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BOX_00
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, ESTB.ESTBNAME,
PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY,
PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY.
MC01
{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}
{Is/Was} {your/{POLICYHOLDER}’s} {NAME OF INSURER
BEING LOOPED ON} an
HMO {as of {END DATE}}? {When answering this question,
do not consider
{your/his/her} 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 {BOX_01}
NO ..................................... 2 {BOX_01}
REF ................................... -7 {BOX_01}
DK .................................... -8 {BOX_01}
HELP AVAILABLE FOR DEFINITION OF HMO.
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 {your/his/her} insurance through
Medicare.’ IF POLICYHOLDER BEING ASKED ABOUT IS
ALSO COVERED BY MEDICARE. OTHERWISE, USE A NULL
DISPLAY.
MC02
OMITTED.
MC03
OMITTED.
MC04
OMITTED.
MC05
OMITTED.
BOX_01
RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN HX OR
OE.
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