Who is enrolled in the insurance plan that gives this person health insurance?
ASK THE QUESTIONS FOR EACH HOUSEHOLD MEMBER IN THE SAME ORDER AS THE HOUSEHOLD ROSTER, WITH ONE ROW PER HOUSEHOLD MEMBER
[USE CATEGORIES APPROPRIATE TO EACH COUNTRY]
INDICATE Line Number from Household Roster of Person if he/she is in the Household
If Person not in Household ENTER “999"
I would like to ask you some questions about health insurance. When we say someone is "covered by health insurance", we mean that he or she is enrolled with an
organization that pays for health care costs if he or she gets sick or injured.