Section 13, Part B.1 - Other Type of Insurance - Detailed Questions - FOR NEW HOUSEHOLDS ONLY

Section 13, Part B.1 collects detailed information on non-health insurance policies other than long term insurance, homeowners' insurance, life insurance, renters' insurance, or vehicle insurance reported in Part A.2.

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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 -

  1. Entirely by you or your household?
  2. Partially by you or your household and partially by someone outside your household?
  3. Entirely by an employer or union?
  4. Entirely by another group or persons outside your household?

Are any premiums paid through payroll deductions?

  1. Yes
  2. No

Since the first of the reference month, what was your or your household total expense for this insurance policy? [enter value] ______________

* Enter the actual amount the household paid. Do not include any expenses paid for the household by others

How much was paid this month? [enter value] ______________

* Enter 'C' for a combined expense

  1. C
  2. 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

  1. Long term care insurance
  2. Life insurance or other policies which provide benefits in case of death or disability
  3. Homeowners' insurance which protects your home, furniture, personal effects or other property against fire, flood, theft, loss or damage
  4. Renters' insurance which protects your home, furniture, personal belongings or other property against fire, flood, theft, loss or damage
  5. Automobile or other vehicle insurance
  6. Other types of non-health insurance
  7. Misc. combined (unable to specify/DK)

Which property (ies) does this policy cover? [enter text] ______________

Do you or any members of your household have any or make payments for any other "other type of non-health insurance" policy?

  1. Yes
  2. 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 HOUSEHOLDS ONLY »

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Last Modified Date: April 5, 2010