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 you some questions about your reimbursements.

By reimbursements I mean any money received for any members of your CU from an insurance company, medical care provider or non-CU member for medical expenses which you previously paid or will pay. Do not include reimbursements from a flexible spending account.

1. Enter 1 to continue



For definitions Information Booklet »

Since the first of the reference month, have you or any members of your CU received any medical reimbursements?
* IF YES - What did you get reimbursed for?

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. Lab tests or x-rays
8. Care in convalescent or nursing homes
9. Other medical care
10. Hearing aids
11. Prescribed medicines or prescribed drugs
12. Rental of supportive or convalescent equipment
13. Purchase of supportive or convalescent equipment
14. Rental of medical or surgical equipment for general use
15. Purchase of medical or surgical equipment for general use
99. None/No more

* Ask if not apparent

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

* Ask if not apparent

Who was/were the "care/service/item" for?

1. Active member CU "number"
55. Non-CU member

* Enter name of person: [enter text] _____________

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

1. C
2. Not combined expense

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

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. Lab tests or x-rays
8. Care in convalescent or nursing homes
9. Other medical care
10. Hearing aids
11. Prescribed medicines or prescribed drugs
12. Rental of supportive or convalescent equipment
13. Purchase of supportive or convalescent equipment
14. Rental of medical or surgical equipment for general use
15. Purchase of medical or surgical equipment for general use
77. Misc. combined (unable to specify/DK)

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

1. Yes
2. No

End of Section 15B

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Last Modified Date: November 8, 2007