HEALTH INSURANCE CODING - COR608.WP5 HEALTH INSURANCE - #1 *** This is for question 826s: "Can you tell me the main reason that you don't have any health insurance?" 1 TOO EXPENSIVE 2 DON'T NEED HEALTH INSURANCE 3 JOB LAYOFF OR JOB LOSS 4 DENIED HEALTH INSURANCE; HAS MEDICAL CONDITIONS COMPANY WILL NOT INSURE 5 SELF-INSURED THROUGH SAVINGS OR INVESTMENTS 6 RELIGIOUS REASONS 7 OTHER 97 DON'T KNOW 98 INAPPROPRIATE 99 REFUSED * R's who state that they have been denied health insurance because of a medical condition receive code (4). * R's who state that they don't need insurance. These responses usually state that R is healthy and has never had any problem and therefore doesn't need health insurance receive code (2). NOTE: Their response is different from R's who say that they do not need health insurance because they are "self-insured" - (5). * R's who do not have health insurance because they have been laid off or lost their jobs. For example, one R does not have health insurance because he was laid off two months ago, just recently returned to work and will not be covered until after a 90 day probationary period. He does not have health insurance because of an earlier job layoff so code (3). The same applies for R's who say that they do not have health insurance because they are "in between jobs". * R's who state that health insurance is too expensive code (1). * "98 INAPPROPRIATE": Several R's should not have been asked item 826s because they, in fact, do have health insurance. A few cases report that they are retired military personnel and receive health care on that basis (i.e., CHAMPUS--health benefits for former military personnel). Others say that they have health insurance through "SS" (Social Security) or medicare. It is not clear from the answers if the R's misunderstood earlier questions or what, but in each of these cases the R's should be coded '98' and their IDSWL's should be kept track of. * "5 SELF-INSURED THROUGH SAVINGS OR INVESTMENTS": R's who are "self-insured" usually explain that they have chosen not to purchase health insurance, per se. Instead, they have invested the money they would have used to purchase insurance and plan to use these savings or assets to pay for any future medical expenses. * "6 RELIGIOUS REASONS": Several R's state that they will not purchase or use or do not believe in health insurance for religious reasons. * "7 OTHER": Responses not covered by the above categories. Examples include: an R who works for his/her employer only part- time and therefore is not eligible for employer-provided health insurance coverage. An R who says that he/she "does not trust western medicine." This category also includes a couple of R's who state that they are "in the process" of getting insurance but "Haven't had time to investigate it." * Foe multiple responses use the first one mentioned. In at least one case R says "all of the above", in cases like this where you can't even determine what the first one mentioned is code (7)OTHER. HEALTH INSURANCE - #2 *** This is for question 826n: "Can you tell me more about that [health insurance]?" 1 CHAMPUS, MILITARY HEALTH BENEFITS 2 MEDICARE, SOCIAL SECURITY - DISABILITY 3 MEDICAID, STATE SPONSORED MEDICAL ASSISTANCE 4 ADDITIONAL COVERAGE-CANCER 5 ADDITIONAL COVERAGE- HOSPITALIZATION 6 ADDITIONAL COVERAGE-MAJOR MEDICAL 7 ADDITIONAL COVERAGE-DENTAL 8 ADDITIONAL COVERAGE-VISION, EYECARE 9 ADDITIONAL COVERAGE-ACCIDENT POLICY 10 ADDITIONAL COVERAGE-LONG-TERM CARE 11 ADDITIONAL COVERAGE-CATASTROPHIC ILLNESS 12 ADDITIONAL COVERAGE-DISABILITY, INCOME CONTINUATION 13 ADDITIONAL COVERAGE-OTHER 14 ADDITIONAL COVERAGE-NOT SPECIFIED 15 COVERAGE PURCHASED FROM AN INSURANCE COMPANY - BASIC OR TYPE NOT SPECIFIED 16 COVERAGE THROUGH CURRENT SPOUSE'S HEALTH INSURANCE PLAN - BASIC OR TYPE 17 COVERAGE THROUGH FORMER SPOUSE'S EMPLOYER OR UNION - BASIC OR TYPE 18 HMO (HEALTH MAINTENANCE ORGANIZATION), PPO (PREFERRED PROVIDER ORGANIZATION) 19 OTHER 98 INAPPROPRIATE * "1 CHAMPUS, MILITARY HEALTH BENEFITS": Health insurance coverage available to R's who are currently in the military or are retired military personnel. Responses may include statements about "military benefits," "CHAMPUS"(Often misspelled as CAMPAS or CHAMPAS), or benefits administered by the veterans' administration. * "2 MEDICARE, SOCIAL SECURITY - DISABILITY": Health insurance provided by the federal gov't for persons over the age of 65 (or 60 for widows) or for persons who have a disability and are unable to work for pay. * "3 MEDICAID, STATE SPONSORED MEDICAL ASSISTANCE": Health insurance provided to persons based on economic need. These programs are usually sponsored by or administered by the state. Hence, they may be referred to by the name of the state program (e.g., Wisconsin Medical Assistance, U-Cal(California)). * "4 - 14 ADDITIONAL COVERAGE - type": Many R's have purchased additional or supplemental insurance to cover the costs of specific types of illnesses, diseases, or accidents. - A separate category "13 ADDITIONAL COVERAGE - OTHER": is provided for cases in which R (a)specifies that he/she has a supplemental or additional form of health insurance; and (b) specifies what the insurance is for (e.g, vision); but (c) this type has not been allocated a separate category by the list provided here. - A separate category "14 ADDITIONAL COVERAGE - NOT SPECIFIED": is provided for cases in which R says that he/she has additional or supplemental coverage but does not explain what type of illness or injury is covered by this insurance. - Additional or supplemental coverage may be sponsored (in whole or in part) by an employer or R may purchase it from a private insurance company. In the latter case, R will often name the insurance company. The NAME of the company is not as important as the type of coverage. A separate category is reserved for cases where R has purchased insurance from a private insurance company for either his/her basic medical needs or if the type is not specified. - Income continuation insurance is like disability insurance. * "15 COVERAGE PURCHASED FROM AN INSURANCE COMPANY - BASIC OR TYPE NOT SPECIFIED": This category is reserved for instances where R has purchased health insurance from a private company and this is either his/her basic insurance coverage or he/she does not state clearly that the insurance is for a specific illness (e.g., cancer insurance). These respondents often include the name of the company. Examples include Time Insurance Co., Wausau, American Family. - AARP(American Association of Retired Persons) and AAA(American Automobile Association) are two additional examples and are usually supplemental forms of coverage. - At least one respondent refers to "term insurance." This is insurance purchased from a specific company that provides coverage for a specific period of time (e.g., if R is in between jobs). * "16 COVERAGE THROUGH CURRENT SPOUSE'S HEALTH INSURANCE PLAN - BASIC OR TYPE":R's who state they are covered by a current spouse's health insurance policy either through his/her employer or union or from a policy purchased directly from a company. In some instances these responses will involve additional or supplemental coverage. If so and if the type is specified (e.g., hospitalization), then the response should be coded by type. If the type of supplemental coverage is not specified or if it is basic coverage then the response should be coded as (16). * "17 COVERAGE THROUGH FORMER SPOUSE'S EMPLOYER OR UNION - BASIC OR TYPE": Divorced or widowed R's who are covered by the health insurance policy of their former spouses. In some instances, these responses will involve additional or supplemental coverage. If so and if the type is specified (e.g., hospitalization), the response should be coded by type. If the type of supplemental coverage is not specified or if it is basic coverage then the response should be coded as (17). * "18 HMO (HEALTH MAINTENANCE ORGANIZATION), PPO (PREFERRED PROVIDER ORGANIZATION)": R's who participate in health insurance or health protection plans. Often the name is included. Some examples are Kaiser Permanente, Dean Care, U-Care. * "19 OTHER": Examples include those who are covered by the national health care systems of Canada or England. * Multiple responses should code the first response given. * Responses that mention both coverage from R and coverage from spouse should be coded by the coverage pertaining to R.