2006 MEPS IC HEALTH INSURANCE COST STUDY Government Unit Questionnaire


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 Medical Expenditure Panel Survey - Insurance Component HEALTH INSURANCE COST STUDY Government Unit Questionnaire (FORM MEPS-11(R) (4-26-2007)) Section C - RETIREE HEALTH COVERAGE CHARACTERISTICS Exclude any retirees that have coverage through PHSA(COBRA) or State Continuation-of-Benefits laws. See the Definition Sheet included with this package for an explanation of these terms. Did your government unit or some other government unit provide health insurance coverage to any person who retired from your government unit ON OR BEFORE December 31, 2006, or to any of their survivors? If PHSA (COBRA) was the only coverage offered mark “No”. _____ Yes - This government unit - Continue with Question 2 _____ Yes - Another government unit __________ Enter name of other government unit *Continue with Question 2 if information is available. Otherwise, SKIP to Section D* ______ No - SKIP to Section D ______ Don't know - *SKIP to Section D* In 2006, what was the total number of retirees enrolled in health insurance through your government unit? __________ Total retirees enrolled UNDER 65 YEARS OF AGE Exclude any retirees that have coverage through PHSA(COBRA) or State Continuation-of-Benefits Laws. If this was a self-insured plan, report the premium equivalent. a. Were any of the enrolled retirees reported in Question 2, under 65 years of age? _____ Yes - Continue with Question 3b _____ No - *SKIP to Question 4a* b. What was the TOTAL number of retirees under 65 years of age enrolled in health insurance through your government unit in 2006? __________ Total retirees under 65 covered by insurance c. What percentage of those retirees were ENROLLED in SINGLE coverage? __________% Retirees under 65 enrolled in single coverage d. For a typical plan in 2006, how much did the GOVERNMENT UNIT contribute toward the monthly plan premium for one typical retiree with SINGLE coverage? $__________.00 Government unit contribution for single premium e. For that same plan, what was the TOTAL monthly premium for this typical retiree with SINGLE coverage? $__________.00 Total single premium f. For a typical plan in 2006, how much did the GOVERNMENT UNIT contribute toward the monthly plan premium for one typical retiree with FAMILY coverage? For retirees, if premium varied by family size, report for a family of two. $__________.00 Government unit contribution for family premium g. For that same plan, what was the TOTAL monthly premium for this typical retiree with FAMILY coverage? $__________.00 Total family premium 65 YEARS AND OVER Exclude any retirees that have coverage through COBRA or State Continuation-of-Benefits Laws. a. Were any of the enrolled retirees reported in Question 2, 65 years of age or over? ____ Yes - Continue with Question 4b ____ No - SKIP to Question 5a b. What was the TOTAL number of retirees 65 years or over enrolled in health insurance through your government unit in 2006? __________ Total retirees 65 years or over enrolled in health insurance c. What percentage of those retirees were ENROLLED in SINGLE coverage? ________% Retirees 65 years or over enrolled in single coverage d. For the 2006 plan with the largest enrollment, how much did the GOVERNMENT UNIT contribute toward the monthly plan premium for one typical retiree with SINGLE coverage? $__________.00 Government unit contribution for single premium e. For that same plan, what was the TOTAL monthly premium for this typical retiree with SINGLE coverage? $__________.00 Total single premium f. For the 2006 plan with the largest enrollment, how much did the GOVERNMENT UNIT contribute toward the monthly plan premium for one typical retiree with FAMILY coverage? For retirees, if premium varied by family size, report for a family of two. $__________.00 Government unit contribution for family premium g. For that same plan, what was the TOTAL monthly premium for this typical retiree with FAMILY coverage? $__________.00 Total family premium NEW RETIREES Exclude any retirees that have coverage through COBRA or State Continuation-of-Benefits Laws. For Questions 5a through 5c, NEW RETIREES refers only to persons who retired from your government unit in 2006. a. Did your government unit offer health insurance to any NEW RETIREES? _____ Yes - Continue with Question 5b _____ No - *SKIP to Section D* _____ Don't know - SKIP to Section D b. Were NEW RETIREES under 65 years of age eligible for health insurance? _____ Yes _____ No _____ Don't know c. Were NEW RETIREES 65 years of age or over eligible for health insurance? _____ Yes _____ No _____ Don't know Section D - HEALTH COVERAGE CHARACTERISTICS a. Which of the listed optional coverage services, if any, did your government unit offer to its ACTIVE employees in 2006 at a premium SEPARATE from the comprehensive health plan premium? Report single service insurance plans only. Do not include single services covered under a comprehensive health plan. Long-term care insurance helps to cover the cost of institutional and home care required by the chronically ill or disabled. Mark (x) all that apply. _____ Dental - Continue with Question 1b _____ Vision - Continue with Question 1b _____ Prescription drugs - Continue with Question 1b _____ Long-term care - Continue with Question 1b _____ No optional coverage - *SKIP to Question 2a* b. What was the total amount paid for optional coverage for all ACTIVE employees at THIS GOVERNMENT UNIT in 2006? $_______________.00 Optional coverage cost a. For 2006, did your government unit impose a waiting period before new employees could be covered by health insurance? _____ Yes - Continue with Question 2b _____ No - SKIP to Section E b. For 2006, what was the TYPICAL waiting period? Mark (X) only one. _____ Less than 2 weeks _____ 2 weeks to less than 1 month _____ Until the first day of the next month _____ 1-3 months _____ More than 3 months Section E - EMPLOYMENT CHARACTERISTICS Estimates are acceptable for all employment, eligibility, and enrollment figures. Include part-time, temporary, and seasonal employees. Exclude leased or contract workers and retirees. a. How many ACTIVE employees were ELIGIBLE for at least one health plan through your government unit in 2006? __________ Eligible employees b. How many of those ACTIVE employees were ENROLLED in ANY health plan through your government unit? __________ Enrolled employees a. Did your government unit have any part-time employees in 2006? If your government unit did not offer health insurance in 2006, then SKIP to Section F. _____ Yes - Continue with Question 2b _____ No - SKIP to Question 3 _____ Don't know - *SKIP to Question 3* b. How many of those part-time employees were ELIGIBLE for at least one health plan through your government unit? __________ Eligible part-time employees c. How many of those part-time employees were ENROLLED in ANY health plan through your government unit? __________ Enrolled part-time employees Did your government unit offer health insurance to its temporary or seasonal employees in 2006? Mark (x) only one. _____ Yes _____ No _____ No temporary or seasonal employees _____ Don't know If your government unit offered health insurance, how many hours per week must an employee work to be eligible for health insurance? __________ Hours worked per week to be eligible Section F - FRINGE BENEFITS CHARACTERISTICS Which of the following fringe benefits did your government unit offer its employees in 2006? Paid vacation.............................. ___ Yes (1) ___ No (2) ___ Don't know (3) Paid sick leave........................... ___ Yes (1) ___ No (2) ___ Don't know (3) Life insurance............................. ___ Yes (1) ___ No (2) ___ Don't know (3) Disability insurance.................... ___ Yes (1) ___ No (2) ___ Don't know (3) Retirement/pension plans.......... ___ Yes (1) ___ No (2) ___ Don't know (3) Did your government unit offer any of these tax-advantaged benefits to its employees in 2006? See the Definition Sheet included with this package for an explanation of these benefits. These plans are also known as Section 125 Plans. Employee contributions to health insurance made on a pre-tax basis _____ Yes (1) _____ No (2) _____ Don't know (3) Flexible SPENDING account (FSA) for healthcare _____ Yes (1) _____ No (2) _____ Don't know (3) Flexible Benefits Plans (full cafeteria plans that offer employees a set of benefits from which to choose.) _____ Yes (1) _____ No (2) _____ Don't know (3) Section G - EMPLOYEE CHARACTERISTICS Provide information for a TYPICAL pay period in 2006. Estimates are acceptable. The following workforce characteristics are used to group similar government units together for analytical purposes. If none, enter "0". Approximately what percentage of the employees at this government unit were women? __________ % Women employees Approximately what percentage of the employees at this government unit were 50 years old or older? __________% Employees 50 years old or older Approximately what percentage of the employees at this government unit were union members? __________% Union members For the employees at this government unit in 2006, approximately what percentage earned - Less than $10.50 per hour? . . . . . . . . . . . . . . . . Approximately $21,840 a year or less __________ % Earned less than $10.50 per hour Between $10.50 and $23.50 per hour? . . . . . . Approximately $21,840 to $48,880 a year __________ % Earned between $10.50 and $23.50 per hour More than $23.50 per hour? . . . . . . . . . . . . . . Approximately $48,880 a year or more __________ % Earned more than $23.50 per hour Section H - PERSON COMPLETING THIS QUESTIONNAIRE Name (Please Print) _________________________________________________ Title _________________________________________________ Signature _________________________________________________ Date (Month/Day/Year) __________(MM)__________(DD)__________(YY) Telephone number (________)____________________ Extension _______________ Fax Number (________)____________________ E-mail address _________________________________________________ *PLEASE RETAIN A COPY OF THIS FORM FOR YOUR RECORDS* OMB No. 0935-0110: Approval Expires FORM MEPS-11(R) (4-26-2007)