Routing for UAS110
sc002 := getSC002()
treatment := getTreatment()
FLSite := getExchangeSite(sc002)
FLEndDateUnix := getEndDate(sc002)
FLEndDate := getLanguageDate("F j, Y", "", FLEndDateUnix)
FLEndDate2 := getLanguageDate("F j, Y", "+2 weeks", FLEndDateUnix)
FLDatePlus2 := getLanguageDate("F j, Y", "+2 days", FLEndDateUnix)
FLSecondSurveyDate := getLanguageDate("F j, Y", "+1 weeks", FLEndDateUnix)
FLSecondSurveyMonth := getLanguageDate("F", "", FLEndDateUnix)
Fill code of question 'FLTreatment' executed
Fill code of question 'FLTreatment1' executed
intro
This is a short survey to provide confirmation of your enrollment in health insurance on the Health Insurance Marketplace for 2018.
You will get $25 [the day you send us the confirmation/in one week after you send us the confirmation/two weeks after open enrollment ends (on ^FLEndDate2) for the confirmation/], deposited on your ClinCard.
PLEASE COMPLETE THIS SURVEY ONLY AFTER YOU HAVE ENROLLED IN HEALTH INSURANCE FOR NEXT YEAR.
[the day you send us the confirmation/in one week after you send us the confirmation/two weeks after open enrollment ends (on ^FLEndDate2) for the confirmation/]1
You will get $25 [the day you send us the confirmation/in one week after you send us the confirmation/two weeks after open enrollment ends (on ^FLEndDate2) for the confirmation/], deposited on your ClinCard.
PLEASE COMPLETE THIS SURVEY ONLY AFTER YOU HAVE ENROLLED IN HEALTH INSURANCE FOR NEXT YEAR.
[the day you send us the confirmation/in one week after you send us the confirmation/two weeks after open enrollment ends (on ^FLEndDate2) for the confirmation/]1
We ask that you send us your confirmation by 2 days after open enrollment ends - by [[]] - to get your payment.
ins001 (signed up insurance next year)
Did you enroll (or re-enroll) in health insurance in the Health Insurance Marketplace for 2018?
1 Yes
2 No
2 No
signedup := 2
if ins001 = 2 then
ins002 (signed up for non exchange plan)
Did you enroll in a plan that is NOT part of the Health Insurance Marketplace?
1 Yes
2 No
2 No
if ins002 = 1 then
Group of questions presented on the same screen
ins003 (why not on exchange)
You previously stated that you planned to sign up for your state’s or the federal health insurance exchange. Why did you change your mind?
1 I got alternative coverage (through an employer etc.)
2 I made a mistake
2 I made a mistake
End of group of questions
if ins003 = 1 then
ins_exit2
You are not eligible for this confirmation survey because you did not enroll in coverage through the Health Insurance Marketplace. However, you will still be eligible to complete the final survey after [[]].
Exit the survey
Else
ins_temp
Please wait to complete this survey until after you have signed up for health insurance on the Health Insurance Marketplace. If you do not enroll in health insurance through the Health Insurance Marketplace, you can still complete the final survey, which will be made available after [[]].
Once you have enrolled, please select 'I have enrolled' below and click next to start this survey from the beginning again. If you did not enroll yet, please close this browser window for now.
Once you have enrolled, please select 'I have enrolled' below and click next to start this survey from the beginning again. If you did not enroll yet, please close this browser window for now.
1 I have enrolled
ins001 := empty
ins002 := empty
ins003 := empty
End of if
Else
ins_temp
Please wait to complete this survey until after you have signed up for health insurance on the Health Insurance Marketplace. If you do not enroll in health insurance through the Health Insurance Marketplace, you can still complete the final survey, which will be made available after [[]].
Once you have enrolled, please select 'I have enrolled' below and click next to start this survey from the beginning again. If you did not enroll yet, please close this browser window for now.
Once you have enrolled, please select 'I have enrolled' below and click next to start this survey from the beginning again. If you did not enroll yet, please close this browser window for now.
1 I have enrolled
ins001 := empty
ins002 := empty
End of if
End of if
signedup := 1
ins004_intro
After you answer a few questions about your choice, we will ask that you submit a screenshot of your insurance enrollment confirmation for the Health Insurance Marketplace for 2018. You should submit both your e-mail confirmation of enrollment and a screenshot of your plan details from [[]].
Examples of your confirmation screen and e-mail are below. Please have this documentation ready. If you reviewed your plan choices and decided to keep the same plan as last year, you may not have received an e-mail confirmation. Further instructions will be provided later in the survey.
Note: you will not get paid for this survey unless you provide confirmation of your enrollment in the Health Insurance Marketplace for 2018. Confirmation of enrollment in employer-sponsored coverage or Medicaid does not count.
Examples of your confirmation screen and e-mail are below. Please have this documentation ready. If you reviewed your plan choices and decided to keep the same plan as last year, you may not have received an e-mail confirmation. Further instructions will be provided later in the survey.
Note: you will not get paid for this survey unless you provide confirmation of your enrollment in the Health Insurance Marketplace for 2018. Confirmation of enrollment in employer-sponsored coverage or Medicaid does not count.
FLCheckEndDate := date("Y/m/d", strtotime(FLEndDate))
Group of questions presented on the same screen
en001 (when signed up)
Now we will ask you about your enrollment decision.
When did you sign up?
When did you sign up?
1 Today
2 Other date:
3 I don’t remember
2 Other date:
3 I don’t remember
en001_date (date when signed up)
End of group of questions
en002 (constrained for time)
Before we continue, we'd like to ask you about how your week went in general.
Did you feel unusually constrained for time this week?
Did you feel unusually constrained for time this week?
1 (YES) Yes
2 (NO) No
2 (NO) No
en003 (free time)
Did you feel like you had an unusual amount of free time this week?
1 (YES) Yes
2 (NO) No
2 (NO) No
FLRow := getHHMembers()
FLSpouse := getSpouse()
hh003 := getHH003()
if cv001 = empty then
cv001_1_ := response
if FLSpouse = response then
cv001_2_ := response
End of if
if hh003 > 0 then
Loop from 1 to HH003
if cnt = 1 then
cv001_3_ := response
elseif cnt = 2 then
cv001_4_ := response
elseif cnt = 3 then
cv001_5_ := response
elseif cnt = 4 then
cv001_6_ := response
elseif cnt = 5 then
cv001_7_ := response
elseif cnt = 6 then
cv001_8_ := response
End of if
End of loop
End of if
End of if
if hh003 > 0 OR FLSpouse = response then
cv001 (confirmed coverage)
Now please confirm the household members for whom you got coverage. Deselect any member who did not get coverage under your plan.
1 Me
2 [Spouse]
3 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
4 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
5 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
6 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
7 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
8 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
2 [Spouse]
3 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
4 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
5 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
6 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
7 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
8 [Dependent ^cnt (^hh009[cnt], ^hh010[cnt])]
Else
cv001 := 1
End of if
Group of questions presented on the same screen
ne_intro
Now we’d like to ask you a little bit about your health care needs.
Please list the names of up to 4 doctors that you or someone in your family plan to visit in 2018. This can be a primary care physician or other provider.
Please list the names of up to 4 doctors that you or someone in your family plan to visit in 2018. This can be a primary care physician or other provider.
Loop from 1 to 4
ne001 (provider to visit)
STRINGEnd of loop
End of group of questions
ne002 (level medical service )
Choose the category that best describes the medical service use you expect for the next year. If you got family coverage, choose the category that best fits the person who probably will need the most medical services next year.
1 Low Use: 1-2 doctor visits and lab tests each year; preventive care too.
2 Medium Use: 3-5 doctor visits and lab tests with an x-ray each year; one or more small treatments done in doctor’s office; often the care is for an ongoing health problem.
3 High Use: 6 or more doctor visits and a number of lab tests; a surgery, therapy or other treatment in an outpatient center plus follow-up care.
4 Very High Use: a hospital stay, high cost radiology scans or outpatient treatment; more than 6 doctor visits with lab tests and other care.
2 Medium Use: 3-5 doctor visits and lab tests with an x-ray each year; one or more small treatments done in doctor’s office; often the care is for an ongoing health problem.
3 High Use: 6 or more doctor visits and a number of lab tests; a surgery, therapy or other treatment in an outpatient center plus follow-up care.
4 Very High Use: a hospital stay, high cost radiology scans or outpatient treatment; more than 6 doctor visits with lab tests and other care.
pi001 (how signed up)
Now we’ll ask you about your decision.
How did you sign up?
How did you sign up?
1 Online at [[]]
2 By phone
3 With in-person help through a certified application counselor, navigator, or health insurance agent/broker
2 By phone
3 With in-person help through a certified application counselor, navigator, or health insurance agent/broker
if pi001 = 3 then
pi001a (how long to get appointment)
How long did it take you to get your appointment with your certified application counselor, navigator or health insurance agent/broker?
1 Same day appointment
2 Less than 1 week
3 1-2 weeks
4 2 + weeks
2 Less than 1 week
3 1-2 weeks
4 2 + weeks
elseif pi001 = 1 then
pi001c (any downtime site cause delay enrollment)
Did [[]] have any down-time or other issues that caused you to delay your enrollment?
1 Yes
2 No
3 Don't know
2 No
3 Don't know
End of if
if FLSpouse = response then
pi001b (who made decision)
Who made your enrollment decision?
1 I did
2 My spouse and I made the decision together
3 My spouse made the decision
2 My spouse and I made the decision together
3 My spouse made the decision
Else
pi001b := 1
End of if
planintro2
Now it is time to upload confirmation of your enrollment.
Please go to [[]].
Log in, go to your profile, and then to "My Plans and Programs."
You should see information about your plan for 2018 that looks like the below. It may not look exactly the same since different states display information differently. If you are having trouble finding this page, please call the helpline at [[]] or call us and we can help. You will need to upload a page that looks like this at the end of the survey.
Please go to [[]].
Log in, go to your profile, and then to "My Plans and Programs."
You should see information about your plan for 2018 that looks like the below. It may not look exactly the same since different states display information differently. If you are having trouble finding this page, please call the helpline at [[]] or call us and we can help. You will need to upload a page that looks like this at the end of the survey.
Group of questions presented on the same screen
pi003a (2018 plan name)
Please be sure you are looking at your information for 2018. Write the full name of your plan for 2018:
STRINGpi003b (2018 base premium)
What is your base premium?
pi003c (2018 tax credit)
What is your premium tax credit?
pi003d (how many people enrolled)
How many people in your family are enrolled?
1 Only me
2 Me and my spouse
3 Me and my family
4 Don't know
2 Me and my spouse
3 Me and my family
4 Don't know
planintro3
If you are having trouble with these questions, please reference the example below.
The correct responses for this example plan are circled:
The plan name is Capital BlueCross Silver PPO 4500/0/10.
The base premium is $475.25.
The premium tax credit is $160.00.
The correct responses for this example plan are circled:The plan name is Capital BlueCross Silver PPO 4500/0/10.
The base premium is $475.25.
The premium tax credit is $160.00.
End of group of questions
pl001b (health insurance in 2017)
Did you have health insurance through the Health Insurance Marketplace in 2017?
1 Yes
2 No, but I had insurance through my employer, spouse's employer, my school or my parents' employer
3 No, but I had insurance through a federal program like Medicaid
4 No, and I did not have any insurance
2 No, but I had insurance through my employer, spouse's employer, my school or my parents' employer
3 No, but I had insurance through a federal program like Medicaid
4 No, and I did not have any insurance
if pl001b = 1 then
Fill code of question 'FLBase' executed
Group of questions presented on the same screen
pl_intro
Please now go to your plan details for 2017 on [[]]. There should be a separate tab under "My Plans and Programs."
pl001a (2017 plan name)
Write the full name of your plan from 2017
STRINGpl001c (2017 base premium)
What was your[ base] premium?
pl001d (2017 tax credit)
What was your premium tax credit?
pl001e (2017 how many enrolled)
How many people in your family were enrolled?
1 Only me
2 Me and my spouse
3 Me and my family
4 Don’t know
2 Me and my spouse
3 Me and my family
4 Don’t know
pl001f (same plan as in 2018)
Is this the same plan you enrolled in for 2018?
1 Yes
2 No
2 No
End of group of questions
elseif pl001b in [2,3] then
Fill code of question 'FLBase' executed
Group of questions presented on the same screen
pl001a (2017 plan name)
Write the full name of your plan from 2017
STRINGpl001c (2017 base premium)
What was your[ base] premium?
pl001e (2017 how many enrolled)
How many people in your family were enrolled?
1 Only me
2 Me and my spouse
3 Me and my family
4 Don’t know
2 Me and my spouse
3 Me and my family
4 Don’t know
End of group of questions
End of if
uploaded_proof := 2
uploaded_email := 2
Fill code of question 'FLEmail' executed
Fill code of question 'FLNoEmail' executed
Group of questions presented on the same screen
uploadq (upload)
Now we ask that you submit confirmation of your enrollment in the Health Insurance Marketplace.You can do this in 2 simple steps.
You will receive $25 [the day you send us the confirmation/in one week after you send us the confirmation/two weeks after open enrollment ends (on ^FLEndDate2) for the confirmation/], deposited on your ClinCard. [the day you send us the confirmation/in one week after you send us the confirmation/two weeks after open enrollment ends (on ^FLEndDate2) for the confirmation/]1
Step 1: Upload screenshot confirming plan details
Please send us a screenshot or PDF of your plan information webpage. This confirmation should include the plan type, base premium, your premium credit and coverage dates. Please do not blank out any information about your plan. We will blank out your name after we receive your confirmation. You can find this information under "My Plans and Programs" or similar.
An example is below.
uploadq2
| Plan Information Upload |
You will need to send the confirmation with the information indicated to get paid for this survey. If you are unable to gather this item, please give us a call and we can help.
uploaded_proof (uploaded proof)
End of group of questions
if uploaded_proof != 1 then
uploadwarning
You need to upload your confirmation of enrollment in the Health Insurance Marketplace to receive payment for this survey. Please go "back" and upload a screenshot or PDF of your confirmation. If you are having trouble, please call us.
End of if
Group of questions presented on the same screen
forwardemail
Step 2: Forward us your email confirmation
Please forward your confirmation email to us at uashelp@usc.edu. Your healthcare.gov confirmation email should look something like this:
if pl001f = 1 then
uploadq_noemail
If you did not receive such an email, please check the box below.
1 Did not receive email
End of if
End of group of questions
if uploaded_proof = 1 then
uploadconfirm
Thank you for uploading your confirmation. We will look over it to make sure everything we need is included and contact you if there is a problem. If everything looks good, we will begin processing your payment for this survey.
dummy := sendUploadEmail(uploaded_proof,uploaded_email)
End of if
CS_001 (HOW PLEASANT INTERVIEW)
Could you tell us how interesting or uninteresting you found the questions in this interview?
1 Very interesting
2 Interesting
3 Neither interesting nor uninteresting
4 Uninteresting
5 Very uninteresting
2 Interesting
3 Neither interesting nor uninteresting
4 Uninteresting
5 Very uninteresting
CS_003 (comments)
Do you have any other comments on the interview? Please type these in the box below.(If you have no comments, please click next to complete this survey.)
STRING