1998 Medical Expenditure Panel Survey Insurance Component HEALTH INSURANCE  COST STUDY Establishment Questionnaire
(Please correct any errors in name, address, and ZIP Code. Enter number and street if not shown.)
U.S. DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. CENSUS BUREAU ACTING AS COLLECTING AGENT FOR U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
RETURN TO	U.S. Census Bureau 1201 East 10th Street Jeffersonville, IN 47132-0001
PLEASE RETURN ENTIRE PACKAGE WITHIN ______________
INSTRUCTIONS Please report for the establishment identified on the cover sheet, unless otherwise specified. Please report data for 1998, unless otherwise specified. Estimates are acceptable. Refer to the Definition Sheet included with this package for explanation of unfamiliar terms. If you have any questions or need assistance in completing the questionnaire, please call
Paperwork Reduction Act and Burden Statements We expect that it will take 20 minutes, on average, per establishment, to complete the basic questionnaire. Establishments with more than one health plan will take an additional 10 minutes per plan, on average, up to the maximum of four plans to be reported. In addition, we estimate that it will take 15 minutes to review the instructions and locate the requested information. You may send any comments regarding this burden estimate or any other aspect of the collection of information, including suggestions for reducing burden, to the following address: Director, Center for Cost and Financing Studies, Paperwork Reduction Project 0935-0110, Agency for Healthcare Policy and Research, Executive Office Center, Suite 500, 2101 East Jefferson Street, Rockville, MD 20852-4908.
Section A – NUMBER OF PLANS
Please respond for the location identified on the cover sheet unless otherwise specified. Respond for active employees only.
1a. Did your organization make available or contribute to the cost of any health insurance plans for its employees in 1998? For this survey, a health insurance plan is hospital and/or physician coverage made available to employees. Yes – Continue with Question 1b No – SKIP to Section B
b. How many different health insurance choices did your organization make available or contribute to for its employees during the 1998 plan year? Do not count single service plans (optional plans) such as dental or vision. Plans offered by the same insurance company which offer: Single and family plans providing the same level of benefits count as one plan. High and standard options count as two plans. An HMO and a conventional plan count as two plans. SKIP to Page 4, Section C
Section B – HEALTH INSURANCE NOT OFFERED
Complete only if health insurance was NOT offered during 1998, otherwise; SKIP to Page 4, Section C. 1a. Did your organization offer any health insurance as a benefit to its employees at this location between January 1, 1993 and December 31, 1997?   Yes – Continue with Question 1b  No – SKIP to Question 2
b. What was the last year your organization offered health insurance coverage to its employees at this location?    199___  Last year offered
2. In 1998, did your organization pay the medical or hospital bills of its employees directly, other than for workers’ compensation and/or injuries suffered on the job?   Yes  No
3a.Instead of providing a health plan in 1998, did your organization provide a voucher or stipend to its employees which could be used to purchase health insurance?   Yes – Continue with Question 3b  No – SKIP to Page 4, Section C
b. Was this voucher or stipend to be used exclusively for health insurance or health care?   Yes  No
c. What was the average value PER EMPLOYEE of this voucher or stipend at this location?  $ __________________ Voucher value
d. How frequently was this voucher or stipend paid? Mark (X) only one.  ____ Weekly  ____ Every 2 weeks  ____ Monthly  ____ Quarterly  ____ Yearly
Section C – EMPLOYMENT CHARACTERISTICS
Estimates are acceptable for all employment, eligibility, and enrollment figures.  Include officers, owners, part-time, temporary and seasonal employees.  Exclude leased or contract workers. 1. What was the total number of employees your organization had at ALL locations for a typical pay period in 1998?  _______ Employees at all locations
Complete questions 2–7 for the location listed on the cover sheet. 2a. How many employees were on your organization’s payroll AT THIS LOCATION for a typical pay period in 1998?  ___________All employees at this location   If your organization did not offer health insurance in 1998, SKIP to Question 3a.
b.  How many of these employees were eligible for at least one health plan through your organization? _______ Eligible employees
c. How many of these employees were enrolled in any health plan through your organization?  _______ Enrolled employees
3a. For the same typical pay period in 1998, how many of the employees reported in C2a worked part-time? ______ Part-time employees  If your organization did not offer health insurance in 1998, SKIP to Question 4a.
b. How many of these part-time employees were eligible for at least one health plan through your organization?  ______ Eligible part-time employees
c. How many of these part-time employees were enrolled in any health plan through your organization?  ______ Enrolled part-time employees
4a. For the same typical pay period in 1998, how many of the employees reported in C2a were temporary or seasonal employees?  ______ Temporary or seasonal employees If your organization did not offer health insurance in 1998, SKIP to Question 5.
b. How many of these temporary or seasonal employees were eligible for at least one health plan through your organization?  ______ Eligible temporary or seasonal employees
c. How many of these temporary or seasonal employees were enrolled in any health plan through your organization?  ______ Enrolled temporary or seasonal employees
5.  Is the information you provided in questions 2, 3, and 4 above for the location listed on the cover sheet OR did you provide information for multiple locations?  ____ Information for specified location  ____Information for multiple locations
Section C – EMPLOYMENT CHARACTERISTICS – Continued
Provide information for a typical pay period in 1998. Estimates are acceptable. The following workforce characteristics are used to group similar organizations together for analytical purposes. 6a. What percentage of the employees at this location were women?  ________%  Women employees
b. What percentage of the employees at this location were 50 years old or older? _______ Employees 50 years old or older
c.  What percentage of the employees at this location were union members? ______% Union members
d. For the employees at this location in 1998, approximately what percentage earned –   Less than $6.50 per hour? ................... Approximately $13,000 a year or less _____% Earned less than $6.50 per hour Between $6.50 and $15.00 per hour? ........... Approximately $13,000 to $30,000 a year _____% Earned between $6.50 and $15.00 per hour More than $15.00 per hour? .................. Approximately $30,000 a year or more  _____% Earned more than $15.00 per hour
7. How many hours per week must an employee work to be considered full-time at this location?  ____ Hours
Section D – BUSINESS CHARACTERISTICS
1a. Which of the following categories best describes the operational status of the establishment at this location at the end of 1998? Mark (X) only one. ___ In operation  (SKIP to Question 2a) ___ Temporarily or seasonally inactive  (SKIP to Question 2a) ___ Ceased operation  (Continue with Question 1b) ___ Sold or leased to another operator  (Continue with Question 1b)
b. During what month and year did this establishment’s change in operational status occur? Enter two digit numeric responses Example: January 1998 – 01 1998 _____ Mo.   19____ Yr.
2a. Did your organization offer any of these fringe benefits to its employees at this location in 1998? See Definition Sheet included with this package for explanation of benefits. Mark (X) all that apply.  ___ Paid vacation ___ Paid sick leave ___ Life insurance ___ Disability insurance ___ Retirement/pension plans ___ Medical savings accounts (MSAs) ___ Flexible spending accounts ___ Flexible benefit plan (Cafeteria Plan) If marked, continue with Question 2b, otherwise SKIP to Question 3.
b. If your organization offered a Flexible benefit plan (Cafeteria Plan), what was the average annual value of the plan, for a TYPICAL EMPLOYEE, at this location? $__________ Flexible benefit plan value
3. Which one of these categories BEST describes your type of business ownership? Mark (X) only one. ___ S corporation ___ Corporation ___ Partnership ___ Sole proprietorship ___ Government (Federal, state, or local) ___ Joint venture or cooperative
4. Is this a not-for-profit business? ___ Yes ___ No
5. Which one of these categories BEST describes the principal business activity at this location? If more than one apply, mark the category which generates the most revenue.  Mark (X) only one. ___ Retail trade ___ Personal services (e.g., beauty shops, dry cleaners)  ___ Business services (e.g., advertising, computer processing)  ___ Other services (e.g., legal and health services)  ___ Manufacturing ___ Wholesale trade  ___ Finance, insurance, or real estate  ___ Transportation, communication, electric, gas, or sanitary services ___ Construction  ___ Agriculture or forestry  ___ Mining
6. Approximately how many years has your company been in business? If your organization operates at more than one location, enter the number of years the parent company has been in business. _________ Approximate number of years in business
If your organization DID offer health insurance coverage to its employees in 1998, continue with Page 7, Section E. If your organization DID NOT offer health insurance coverage to its employees in 1998, SKIP to Page 8, Section F.
Section E – GENERAL HEALTH COVERAGE CHARACTERISTICS
Complete Section E if your organization made insurance available to its employees at this location in 1998. Estimates are acceptable. Please complete questions 1–3 for this location ONLY. 1. What was the total annual cost of coverage for ALL hospital and/or physician plans offered AT THIS LOCATION in 1998? Include both employer and employee contributions. Include the total cost of coverage for all active employees at the location identified on the cover sheet.  $_________________ Annual cost for hospital and/or physician plans
2a. Which of the listed optional coverage services, if any, did your organization offer to its active employees in 1998 at a premium separate from the comprehensive plan premium? Do not include single services covered under a comprehensive health plan. Report on single service insurance plans only. Mark (X) all that apply. ___ Dental - Continue with Question 2b ___ Vision - Continue with Question 2b ___ Prescription drugs - Continue with Question 2b ___ Long-term care - Continue with Question 2b ___ No optional coverage – SKIP to Question 3a
b. What was the total amount paid for optional coverage for all active employees enrolled AT THIS LOCATION in 1998? $________ Optional coverage cost
3a. For 1998, did your organization impose a waiting period before new employees could be covered by health insurance? Yes – Continue with Question 3b No –   SKIP to Question 4
b. For 1998, what was the typical waiting period? Mark (X) only one. ___ Less than 2 weeks ___ weeks to less than 1 month ___ Until the first day of the next month ___ 1–3 months ___ More than 3 months
Please complete questions 4–9 for ALL locations. 4. In 1998, did your organization provide health insurance to any employees who retired from your organization? If your organization did not have retirees, mark "No." ___ Yes – Continue with Question 5a ___ No - SKIP to Page 8, Section F ___ Don’t know - SKIP to Page 8, Section F
5a. Were retirees under 65 years of age eligible to receive health insurance in 1998? ___ No ___ Yes
b. Were retirees 65 years of age and over eligible to receive health insurance in 1998? ___ No  ___ Yes
6. How many RETIREE-ONLY hospital and/or physician plan choices did your organization offer in 1998? ________ Retiree-only plans OR ___ None
7. Did your organization offer its retirees at least one portable plan? A portable plan allows the retiree to obtain care in almost all localities within the country. ___ No ___ Yes
Section E – GENERAL HEALTH COVERAGE CHARACTERISTICS – Continued
8a. What was the total number of retirees covered by health insurance through your organization at all of its locations in 1998? __________ Retirees covered by insurance
b. What percentage of these retirees were enrolled in single coverage? __________% Retirees enrolled in single coverage
9a. For a typical plan in 1998, what was the total monthly premium for one TYPICAL retiree with SINGLE coverage? $__________  Single coverage premium
9a. For this same plan, how much did the EMPLOYER contribute toward the plan premium for this typical retiree with single coverage? $___________ Employer contribution
10a. For a typical plan in 1998, what was the total monthly premium for a one TYPICAL retiree with FAMILY coverage? For retirees, if premiums vary, report for a family of two. $__________ Family coverage premium
10a. For this same plan, how much did the EMPLOYER contribute toward the plan premium for this typical retiree with family coverage? $___________ Employer contribution
Remarks
Section F – PERSON COMPLETING THIS QUESTIONNAIRE
*** PLEASE NOTE *** If your organization offered health insurance, please complete Section F and the attached MEPS-10(S), Plan Information Questionnaire for each plan offered. If your organization DID NOT offer health insurance, please complete Section F and END the form.

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