Section 13, Part B - Other Type of Insurance - Detailed Questions
Section 13, Part B collects detailed information on non-health insurance policies other than long term insurance,
homeowner's insurance, life insurance, renters' insurance, or vehicle insurance reported in Part A.1.
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.
Briefly describe the other type of non-health insurance policy?
[enter text] ______________
Are the policy premiums paid -
Are any premiums paid through payroll deductions?
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: September 4, 2008
