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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, homeowners' 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 -
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?
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?
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] ______________
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: April 7,2016