PRSAP
Covered by private insurance through self-employment in April
Description
Extracts include the PRSJA-PRSDE variables if users choose PRSMM during the extract process.
Codes and Frequencies
An 'X' indicates the category is available for that sample
Code | Label |
17
|
16
|
15
|
14
|
13
|
12
|
11
|
10
|
09
|
08
|
07
|
06
|
05
|
04
|
03
|
02
|
01
|
00
|
99
|
98
|
97
|
96
|
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
0 | NIU | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X |
1 | No | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X |
2 | Yes | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X |
Can't find the category you are looking for? Try the Detailed codes
Comparability
No information available.Universe
- 1996-2017: All persons in a reference period that includes April of the current year.
Availability
- 1996-2017
Survey Text
2017 | 2011 | 2005 | 1999 |
2016 | 2010 | 2004 | 1998 |
2015 | 2009 | 2003 | 1997 |
2014 | 2008 | 2002 | 1996 |
2013 | 2007 | 2001 | |
2012 | 2006 | 2000 |
2017
Survey form
view entire document:
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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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2016
Survey form
view entire document:
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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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2015
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2014
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2013
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2012
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2011
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2010
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2009
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2008
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2007
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2006
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2005
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2004
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2003
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2002
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2001
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
2000
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
1999
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
1998
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
1997
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
1996
Survey form
view entire document:
text
image
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?
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.
----------------------------------------------------
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'.
----------------------------------------------------
HX48
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.
----------------------------------------------------
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'.
----------------------------------------------------
====
[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
====
[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
Weights
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