Section 13, Part B - Other Type of Insurance - Detailed Questions
Section 13, Part B collects detailed information on non-health insurance policies other than
homeowner's insurance, life insurance, tenant's insurance, or vehicle insurance reported in Part A.
For definitions Information Booklet »
What is the name of the insurance company for "your (1st, 2nd, 3rd)"
other type of insurance policy listed? [enter text] ____________________
* Enter name of insurance company, not the insurance agent.
What type of policy is this?
- Policy for someone INSIDE the CU
- Policy you no longer have
- Policy for someone NOT IN YOUR CU
Briefly describe the other type of non-health insurance policy?
[enter text] ______________
Briefly describe the other type of non-health insurance policy that you used to have?
[enter text] ______________
Briefly describe the other type of non-health policy that you pay for
someone outside your CU?
[enter text] ______________
Are the policy premiums paid -
- Entirely by you or your CU?
- Partially by you or your CU and partially by someone outside your CU?
- Entirely by an employer or union?
- Entirely by another group or persons outside your CU?
Are any premiums paid through payroll deductions?
- Yes
- No
How often are premiums on this policy paid?
- Weekly
- Biweekly
- Monthly - directly
- Monthly - in mortgage payment
- Quarterly
- Semiannually
- Annually
- Paid-up policy
- Other - Specify
* Specify: [enter text] ___________
Since the first of the reference month,
what was your or your CU total expense for this insurance policy?
[enter value] ______________
* Enter the actual amount the CU paid. Do not include any expenses paid for the CU
by others
How much was paid this month?
[enter value] ______________
End of Section 13B Other Type of Insurance
Go back to Section 13 Part B - Insurance Other Than Health - Detailed Questions »
Go to Section 14 Part A.1 - Hospitalization and Health Insurance »
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Last Modified Date: October 11, 2005
