Survey Text

2017 2011 2005 1999
2016 2010 2004 1998
2015 2009 2003 1997
2014 2008 2002 1996
2013 2007 2001
2012 2006 2000
top
2017
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

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2016
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

top
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?
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
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
SHOW CARD HX-7.
Now I'd like to ask a few questions about (POLICYHOLDER)'s health insurance through (ESTABLISHMENT). What type of health insurance [(do/does)/did] (POLICYHOLDER) get through (ESTABLISHMENT)?
CODE ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(do/does)' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT] [END-DT]
During the last interview, we recorded that someone in the family was covered by (POLICYHOLDER)'s (ESTABLISHMENT) health insurance. (Are/Is) (POLICYHOLDER) or anyone in the family covered by (POLICYHOLDER)'s health insurance through (ESTABLISHMENT) as of today, (END DATE)?
YES ................................... 1 [BOX_02]
NO .................................... 2
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT.........] [STR-DT]
(Were/Was) (PERSON) covered the whole time from (START DATE) until today, or only part of the time?
WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]