Section 14, Part B - Hospitalization and Health Insurance - Detailed Questions
Section 14, Part B collects detailed information about each health insurance policy that was reported in Part A.
What is the name of the insurance company for this policy? * Enter name of insurance company, not the insurance agent.
* Do not read to respondent.
Is the insurance company Blue Cross/Blue Shield?
Is the insurance company Tricare?
How many household members are/were covered by this policy?
What type of insurance plan is it?
* Do not include Medicare prescription drug plans in Commercial Medicare Supplements. Medicare prescription drug plans are collected in Part C.
For definitions Information Booklet »
Under normal circumstances, if you go to a doctor who is not part of your plan without a referral, will your insurance company pay for the cost?
Is this special purpose insurance plan -
* Specify: [enter text]
Was the policy obtained on an individual or group basis?
Was the policy obtained through Healthcare.gov?
Is this policy a platinum, gold, silver, bronze, or catastrophic plan?
Do you or any member of your household pay ANY portion of the premiums for this policy?
Who pays the policy premiums?
Are any premiums paid through payroll deductions?
How much [do you/does your household] currently spend for
this plan [including payroll deductions]?