MEPS-HC Survey Instrument

Managed Care (MC) Section
Beta

MC01

Help Enabled (HMO)
Variable Name
EPIN.HMOPLAN

Comment Enabled

Jump Back Enabled

Label
IS POLICYHOLDERS PLAN AN HMO PLAN?

Size
2

{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
Now I will ask you a few questions about how (POLICYHOLDER)'s health
insurance through (ESTABLISHMENT) {works/worked} for non-emergency
care {on (END DATE)}.
We are interested in knowing if (POLICYHOLDER)'s (ESTABLISHMENT) plan
is an HMO, that is, a Health Maintenance Organization. With an HMO, you
must generally receive care from HMO physicians. For other doctors, the
expense is not covered unless you were referred by the HMO or there was a
medical emergency.
{When answering this question, do not consider (POLICYHOLDER)’s
insurance through Medicare.}
{Is/Was} (POLICYHOLDER)’s (INSURER NAME) an HMO {on (END DATE)}?
YES
NO

1
2

{MC05}
{MC02}

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Refused
Don't Know

RF
DK

{MC02}
{MC02}

HELP AVAILABLE FOR DEFINITION OF HMO.

1

Managed Care (MC) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY ‘When answering this question, do not consider
(POLICYHOLDER)’s insurance through Medicare.’ IF POLICYHOLDER
BEING ASKED ABOUT IS ALSO COVERED BY MEDICARE. OTHERWISE, USE
A NULL DISPLAY.
DISPLAY 'works' AND 'is' IF NOT ROUND 5. DISPLAY 'worked' AND
'was' IF ROUND 5.
DISPLAY 'on (END DATE)' IF ROUND 5.
DISPLAY.

2

OTHERWISE, USE A NULL

Managed Care (MC) Section
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MC02

Help Enabled (PROGDR)
Variable Name
EPIN.PROGDR

Comment Enabled

Jump Back Enabled

Label
PRIV PLAN REQUIRES SIGNING W/PHYS,GROUP

Size
2

{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
{(Do/Does)/As of (END DATE), did} (POLICYHOLDER)’s insurance plan
require (POLICYHOLDER) to sign up with a certain primary care doctor,
group of doctors, or a certain clinic which (POLICYHOLDER) must go to for all
of (POLICYHOLDER)’s routine care?
PROBE: Do not include emergency care or care from a specialist you were
referred to.
YES
NO

1
2

{MC04}
{MC03}

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Refused
Don't Know

RF
DK

{MC03}
{MC03}

HELP AVAILABLE FOR DEFINITION OF PRIMARY CARE DOCTOR AND
ROUTINE CARE.
DISPLAY INSTRUCTIONS:
DISPLAY 'Do/Does' IF NOT ROUND 5.
did' IF ROUND 5.

3

DISPLAY 'As of (END DATE),

Managed Care (MC) Section
Beta

MC03

Help Enabled
Variable Name
EPIN.DRLIST

Comment Enabled

Jump Back Enabled

Label
DOES PLAN HAVE A BOOK/LIST OF DOCTORS?

Size
2

{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
{Is/As of (END DATE), was} there a book or list of doctors associated with the
plan?
YES
NO

1
2

{MC04}
{BOX_01}

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Refused
Don't Know
DISPLAY INSTRUCTIONS:
DISPLAY 'is' IF NOT ROUND 5.
IF ROUND 5.

RF
DK

{BOX_01}
{BOX_01}

DISPLAY 'As of (END DATE), was'

4

Managed Care (MC) Section
Beta

MC04

Help Enabled
Variable Name
EPIN.VISITPAY

Comment Enabled

Jump Back Enabled

Label
PLAN PAY FOR NON-HMO, NON-REFER DR VISIT

Size
2

{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
{Will/As of (END DATE), would} (POLICYHOLDER)’s plan pay for any of the
costs of visits to doctors who are not associated with (POLICYHOLDER)’s
plan, even if (POLICYHOLDER) {(do/does)/did} not have a referral?
YES
NO

1
2

{BOX_01}
{BOX_01}

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Refused
Don't Know

RF
DK

DISPLAY INSTRUCTIONS:
DISPLAY 'Will' AND '(do/does)' IF NOT ROUND 5.
(END DATE), would' AND 'did' IF ROUND 5.

5

{BOX_01}
{BOX_01}

DISPLAY 'As of

Managed Care (MC) Section
Beta

MC05

Help Enabled
Variable Name
EPIN.VISITPAY

Comment Enabled

Jump Back Enabled

Label
PLAN PAY FOR NON-HMO, NON-REFER DR VISIT

Size
2

{POLICYHOLDER’S FIRST MIDDLE LAST NAME} {NAME OF ESTABLISHMENT}
{STR-DT} {END-DT}
INSURER NAME: {NAME OF INSURER BEING LOOPED ON}
{Will/As of (END DATE), would} (POLICYHOLDER)’s plan pay for any of the
costs of visits to doctors who are not part of (POLICYHOLDER)’s HMO, even
if (POLICYHOLDER) {(do/does)/did} not have a referral?
YES
NO

1
2

{BOX_01}
{BOX_01}

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Refused
Don't Know

RF
DK

DISPLAY INSTRUCTIONS:
DISPLAY 'Will' AND '(do/does)' IF NOT ROUND 5.
of (END DATE), would' AND 'did' IF ROUND 5.

BOX_01
RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN HX OR OE.

6

{BOX_01}
{BOX_01}

DISPLAY 'As