Managed Care (MC) Section
BOX_00
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CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, ESTB.ESTBNAME,
PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY,
PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY.
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MC01
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}
{Is/Was} (POLICYHOLDER)’s {NAME OF INSURER BEING
LOOPED ON} an HMO
{as of (END DATE)}? {When answering this question, do
not consider
(POLICYHOLDER)’s insurance through Medicare.}
[With an HMO, you must generally receive care from HMO
physicians.
For other doctors, the expense is not covered unless
you were
referred by the HMO or there was a medical emergency.]
YES .................................... 1 {MC05}
NO ..................................... 2 {MC02}
REF ................................... -7 {MC02}
DK .................................... -8 {MC02}
HELP AVAILABLE FOR DEFINITION OF HMO.
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DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘Was’ IF
ROUND 5.
DISPLAY ‘as of (END DATE)’ IF ROUND 5. OTHERWISE,
USE A NULL DISPLAY.
DISPLAY ‘When answering this question, do not
consider (POLICYHOLDER)’s insurance through
Medicare.’ IF POLICYHOLDER BEING ASKED ABOUT IS
ALSO COVERED BY MEDICARE. OTHERWISE, USE A NULL
DISPLAY.
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MC02
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
{(Do/Does)/As of (END DATE), did} (POLICYHOLDER)’s
insurance
plan require (POLICYHOLDER) to sign up with a
certain primary
care doctor, group of doctors, or a certain clinic
which
(POLICYHOLDER) must go to for all of (POLICYHOLDER)’s
routine
care?
PROBE: Do not include emergency care or care from a
specialist
you were referred to.
YES .................................... 1 {MC04}
NO ..................................... 2 {MC03}
REF ................................... -7 {MC03}
DK .................................... -8 {MC03}
HELP AVAILABLE FOR DEFINITION OF PRIMARY CARE DOCTOR
AND ROUTINE CARE.
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DISPLAY ‘(Do/Does)’ IF NOT ROUND 5. DISPLAY ‘As
of (END DATE), did’ IF ROUND 5.
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MC03
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
{Is/As of (END DATE), was} there a book or list of
doctors
associated with the plan?
YES .................................... 1 {MC04}
NO ..................................... 2 {BOX_01}
REF ................................... -7 {BOX_01}
DK .................................... -8 {BOX_01}
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DISPLAY ‘Is’ IF NOT ROUND 5. DISPLAY ‘As of (END
DATE), was’ IF ROUND 5.
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MC04
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
{Will/As of (END DATE), would} (POLICYHOLDER)’s plan
pay for any
of the costs of visits to doctors who are not
associated with
(POLICYHOLDER)’s plan, even if (POLICYHOLDER)
{(do/does)/did}
not have a referral?
YES .................................... 1 {BOX_01}
NO ..................................... 2 {BOX_01}
REF ................................... -7 {BOX_01}
DK .................................... -8 {BOX_01}
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DISPLAY ‘Will’ AND ‘(do/does)’ IF NOT ROUND 5.
DISPLAY ‘As of (END DATE), would’ AND ‘did’ IF
ROUND 5.
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MC05
====
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
{Will/As of (END DATE), would} (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)/did} not
have a referral?
YES .................................... 1 {BOX_01}
NO ..................................... 2 {BOX_01}
REF ................................... -7 {BOX_01}
DK .................................... -8 {BOX_01}
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DISPLAY ‘Will’ AND ‘(do/does)’ IF NOT ROUND 5.
DISPLAY ‘As of (END DATE), would’ AND ‘did’ IF
ROUND 5.
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BOX_01
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RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN HX OR
OE.
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