PDKMY
Covered by private (don't know source) insurance in May
Description
Extracts include the PDKJA-PDKDE variables if users choose PDKMM during the extract process.
Codes and Frequencies
An 'X' indicates the category is available for that sample
| Code | Label |
22
|
21
|
20
|
19
|
18
|
17
|
16
|
15
|
14
|
13
|
12
|
11
|
10
|
09
|
08
|
07
|
06
|
05
|
04
|
03
|
02
|
01
|
00
|
99
|
98
|
Code | Label |
97
|
96
|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0 | NIU | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | 0 | NIU | X | X |
| 1 | No | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | 1 | No | X | X |
| 2 | Yes | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | 2 | Yes | X | X |
Can't find the category you are looking for? Try the Detailed codes
Comparability
No information available.Universe
- 1996-2022: All persons in a reference period that includes May of the current year.
Availability
- 1996-2022
Survey Text
| 2022 | 2015 | 2008 | 2001 |
| 2021 | 2014 | 2007 | 2000 |
| 2020 | 2013 | 2006 | 1999 |
| 2019 | 2012 | 2005 | 1998 |
| 2018 | 2011 | 2004 | 1997 |
| 2017 | 2010 | 2003 | 1996 |
| 2016 | 2009 | 2002 |
2018
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2017
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2016
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2015
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2014
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2013
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2012
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2011
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2010
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2009
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2008
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2007
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2006
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2005
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2004
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2003
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2002
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2001
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2000
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
1999
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
1998
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
1997
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
1996
Survey form
view entire document:
text
image
HX23
====
====
====
====
====
====
[STR-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?
FROM A GROUP OR ASSOCIATION ........... 1 [BOX_24]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
HX48
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................ 2 [BOX_24]
DIRECTLY THROUGH A SCHOOL ............. 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ...... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY ....... 5 [BOX_24]
DIRECTLY FROM AN HMO .................. 6 [BOX_24]
FROM A UNION .......................... 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ......................... 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER ............................ 10 [BOX_24]
FROM SOME OTHER EMPLOYER .............. 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE . 12 [BOX_24]
OTHER SOURCE .......................... 91
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One.]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
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.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[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) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (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]
HP01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ01
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
Weights
- 1996-2022 : PERWEIGHT