} (END DATE)?
IF RESPONDENT VOLUNTEERS THAT THIS INSURANCE HAS ALREADY BEEN DISCUSSED, CODE ‘3’.
YES ................................... 1 {OE41} NO .................................... 2 INSURANCE ALREADY DISCUSSED ........... 3 {END_LP13} REF ................................... -7 {END_LP13} DK .................................... -8 {END_LP13}
[Code One]
---------------------------------------------------- | DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF | | ROUND 5. | | | | DISPLAY ‘today,’ AND ‘ now’ IF NOT ROUND 5. | | OTHERWISE, USE A NULL DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘3’ (INSURANCE ALREADY DISCUSSED), FLAG | | ITEM FOR SOURCE CLEAN-UP. | ----------------------------------------------------
OE40 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
On what date did this health insurance through (ESTABLISHMENT) end?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
---------------------------------------------------- | EDIT (FOR ROUND 5 ONLY): COMPLETE DATE ENTERED | | CANNOT BE AFTER 12/31/2004. IF A DATE AFTER | | 12/31/2004 IS ENTERED, DISPLAY THE FOLLOWING | | MESSAGE: ‘DATE CANNOT BE AFTER 12/31/2004. IF | | INSURANCE ENDED AFTER 12/31/2004, USE CTRL/B TO | | BACK-UP AND CHANGE RESPONSE TO OE39. | ----------------------------------------------------
---------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T| | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE40OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE43 | ----------------------------------------------------
OE40OV ======
Can you just tell me if (POLICYHOLDER) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 PART OF THE MONTH ..................... 2 REF ................................... -7 DK .................................... -8
[Code One]
---------------------------------------------------- | IF ONLY ONE PERSON COVERED AT END OF PREVIOUS | | ROUND, GO TO OE43 | ----------------------------------------------------
OE41 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT).
{Are/Were} they all covered by this health insurance {until {{OE40 DATE}/it ended}/on (END-DT)}?
TO SCROLL, USE ARROW KEYS. TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
{PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT} {PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT} {PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT}
YES ................................... 1 NO .................................... 2 REF ................................... -7 DK .................................... -8
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- | | PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY | | THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: | | - PERSON WAS COVERED AT THE PREVIOUS ROUND'S | | INTERVIEW DATE BY THE INSURANCE FROM THIS | | ESTABLISHMENT-PERSON-PAIR, | | - PERSON IS AN RU MEMBER | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'Are' IF OE39 IS CODED ‘1’ (YES). | | DISPLAY 'Were' IF OE39 IS CODED ‘2’ (NO) OR IF | | CURRENT ROUND IS ROUND 5. | | | | DISPLAY 'until {OE40 DATE}' IF OE39 IS CODED ‘2’ | | (NO). | | DISPLAY 'on (END-DT)' IF OE39 IS CODED ‘1’ (YES). | | | | DISPLAY THE DATE RECORDED AT OE40 FOR ‘OE40 DATE’.| | IF THE MONTH AND DAY FIELD AT OE40 IS CODED ‘-7’ | | (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’| | FOR ‘OE40 DATE’. | ----------------------------------------------------
---------------------------------------------------- | IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND | | TO THE END DATE OF THE CURRENT ROUND, THAT IS: | | | | IF OE39 IS CODED '1' (YES) AND OE41 IS CODED '1' | | (YES), | | | | FLAG INSURANCE FOR ALL COVERED PERSONS AS | | 'CONTINUOUS COVERAGE' THROUGH THE REFERENCE PERIOD| | END DATE AND | | | | GO TO BOX_31 | ----------------------------------------------------
---------------------------------------------------- | IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND | | TO PART OF THE CURRENT ROUND, THAT IS: | | | | IF OE39 IS CODED '2' (NO) AND OE41 IS CODED '1' | | (YES), | | | | FLAG INSURANCE FOR ALL COVERED PERSONS AS | | 'CONTINUOUS COVERAGE' THROUGH THE DATE RECORDED | | AT OE40 AND | | | | GO TO BOX_31 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE (I.E., OE41 CODED ‘2’ (NO), ‘-7’ | | (REFUSED), OR ‘-8’ (DON'T KNOW)), | | CONTINUE WITH OE42 | ----------------------------------------------------
OE42 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Who {is/was} no longer covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {until {{OE40 DATE}/it ended}/on (END-DT)}?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65] [2. First Name, [Middle Name], Last Name-65] [3. First Name, [Middle Name], Last Name-65]
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- | | PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY | | THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS: | | - PERSON WAS COVERED AT THE PREVIOUS ROUND'S | | INTERVIEW DATE BY THE INSURANCE FROM THIS | | ESTABLISHMENT-PERSON-PAIR, | | - PERSON IS AN RU MEMBER | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'is' IF OE39 IS CODED ‘1’ (YES). | | DISPLAY 'was' IF OE39 IS CODED ‘2’ (NO) OR IF | | CURRENT ROUND IS ROUND 5. | | | | DISPLAY 'until {OE40 DATE}' IF OE39 IS CODED ‘2’ | | (NO). | | DISPLAY 'on (END-DT)' IF OE39 IS CODED ‘1’ (YES). | | | | DISPLAY THE DATE RECORDED AT OE40 FOR ‘OE40 DATE’.| | IF THE MONTH AND DAY FIELD AT OE40 IS CODED ‘-7’ | | (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY ‘it ended’| | FOR ‘OE40 DATE’. | ----------------------------------------------------
---------------------------------------------------- | IF FAMILY STILL HAS INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED '1' | | (YES)), FLAG INSURANCE FOR ALL PERSONS NOT | | SELECTED AT OE42 AS CONTINUOUS COVERAGE FROM THE | | REFERENCE PERIOD START DATE UNTIL THE REFERENCE | | PERIOD END DATE. | ---------------------------------------------------- ---------------------------------------------------- | IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH | | THIS ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED '2' | | (NO), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED | | AT OE42 AS 'CONTINUOUS COVERAGE' FROM THE | | REFERENCE PERIOD START DATE UNTIL DATE RECORDED | | AT OE40. | ----------------------------------------------------
LOOP_14 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- | | PERS-TRPLS-ROSTER, ASK OE43 - END_LP14. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_14 COLLECTS THE DATE ON | | WHICH THE INSURANCE COVERAGE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER| | WHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCE| | PERIOD END DATE OR THE DATE REPORTED IN OE40. | | THIS LOOP CYCLES ON PERSONS SELECTED AT OE42. | ----------------------------------------------------
OE43 ====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
On what date did the health insurance through (ESTABLISHMENT) end for (PERSON)?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
---------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T| | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE43OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_30 | ----------------------------------------------------
OE43OV ======
Can you just tell me if (PERSON) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 PART OF THE MONTH ..................... 2 REF ................................... -7 DK .................................... -8
[Code One]
BOX_30 ======
---------------------------------------------------- | FLAG INSURANCE FOR PERSON AS 'CONTINUOUS COVERAGE'| | THROUGH THE COMPLETE DATE RECORDED AT OE43 AND | | OE43OV. | ----------------------------------------------------
END_LP14 ========
---------------------------------------------------- | 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_14 AND CONTINUE WITH BOX_31 | ----------------------------------------------------
BOX_31 ======
---------------------------------------------------- | IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY | | THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,| | (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU | | MEMBERS NOT COVERED BY THIS INSURANCE ON THE | | PREVIOUS ROUND’S INTERVIEW DATE, BUT EXCLUDES RU | | MEMBERS JUST MARKED AS NO LONGER COVERED IN OE42),| | CONTINUE WITH OE44 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO OE47 | ----------------------------------------------------
OE44 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, have any persons living here, we have not yet mentioned, been covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT)?
YES ................................... 1 NO .................................... 2 {OE47} REF ................................... -7 {OE47} DK .................................... -8 {OE47}
PRESS F1 FOR DEFINITION OF DEPENDENT.
---------------------------------------------------- | DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. | | DISPLAY ‘Between (START DATE) and (END DATE)’ IF | | ROUND 5. | ----------------------------------------------------
OE45 ====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
Who {has been/was} covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {since (START DATE)/between (START DATE) and (END DATE)} that we have not yet mentioned?
PROBE: Who else {has been/was} covered by (POLICYHOLDER)’s health insurance through (ESTABLISHMENT) {since (START DATE)/between (START DATE) and (END DATE)} that we have not yet mentioned?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
[1. First Name, [Middle Name], Last Name-65] [2. First Name, [Middle Name], Last Name-65] [3. First Name, [Middle Name], Last Name-65]
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS| | ON THE RU-MEMBERS-ROSTER WHO WERE NOT COVERED BY | | THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- | | PAIR ON THE PREVIOUS ROUND'S INTERVIEW DATE. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘PERSON NOT LISTED IN RU’ AS LAST ENTRY ON| | THIS ROSTER. | ----------------------------------------------------
---------------------------------------------------- | WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- | | COVRD-PERS-TRPLS-ROSTER. | ----------------------------------------------------
---------------------------------------------------- | IF ‘PERSON NOT LISTED IN RU’ IS SELECTED, FLAG | | INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR | | AS ‘COVERING PERSON NOT LISTED IN RU’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘has been’ AND ‘since (START DATE)’ IF NOT| | ROUND 5. DISPLAY ‘was’ AND ‘between (START DATE) | | and (END DATE)’ IF ROUND 5. | ----------------------------------------------------
LOOP_15 =======
---------------------------------------------------- | FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- | | PERS-TRPLS-ROSTER, ASK OE46 - END_LP15. | ----------------------------------------------------
---------------------------------------------------- | LOOP DEFINITION: LOOP_15 COLLECTS THE COVERAGE | | START DATE FOR ALL PERSONS NEWLY COVERED DURING | | THE CURRENT ROUND BY THE INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON | | PERSONS SELECTED AT OE45. | ----------------------------------------------------
OE46 ====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF ESTABLISHMENT.........} {STR-DT} {END-DT}
On what date did the health insurance through (ESTABLISHMENT) begin for (PERSON)?
[Enter Month-2, Day-2, Year-4] ......... REF ................................... -7 DK .................................... -8
---------------------------------------------------- | IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T| | KNOW) AND MONTH FIELD IS NOT CODED ‘-7' (REFUSED) | | OR '-8' (DON'T KNOW), CONTINUE WITH OE46OV | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO BOX_32 | ----------------------------------------------------
OE46OV ======
Can you just tell me if (PERSON) was covered under that insurance the whole month or part of the month?
WHOLE MONTH ........................... 1 PART OF THE MONTH ..................... 2 REF ................................... -7 DK .................................... -8
[Code One]
---------------------------------------------------- | EDIT: COMPLETE DATE AT OE46 MUST BE < THAN | | COMPLETE DATE AT OE40 IF A DATE IS RECORDED AT | | OE40 OR < THAN REFERENCE PERIOD END DATE IF NO | | DATE IS RECORDED AT OE40. | ----------------------------------------------------
BOX_32 ======
---------------------------------------------------- | IF FAMILY STILL HAS INSURANCE THROUGH THIS | | ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED '1' | | (YES)), FLAG INSURANCE FOR THIS PERSON AS | | 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE40 | | UNTIL THE REFERENCE PERIOD END DATE. | ----------------------------------------------------
---------------------------------------------------- | IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH | | ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED '2' (NO))| | FLAG INSURANCE FOR THIS PERSON AS 'CONTINUOUS | | COVERAGE' FROM DATE RECORDED AT OE46 UNTIL DATE | | RECORDED AT OE40. | ----------------------------------------------------
END_LP15 ========
---------------------------------------------------- | CYCLE ON NEXT PERSON IN 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_15 AND GO TO END_LP13 | ----------------------------------------------------
OE47 ====
{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 OE45 | ----------------------------------------------------
END_LP13 ========
---------------------------------------------------- | CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-| | PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN | | THE LOOP DEFINITION. | ----------------------------------------------------
---------------------------------------------------- | IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END | | LOOP_13 AND CONTINUE WITH BOX_33 | ----------------------------------------------------
BOX_33 ======
---------------------------------------------------- | RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN HX. | ----------------------------------------------------