Section 13, Part B.1 - Other Type of Insurance - Detailed Questions - FOR NEW CONSUMER UNITS ONLY
Section 13, Part B.1 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.2.
For definitions Information Booklet »
What is the name of the insurance company for "your (1st, 2nd, 3rd)"
other type of insurance policy? [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 -
- 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
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] ______________
* Enter 'C' for a combined expense
-
C
- Not combined expense
What other type of policy is the "other type of non-health insurance" combined with?
* Enter all that apply, separate with commas
- Long term care insurance
-
Life insurance or other policies which provide benefits in case of death or disability
-
Homeowners insurance which protects your home, furniture, personal effects or other property
against fire, flood, theft, loss or damage
- Renters' insurance which protects your home, furniture, personal belongings or other property
against fire, flood, theft, loss or damage
- Automobile or other vehicle insurance
- Other types of non-health insurance
- Misc. combined (unable to specify/DK)
Which property (ies) does this policy cover?
[enter text] ______________
Do you or any members of your CU have any or make payments for any other "other type of non-health insurance" policy?
- Yes
- No
End of Section 13B Other Type of Insurance
Go back to Section 13 Part B.1 - Insurance Other Than Health - Detailed Questions -
FOR NEW CONSUMER UNITS ONLY »
Go to Section 14 Part A.1 - Hospitalization and Health Insurance »
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Last Modified Date: September 4, 2008