HX03
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-1.
[You mentioned that (PERSON) [(are/is)/(were/was)] self-employed and had health insurance through that business.] Which category on this card comes closest to [the main/another] way (PERSON) (purchase/purchases) this insurance?
FROM A PROFESSIONAL ASSOCIATION ........ 1 [BOX_06]
FROM A SMALL BUSINESS GROUP ............ 2 [BOX_06]
FROM A UNION ........................... 3 [BOX_06]
FROM A HEALTH INSURANCE PURCHASING ALLIANCE ............................... 4 [BOX_06]
DIRECTLY FROM AN INSURANCE AGENT ....... 5 [BOX_06]
DIRECTLY FROM INSURANCE COMPANY ........ 6 [BOX_06]
DIRECTLY FROM AN HMO ................... 7 [BOX_06]
FROM A PREVIOUS EMPLOYER ............... 8 [BOX_06]
FROM A PREVIOUS EMPLOYER (COBRA) ....... 9 [BOX_06]
OTHER ................................. 91
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
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DISPLAY 'You mentioned that (PERSON) [(are/is)/ (were/was)] self-employed and had health insurance through that business.' IF FIRST CYCLE THROUGH LOOP_03. OTHERWISE USE A NULL DISPLAY.
DISPLAY '(are/is)' IF ESTABLISHMENT IS FLAGGED AS A CURRENT EMPLOYER. DISPLAY '(were/was)' IF ESTABLISHMENT IS NOT FLAGGED AS A CURRENT EMPLOYER.
DISPLAY 'the main' IF FIRST CYCLE THROUGH LOOP_03.
OTHERWISE (I.E., NOT FIRST CYCLE), DISPLAY 'another'.
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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.
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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'.
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IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
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OTHERWISE, GO TO BOX_33
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NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
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OE01
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HP09
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Are/Is) (PERSON) the primary insured person or policyholder of this health coverage through (ESTABLISHMENT)?
YES .................................... 1 [LOOP_02]
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF POLICYHOLDER.
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NOTE: PERSON REFERS TO JOBHOLDER.
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IF CODED '1' (YES), FLAG JOBHOLDER AS 'POLICYHOLDER'.
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HQ01
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]