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.
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.
----------------------------------------------------
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]
HP01
====
INSURANCE SOURCE: [CATEGORY NAME FROM HX23]
Does this insurance cover only injuries caused by accidents, or does it have general health coverage?
GENERAL HEALTH COVERAGE ................ 1
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]
HQ02
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Are/Is) (PERSON) covered now?
YES .................................... 1
NO ..................................... 2 [HQ04]
REF ................................... -7 [HQ04]
DK .................................... -8 [HQ04]