Section 15, Part B - Medical and Health Expenditures - Screening Questions for Reimbursements

Section 15, Part B covers reimbursements received by the consumer unit for medical services, prescription drugs, and medical supplies or equipment. IMPORTANT: The Census Bureau does not release to the Bureau of Labor Statistics any confidential information such as names and addresses. This information is only used during the course of the interview.

Now I am going to ask some questions about your reimbursements.


By reimbursements, I mean any money received for any members of your household from an insurance company, medical care provider or non-household member for medical expenses which you previously paid or will pay.

Do not include reimbursements from any consumer-driven health plans such as Flexible Spending Accounts (FSA), Health Reimbursement Accounts (HRA), Health Savings Accounts (HAS), High Deductible Health Plans (HDHP), or Medical Savings Accounts (MSA).

Since the first of the reference month, have you or any members of your household received any medical reimbursements for the items I just asked about?
* IF YES - What did you get reimbursed for?
* Read each item on list

  1. Eye examinations, treatment, or surgery
  2. Purchase of eye glasses or contact lenses
  3. Dental care
  4. Hospital room or hospital services
  5. Services by medical professionals other than physicians
  6. Physician services


  7. Continue list

For definitions Information Booklet »

Have you received any reimbursements for --
* Read each item on list

  1. Lab tests or x-rays
  2. Care in convalescent or nursing homes
  3. Care for invalids, convalescents,handicapped, or elderly persons in the home
  4. Adult day care centers
  5. Other medical care and services
  6. Hearing aids
  7. Prescription drugs
  8. Purchase or rental of supportive or rehabilitative equipment
  9. Purchase or rental of medical or surgical equipment for general use
  10. None/No more

For definitions Information Booklet »

* Ask if not apparent

Describe the care/service/item. [enter text] _____________

* Ask if not apparent

Describe the care/service/item. [enter text] _____________

* Ask if not apparent

Was this a purchase or rental?

* Ask if not apparent

Was/were the care/service/item for a member of your household or someone outside of your household?

In what month was(were) the reimbursement(s) received? [enter text] _____________

What was the total amount received? [enter value] _____________

* Enter 'C' for a combined reimbursement

What other medical reimbursement is the "care/service/item" combined with?
* Enter all that apply

Did you or any members of your household receive any other reimbursements for the "care/service/item"?

End of Section 15B

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Last Modified Date: April 12, 2013