Survey Text

2020 2013 2006 1999
2019 2012 2005 1998
2018 2011 2004 1997
2017 2010 2003 1996
2016 2009 2002
2015 2008 2001
2014 2007 2000
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2020

No questionnaire text is available for this sample.


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2019

No questionnaire text is available for this sample.


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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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

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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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

top
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?
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.
HX24
====

[STR-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time since (START DATE), was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ITEMS ON SHOW CARD.
HX48
====

[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.
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.
----------------------------------------------------
OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) (were/was) covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT).
[Are/Were] they all covered by this health insurance [until [[OE02 DATE]/it ended]/on (END-DT)]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER TO DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
- PERSON IS AN RU MEMBER
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO)

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on (END-DT)' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH AND DAY FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
HP03
====

INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
I'd like to talk about the insurance which is from (a/an) (INSURANCE SOURCE).
CODE '1' UNLESS RESPONDENT VOLUNTEERS REPORTED IN ERROR.
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS NOT ALREADY BEEN DISCUSSED .............................. 1
HEALTH INSURANCE THROUGH (INSURANCE SOURCE) HAS ALREADY BEEN DISCUSSED ..... 2 [BOX_11]
[Code One]
----------------------------------------------------
IF CODED '2' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
Please give me the name of one of the [(INSURANCE SOURCE)] [from which anyone in the family purchased this insurance/which covers anyone in the family/insurance companies for the insurance purchased from an agent].
INTERVIEWER: VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. ESTABLISHMENT
HP04_02. STREET
HP04_03. CITY
1. Establishment [Enter Truncated Street Address] [Enter Truncated City]
2. Establishment [Enter Truncated Street Address] [Enter Truncated City]
3. Establishment [Enter Truncated Street Address] [Enter Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL ESTABLISHMENTS WHICH ARE SOURCES OF PRIVATE INSURANCE IN THE RU-ESTABLISHMENTS-ROSTER (THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES).
----------------------------------------------------
----------------------------------------------------
ESTABLISHMENT ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY ESTABLISHMENT ALREADY LISTED OR SELECT 'NONE OF THE ABOVE'.
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. ESTABLISHMENTS ARE 'ADDED' BY USING 'NONE OF THE ABOVE'.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(INSURANCE SOURCE)' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.

DISPLAY 'from which anyone in the family purchased this insurance' IF NOT LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODES '4' (INSURANCE AGENT) OR '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'which covers anyone in the family' IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23.

DISPLAY 'insurance company for the insurance purchased from an agent' IF LOOPING ON CODE '5' (INSURANCE AGENT) AT HX03 OR CODE '4' (INSURANCE AGENT) AT HX23.
----------------------------------------------------
----------------------------------------------------
NOTE: THE CONTEXT HEADER DISPLAYED ON SCREENS HP04- HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., JOBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE. OTHERWISE, CAPI DISPLAYS THE START DATE.
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'NONE OF THE ABOVE' IS SELECTED, GO TO HP07
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, GO TO HP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP05
----------------------------------------------------
HP11
====

[NAME OF ESTABLISHMENT.........] [STR-DT]
Who is the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
REF .............................. .... -7
DK ............................... ..... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' AS LAST TWO ENTRIES ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES, EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR 'POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered at all during [INTERVIEW MONTH]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------